Elevated vitamin A intake and serum retinol in preadolescent children with cystic fibrosis

• Published in: The American journal of clinical nutrition Vol. 84; no. 1; pp. 174 - 182
• Main Authors: Graham-Maar, Rose C, Schall, Joan I, Stettler, Nicolas, Zemel, Babette S, Stallings, Virginia A
• Format: Journal Article
• Language: English
• Published: Bethesda, MD American Society for Nutrition 01.07.2006; American Society for Clinical Nutrition; American Society for Clinical Nutrition, Inc
• Subjects: bioavailability; Biological and medical sciences; blood chemistry; Child; Child Nutritional Physiological Phenomena; Children & youth; Cross-Sectional Studies; Cystic fibrosis; Cystic Fibrosis - blood; Cystic Fibrosis - drug therapy; dietary nutrient sources; Dietary supplements; Dietary Supplements - adverse effects; Exocrine Pancreatic Insufficiency - blood; Exocrine Pancreatic Insufficiency - drug therapy; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Humans; Male; nutrient deficiencies; nutrient excess; nutrient intake; Nutrition Policy; Nutrition Surveys; nutritional status; pancreatic enzymes; pancreatic insufficiency; school children; steatorrhea; United States; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vitamin A; Vitamin A - administration & dosage; Vitamin A - adverse effects; Vitamin A - blood; Vitamin A Deficiency - prevention & control; vitamin supplements; Vitamins - administration & dosage; Vitamins - blood; United States; Human; Respiratory disease; Nutrition survey; Health; Nutrition disorder; Vitamin; Metabolic diseases; Cystic fibrosis; Preadolescent; Genetic disease; Retinol; Hypervitaminosis; Vitamin A; hypervitaminosis A; children; Digestive diseases; Serum; NHANES; National Health and Nutrition Examination Survey; Child; Nutritional status; Pancreatic disease
• ISSN: 0002-9165; 1938-3207
• DOI: 10.1093/ajcn/84.1.174

BACKGROUND: Persons with cystic fibrosis (CF) and pancreatic insufficiency (PI) are at risk of vitamin A deficiency because of steatorrhea, despite pancreatic enzyme replacement. Long-standing vitamin A supplementation may increase the risk of vitamin A toxicity. OBJECTIVE: The aim was to describe the vitamin A intake and serum retinol concentrations of preadolescent children with CF, PI, and mild-to-moderate pulmonary disease, who were cared for under current practice recommendations. DESIGN: This cross-sectional study evaluated children aged 8.0-11.9 y with CF and PI from 13 US CF centers. Dietary and supplemental vitamin A intakes were compared with the Dietary Reference Intakes (DRIs) for healthy children, CF recommendations, and data from the National Health and Nutrition Examination Survey (NHANES), 1999-2000. Serum retinol concentrations were compared with NHANES data. RESULTS: The 73 subjects with CF had a dietary vitamin A intake of 816 ± 336 μg retinol activity equivalents (165 ± 69% of the recommended dietary allowance), which was similar to the NHANES value. The supplement intake provided 2234 ± 1574 μg retinol activity equivalents/d and exceeded recommendations in 21% of the subjects with CF. Total preformed retinol intake exceeded the DRI tolerable upper intake level in 78% of the subjects with CF. The serum retinol concentration was 52 ± 13 μg/dL (range: 26-98 μg/dL), which was significantly higher than the NHANES value (37 ± 10 μg/dL; range: 17-63 μg/dL; P < 0.001). CONCLUSION: Although supplementation helps to prevent vitamin A deficiency in children with CF and PI, their high vitamin A intakes and serum retinol concentrations suggest that usual care may result in excessive vitamin A intake and possible toxicity that would increase the risk of CF-associated liver and bone complications.