Deficiency of fat-soluble vitamins in chronic pancreatitis: A systematic review and meta-analysis.
OBJECTIVE
Chronic pancreatitis (CP) patients are at risk for fat-soluble vitamins (A, D, E, K) deficiency, but available studies are small and heterogeneous. We conducted a systematic review and meta-analysis to determine the prevalence of fat-soluble vitamins deficiency in CP patients.


METHODS
Medline was searched up to January 2016 for case series and case-control studies reporting prevalence of fat-soluble vitamin deficiency in CP patients. The prevalent deficiency rate was pooled for included studies, and deficiency rate between CP and controls, with relative odds ratio (OR) and 95% confidence interval (CI) calculated for case-control studies.


RESULTS
Twelve studies including 548 patients included. With a random-effect model, the pooled prevalence rate of vitamin A, D and E deficiency were 16.8% (95%CI 6.9-35.7), 57.6% (95%CI 43.9-70.4) and 29.2% (95%CI 8.6-64.5) respectively, with considerable heterogeneity (I2= 75%, 87.1% and 92%). Only one study evaluated vitamin K deficiency. The pooled OR for vitamin D deficiency in CP cases compared with controls was 1.17 (95% CI 0.77-1.78). Sensitivity analyses showed lower prevalence of vitamin A and E, and higher prevalence of vitamin D deficiency in high-quality studies. The rate of pancreatic exocrine insufficiency did not seem affect the deficiency rates, while the use of different cut-offs influences results and heterogeneity for vitamin E, but not A.


CONCLUSIONS
Fat-soluble vitamins deficiency is frequent in CP patients, with considerable heterogeneity. There is, however, no apparent increased risk of vitamin D deficiency in CP compared to controls. Larger, high-quality studies are necessary to better estimate the prevalence of fat-soluble vitamins deficiency, including vitamin K.
Gastroenterology Department, Hospital Universitario Cruces, Barakaldo-Bizkaia, Spain.
Emma
E
Martínez-Moneo
Digestive & Liver Disease Unit, S. Andrea Hospital, University "Sapienza", Rome, Italy.
Serena
S
Stigliano
Karolinska University Hospital, Sweden.
Aleksandra
A
Hedström
Department of Digestive Tract Diseases, University Hospital, Lodz, Poland.
Aleksandra
A
Kaczka
Department of Endocrinology and Gastroenterology, Tartu University Hospital, University of Tartu, Estonia.
Marko
M
Malvik
Department for Internal Medicine I, University Hospital Regensburg, Germany.
Alexander
A
Waldthaler
Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
Patrick
P
Maisonneuve
Department of Medicine A, Ernst-Moritz-Arndt-University Greifswald, Germany.
Peter
P
Simon
Digestive & Liver Disease Unit, S. Andrea Hospital, University "Sapienza", Rome, Italy. Electronic address: gabriele.capurso@gmail.com.
Gabriele
G
Capurso
D001361:Avitaminosis / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D050500:Pancreatitis, Chronic / Q000150:complications* / Q000453:epidemiology; D015995:Prevalence; D014802:Vitamin A Deficiency / Q000150:complications / Q000453:epidemiology; D014808:Vitamin D Deficiency / Q000150:complications / Q000453:epidemiology; D014811:Vitamin E Deficiency / Q000150:complications / Q000453:epidemiology; D014813:Vitamin K Deficiency / Q000150:complications / Q000453:epidemiology
Chronic pancreatitis; Fat-soluble vitamins; Meta-analysis; Vitamin A; Vitamin D; Vitamin E; Vitamin K