title: Vitamin D and vitamin B12 deficiencies are common in patients with midgut carcinoid (SI-NET).
abstract: Patients with small intestinal neuroendocrine tumours (SI-NET) often have diarrhoea from hormonal overproduction, surgery and medical treatment, leading to malabsorption of bile salts, fats, vitamin B12 and fat-souble vitamins. This could lead to malnutrition.
  
  
  
  We assessed nutritional status in 50 consecutive out patients with disseminated SI-NET, 25 patients in each cohort. The first cohort was descriptive and the second cohort supplemented with vitamin D, B12 and calcium. Vitamin D deficiency was defined as <50 nmol/l. All patients were assessed by clinical chemistry and dual-energy X-ray absorptiometry (DXA) and interviewed about weight changes, appetite, gastrointestinal disorders, sunhabits and the use of supplements.
  
  
  
  In the first cohort, 29% of the patients were severely and 17% moderately vitamin D deficient. In patients without prior substitution, 32% had subnormal vitamin B12 levels. Seventy-six percent had low bone density. In the second cohort with vitamin and mineral supplementation, none had severe vitamin D deficiency, but 28% had moderate deficiency. No patient had subnormal vitamin B12 levels. Sixty percent had low bone density. The serum levels of vitamin D and B12 were higher and parathyroid hormone (PTH) lower in the second cohort compared with the first cohort (P⩽0,022). Vitamin D and PTH were negatively correlated, r=-30, P=⩽0.036.
  
  
  
  Low serum levels of vitamin D and vitamin B12, and low bone density are common in patients with disseminated SI-NET. Supplementation of vitamin D, B12 and calcium resulted in higher serum levels of vitamins, lower PTH levels and diminished severe vitamin D deficiency and is thus recommended as standard care.
authors.affiliation: Clinical Nutrition Unit, Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Lind
authors.affiliation: Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Wängberg
authors.affiliation: Clinical Nutrition Unit, Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Ellegård
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D002276:Carcinoid Tumor / Q000097:blood / Q000150:complications*; D003967:Diarrhea / Q000209:etiology; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007408:Intestinal Absorption; D007414:Intestinal Neoplasms / Q000097:blood / Q000150:complications* / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010281:Parathyroid Hormone / Q000097:blood; D014805:Vitamin B 12 / Q000097:blood; D014806:Vitamin B 12 Deficiency / Q000097:blood / Q000150:complications*; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000209:etiology*; D014815:Vitamins / Q000097:blood
chemical_list: D010281:Parathyroid Hormone; D014815:Vitamins; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D014805:Vitamin B 12