Introduction Vitamin D is essential due to its role in bone health and its immunomodulatory propeties.1 Patients with intestinal failure (IF) are at risk of Vitamin D deficiency due to inadequate absorption and lack of exposure to UVB light. Deficiency has been demonstrated in IF patients dependent on home parenteral nutrition.2 We aimed to determine the prevalence of vitamin D deficiency in hospital patients with IF and the efficacy of subsequent prescribed treatment.
Methods All patients admitted to St Mark's Hospital with IF over a 12-month period were included and data on demographics, serum total vitamin D concentration, IF aetiology and vitamin D supplementation prescribed were obtained. If deficiency was identified (≤50 nmol/l) the efficacy of treatment provided was assessed. Descriptive analysis and t-tests were performed.
Results Eighty-four patients were included in the study (42 female, mean age 53±15 years, 92% Caucasian). The aetiology of IF included short bowel (n=30), fistula (n=34), small bowel obstruction (n=13), malabsorption (n=5) and others (n=2). Vitamin D was measured in 76% (n=64) of patients and 75% (n=48) were deficient (mean 41±25 nmol/l, range 9–126). Vitamin D concentrations were lower in men (33.4±15.3 nmol/l) compared to women (49.5±29.5 nmol/l) (p=0.009). No association was demonstrated with age, aetiology of IF, or ethnicity. There was a trend towards reduced Vitamin D and increasing BMI (p=0.187, r2=0.028). No seasonal variation was demonstrated between summer (June–November, 42.8±26.5 nmol/l) and winter (December–May, 39.3±21.6 nmol/l) (p=0.57). Only 26% (n=22) of patients had repeat vitamin D concentrations before discharge. There was a significant increase in vitamin D concentrations from 35±22 nmol/l to 44.8±14.3 nmol/l, (p=0.03). Twenty-nine patients received intramuscular Vitamin D at a dose of 300 000 IU. In these patients there was an increase in concentration before (28.4±13.6 nmol/l) and after (42.8±12.7 nmol/l). Due to the small numbers of patients it was not possible to determine the efficacy of the different vitamin D preparations or the effect of the multivitamin preparation used in parenteral nutrition (Cernevit®) on serum concentrations.
Conclusion Vitamin D deficiency is common and occurs in three-quarters of IF patients. Male gender was associated with lower concentrations. Robust policies need to be in place for the identification of vitamin D deficiency including the supplementation and monitoring of vitamin D deficiency in patients with IF to ensure adequate serum concentrations are achieved.
Competing interests None declared.
References 1. Michal L, Melamed. 25-Hydroxyvitamin D levels and the risk of mortality in the general population Arch Intern Med 2008;168:1629.
2. Tee CT, et al. Hypovitaminosis D in patients on long-term parenteral nutrition. Proc Nut Soc 2010;69:E554.