title: Total serum bilirubin predicts fat-soluble vitamin deficiency better than serum bile acids in infants with biliary atresia.
abstract: OBJECTIVE
  Fat-soluble vitamin (FSV) deficiency is a well-recognized consequence of cholestatic liver disease and reduced intestinal intraluminal bile acid. We hypothesized that serum bile acid (SBA) would predict biochemical FSV deficiency better than serum total bilirubin (TB) level in infants with biliary atresia.
  
  
  METHODS
  Infants enrolled in the Trial of Corticosteroid Therapy in Infants with Biliary Atresia after hepatoportoenterostomy were the subjects of this investigation. Infants received standardized FSV supplementation and monitoring of TB, SBA, and vitamin levels at 1, 3, and 6 months. A logistic regression model was used with the binary indicator variable insufficient/sufficient as the outcome variable. Linear and nonparametric correlations were made between specific vitamin measurement levels and either TB or SBA.
  
  
  RESULTS
  The degree of correlation for any particular vitamin at a specific time point was higher with TB than with SBA (higher for TB in 31 circumstances vs 3 circumstances for SBA). Receiver operating characteristic curve shows that TB performed better than SBA (area under the curve 0.998 vs 0.821). Including both TB and SBA did not perform better than TB alone (area under the curve 0.998).
  
  
  CONCLUSIONS
  We found that TB was a better predictor of FSV deficiency than SBA in infants with biliary atresia. The role of SBA as a surrogate marker of FSV deficiency in other cholestatic liver diseases, such as progressive familial intrahepatic cholestasis, α-1-antitrypsin deficiency, and Alagille syndrome in which the pathophysiology is dominated by intrahepatic cholestasis, warrants further study.
authors.affiliation: *Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA †Department of Surgery and Department of Biostatistics, University of Michigan, Ann Arbor, MI ‡Department of Pediatrics, Washington University, St Louis, MO §Department of Pediatrics, Mount Sinai Medical Center, New York, NY ||Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH ¶Department of Pediatrics, Texas Children's Hospital, Houston #Department of Pediatrics, Children's Health Care of Atlanta, Atlanta, GA **Department of Gastroenterology, Children's Hospital Los Angeles, Los Angeles, CA ††Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA ‡‡Department of Pediatrics, Riley Children's Hospital, Indianapolis, IN §§Department of Pediatrics, Seattle Children's Hospital, Seattle, WA ||||Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada ¶¶School of Public Health, University of Michigan, Ann Arbor ##Department of Pediatrics, University of California San Francisco, San Francisco ***Department of Pediatrics, Johns Hopkins University, Baltimore †††National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD ‡‡‡Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora §§§Department of Pediatrics, Saint Louis University School of Medicine, St Louis, MO ||||||Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA ¶¶¶Department of Pediatrics, Children's Memorial Hospital, Chicago, IL.
authors.forename: Veena L
authors.initials: VL
authors.lastname: Venkat
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Shneider
authors.forename: John C
authors.initials: JC
authors.lastname: Magee
authors.forename: Yumirle
authors.initials: Y
authors.lastname: Turmelle
authors.forename: Ronen
authors.initials: R
authors.lastname: Arnon
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Bezerra
authors.forename: Paula M
authors.initials: PM
authors.lastname: Hertel
authors.forename: Saul J
authors.initials: SJ
authors.lastname: Karpen
authors.forename: Nanda
authors.initials: N
authors.lastname: Kerkar
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Loomes
authors.forename: Jean
authors.initials: J
authors.lastname: Molleston
authors.forename: Karen F
authors.initials: KF
authors.lastname: Murray
authors.forename: Vicky L
authors.initials: VL
authors.lastname: Ng
authors.forename: Trivellore
authors.initials: T
authors.lastname: Raghunathan
authors.forename: Philip
authors.initials: P
authors.lastname: Rosenthal
authors.forename: Kathleen
authors.initials: K
authors.lastname: Schwartz
authors.forename: Averell H
authors.initials: AH
authors.lastname: Sherker
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Sokol
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Teckman
authors.forename: Kasper
authors.initials: K
authors.lastname: Wang
authors.forename: Peter F
authors.initials: PF
authors.lastname: Whitington
authors.forename: James E
authors.initials: JE
authors.lastname: Heubi
mesh_terms: D001361:Avitaminosis / Q000097:blood* / Q000209:etiology; D001647:Bile Acids and Salts / Q000097:blood*; D001656:Biliary Atresia / Q000097:blood* / Q000150:complications; D001663:Bilirubin / Q000097:blood*; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D054586:National Institute of Diabetes and Digestive and Kidney Diseases (U.S.); D010919:Placebos; D011446:Prospective Studies; D014481:United States; D014801:Vitamin A / Q000008:administration & dosage / Q000097:blood; D014807:Vitamin D / Q000008:administration & dosage / Q000097:blood; D014810:Vitamin E / Q000008:administration & dosage / Q000097:blood; D014812:Vitamin K / Q000008:administration & dosage / Q000097:blood; D014815:Vitamins / Q000008:administration & dosage
chemical_list: D001647:Bile Acids and Salts; D010919:Placebos; D014815:Vitamins; D014801:Vitamin A; D014812:Vitamin K; D014807:Vitamin D; D014810:Vitamin E; D001663:Bilirubin