Vitamin D Status in Pediatric and Young Adult Cystic Fibrosis Patients. Are the New Recommendations Effective?

Overview

Journal Nutrients

Date 2021 Dec 28

PMID 34959965

Citations 6

Authors

Carmen Mangas-Sanchez

Maria Garriga-Garcia

Maria Juliana Serrano-Nieto

Ruth Garcia-Romero

Marina Alvarez-Beltran

Elena Crehua-Gaudiza

Rosana Munoz-Codoceo

Lucrecia Suarez-Cortina

Saioa Vicente-Santamaria

Cecilia Martinez-Costa

Juan Jose Diaz-Martin

Carlos Bousono-Garcia

David Gonzalez-Jimenez

Affiliations

Soon will be listed here.

Abstract

Introduction: In recent years, guidelines for vitamin D supplementation have been updated and prophylactic recommended doses have been increased in patients with cystic fibrosis (CF).

Objective: To evaluate safety and efficacy of these new recommendations.

Results: Two cohorts of pancreatic insufficient CF patients were compared before (cohort 1: 179 patients) and after (cohort 2: 71 patients) American CF Foundation and European CF Society recommendations were published. Cohort 2 patients received higher Vitamin D doses: 1509 (1306-1711 95% CI) vs 1084 (983-1184 95% CI) IU/Day ( < 0.001), had higher 25 OH vitamin D levels: 30.6 (27.9-33.26 95% CI) vs. 27.4 (25.9-28.8 95% CI) ng/mL ( = 0.028), and had a lower prevalence of insufficient vitamin D levels (<30 ng/mL): 48% vs 65% ( = 0.011). Adjusted by confounding factors, patients in cohort 1 had a higher risk of vitamin D insufficiency: OR 2.23 (1.09-4.57 95% CI) ( = 0.028).

Conclusion: After the implementation of new guidelines, CF patients received higher doses of vitamin D and a risk of vitamin D insufficiency decreased. Despite this, almost a third of CF patients still do not reach sufficient serum calcidiol levels.

Citing Articles

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Polymorphisms of the Vitamin D Binding Protein (VDBP) and Free Vitamin D in Patients with Cystic Fibrosis.

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Gaudet M, Plesa M, Mogas A, Jalaleddine N, Hamid Q, Al Heialy S Respir Res. 2022; 23(1):252.

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References

Brodlie M, Orchard W, Reeks G, Pattman S, McCabe H, OBrien C . Vitamin D in children with cystic fibrosis. Arch Dis Child. 2012; 97(11):982-4. DOI: 10.1136/archdischild-2011-301398. View

Sinaasappel M, Stern M, Littlewood J, Wolfe S, Steinkamp G, Heijerman H . Nutrition in patients with cystic fibrosis: a European Consensus. J Cyst Fibros. 2004; 1(2):51-75. DOI: 10.1016/s1569-1993(02)00032-2. View

Galior K, Grebe S, Singh R . Development of Vitamin D Toxicity from Overcorrection of Vitamin D Deficiency: A Review of Case Reports. Nutrients. 2018; 10(8). PMC: 6115827. DOI: 10.3390/nu10080953. View

Holick M . Vitamin D deficiency. N Engl J Med. 2007; 357(3):266-81. DOI: 10.1056/NEJMra070553. View

Khazai N, Judd S, Jeng L, Wolfenden L, Stecenko A, Ziegler T . Treatment and prevention of vitamin D insufficiency in cystic fibrosis patients: comparative efficacy of ergocalciferol, cholecalciferol, and UV light. J Clin Endocrinol Metab. 2009; 94(6):2037-43. PMC: 2690417. DOI: 10.1210/jc.2008-2012. View

Garavaglia L, Duncan C, Toucheque M, Farley A, Moffett K . A Quality Improvement Initiative to Improve Patient Adherence to Vitamin Supplementation in Cystic Fibrosis. J Pediatr Gastroenterol Nutr. 2017; 64(2):292-295. DOI: 10.1097/MPG.0000000000001273. View

Juhasz M, Varannai O, Nemeth D, Szakacs Z, Kiss S, Izsak V . Vitamin D supplementation in patients with cystic fibrosis: A systematic review and meta-analysis. J Cyst Fibros. 2020; 20(5):729-736. DOI: 10.1016/j.jcf.2020.12.008. View

Lark R, Lester G, ONTJES D, Blackwood A, Hollis B, Hensler M . Diminished and erratic absorption of ergocalciferol in adult cystic fibrosis patients. Am J Clin Nutr. 2001; 73(3):602-6. DOI: 10.1093/ajcn/73.3.602. View

McCauley L, Thomas W, Laguna T, Regelmann W, Moran A, Polgreen L . Vitamin D deficiency is associated with pulmonary exacerbations in children with cystic fibrosis. Ann Am Thorac Soc. 2013; 11(2):198-204. PMC: 3972970. DOI: 10.1513/AnnalsATS.201208-068OC. View

10.

James D, Alfaham M, Goodchild M . Increased susceptibility to peroxide-induced haemolysis with normal vitamin E concentrations in cystic fibrosis. Clin Chim Acta. 1991; 204(1-3):279-90. DOI: 10.1016/0009-8981(91)90238-8. View

11.

Belderbos M, Houben M, Wilbrink B, Lentjes E, Bloemen E, Kimpen J . Cord blood vitamin D deficiency is associated with respiratory syncytial virus bronchiolitis. Pediatrics. 2011; 127(6):e1513-20. DOI: 10.1542/peds.2010-3054. View

12.

Tangpricha V, Kelly A, Stephenson A, Maguiness K, Enders J, Robinson K . An update on the screening, diagnosis, management, and treatment of vitamin D deficiency in individuals with cystic fibrosis: evidence-based recommendations from the Cystic Fibrosis Foundation. J Clin Endocrinol Metab. 2012; 97(4):1082-93. DOI: 10.1210/jc.2011-3050. View

13.

Cooke N, Haddad J . Vitamin D binding protein (Gc-globulin). Endocr Rev. 1989; 10(3):294-307. DOI: 10.1210/edrv-10-3-294. View

14.

Turck D, Braegger C, Colombo C, Declercq D, Morton A, Pancheva R . ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis. Clin Nutr. 2016; 35(3):557-77. DOI: 10.1016/j.clnu.2016.03.004. View

15.

Thursfield R, Naderi K, Leaver N, Rosenthal M, Alton E, Bush A . Children with cystic fibrosis demonstrate no respiratory immunological, infective or physiological, consequences of vitamin D deficiency. J Cyst Fibros. 2018; 17(5):657-665. DOI: 10.1016/j.jcf.2018.02.011. View

16.

Feranchak A, Sontag M, Wagener J, Hammond K, Accurso F, Sokol R . Prospective, long-term study of fat-soluble vitamin status in children with cystic fibrosis identified by newborn screen. J Pediatr. 1999; 135(5):601-10. DOI: 10.1016/s0022-3476(99)70059-4. View

17.

Borowitz D, Baker R, Stallings V . Consensus report on nutrition for pediatric patients with cystic fibrosis. J Pediatr Gastroenterol Nutr. 2002; 35(3):246-59. DOI: 10.1097/00005176-200209000-00004. View

18.

Ginde A, Mansbach J, Camargo Jr C . Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2009; 169(4):384-90. PMC: 3447082. DOI: 10.1001/archinternmed.2008.560. View

19.

Armas L, Hollis B, Heaney R . Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab. 2004; 89(11):5387-91. DOI: 10.1210/jc.2004-0360. View

20.

Martinez Redondo I, Garcia Romero R, Calmarza P, De Arriba Munoz A, Martinez-Redondo D, Sanz Paris A . [Vitamin D insufficiency in a healthy pediatric population. The importance of early prophylaxis]. Nutr Hosp. 2021; 38(6):1155-1161. DOI: 10.20960/nh.03606. View