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Mangas-Sánchez C, Garriga-García M, Serrano-Nieto MJ, Garcia-Romero R, Álvarez Beltrán M, Crehuá-Gaudiza E, Vicente-Santamaría S, Martínez-Costa C, Díaz-Martín JJ, Bousoño-García C, González-Jiménez D. Safety and efficacy of a new supplementation protocol in patients with cystic fibrosis and vitamin D deficiency. An Pediatr (Barc) 2023; 98:257-266. [PMID: 36932016 DOI: 10.1016/j.anpede.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/23/2022] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVES Based on the European and American Cystic Fibrosis (CF) consensus recommendations, an increase in vitamin D (VD) supplementation in patients with CF and insufficient or defficient levels was proposed. The objective of our study was to determine the safety and efficacy of this new protocol. MATERIAL AND METHODS Multicentre nonrandomized uncontrolled experimental study. Patients with insufficient levels (<30 ng/mL) received increasing doses of VD (between 800 and 10 000 IU/day). Patients were followed up for 12 months, during which their vitamin and nutritional status, pulmonary function and calcium and phosphate metabolism were assessed. STATISTICAL ANALYSIS t test for paired data and multivariate logistic regression analysis. RESULTS Thirty patients aged 1-39 years (median, 9.1) completed the follow-up. Two patients were dropped from the study on account of 25-OH VD levels greater than 100 ng/mL at 3 months without clinical or laboratory signs of hypercalcaemia. At 12 months, we observed an increase of 7.6 ng/mL (95% CI, 4.6-10 ng/mL) in the mean 25-OH VD level and an improvement in vitamin status: 37% achieved levels of 30 ng/mL or greater, 50% levels between 20 and 30 ng/mL and 13% remained with levels of less than 20 ng/mL. We found no association between improved VD levels and pulmonary function. CONCLUSIONS The proposed protocol achieved an increase in serum VD levels and a decrease in the percentage of patients with VD insufficiency, although it was still far from reaching the percentages of sufficiency recommended for this entity.
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Affiliation(s)
- Carmen Mangas-Sánchez
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Central de Asturias, Oviedo, Spain.
| | | | | | - Ruth Garcia-Romero
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Miguel Servet, Zaragoza, Spain
| | - Marina Álvarez Beltrán
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Vall d'Hebron. Barcelona, Spain
| | - Elena Crehuá-Gaudiza
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Cecilia Martínez-Costa
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Juan José Díaz-Martín
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Central de Asturias, Oviedo, Spain
| | - Carlos Bousoño-García
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Central de Asturias, Oviedo, Spain
| | - David González-Jiménez
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Central de Asturias, Oviedo, Spain
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Seguridad y eficacia de una nueva pauta de suplementación en pacientes con fibrosis quística e insuficiencia de vitamina D. An Pediatr (Barc) 2023. [DOI: 10.1016/j.anpedi.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Mielus M, Sands D, Woynarowski M. Improving nutrition in cystic fibrosis – a systematic literature review. Nutrition 2022; 102:111725. [DOI: 10.1016/j.nut.2022.111725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/25/2022] [Indexed: 11/28/2022]
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Mangas-Sánchez C, Garriga-García M, Serrano-Nieto MJ, García-Romero R, Álvarez-Beltrán M, Crehuá-Gaudiza E, Muñoz-Codoceo R, Suárez-Cortina L, Vicente-Santamaría S, Martínez-Costa C, Díaz-Martin JJ, Bousoño-García C, González-Jiménez D. Vitamin D Status in Pediatric and Young Adult Cystic Fibrosis Patients. Are the New Recommendations Effective? Nutrients 2021; 13:nu13124413. [PMID: 34959965 PMCID: PMC8703649 DOI: 10.3390/nu13124413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 12/28/2022] Open
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 (p < 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 (p = 0.028), and had a lower prevalence of insufficient vitamin D levels (<30 ng/mL): 48% vs 65% (p = 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) (p = 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.
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Affiliation(s)
- Carmen Mangas-Sánchez
- Pediatric Gastroenterology and Nutrition Section, Hospital Central de Asturias, 33011 Oviedo, Spain; (C.M.-S.); (C.B.-G.); (D.G.-J.)
| | - María Garriga-García
- Cystic Fibrosis Section, Hospital Ramón y Cajal, 28034 Madrid, Spain; (M.G.-G.); (L.S.-C.); (S.V.-S.)
| | | | - Ruth García-Romero
- Pediatric Gastroenterology and Nutrition Section, Hospital Miguel Servet, 50009 Zaragoza, Spain;
| | - Marina Álvarez-Beltrán
- Pediatric Gastroenterology and Nutrition Section, Hospital Vall d’ Hebron, 08035 Barcelona, Spain;
| | - Elena Crehuá-Gaudiza
- Pediatric Gastroenterology and Nutrition Section, Hospital Clínico de Valencia, 46010 Valencia, Spain; (E.C.-G.); (C.M.-C.)
| | - Rosana Muñoz-Codoceo
- Pediatric Gastroenterology and Nutrition Section, Hospital Infantil Niño Jesús, 28009 Madrid, Spain;
| | - Lucrecia Suárez-Cortina
- Cystic Fibrosis Section, Hospital Ramón y Cajal, 28034 Madrid, Spain; (M.G.-G.); (L.S.-C.); (S.V.-S.)
| | - Saioa Vicente-Santamaría
- Cystic Fibrosis Section, Hospital Ramón y Cajal, 28034 Madrid, Spain; (M.G.-G.); (L.S.-C.); (S.V.-S.)
| | - Cecilia Martínez-Costa
- Pediatric Gastroenterology and Nutrition Section, Hospital Clínico de Valencia, 46010 Valencia, Spain; (E.C.-G.); (C.M.-C.)
| | - Juan José Díaz-Martin
- Pediatric Gastroenterology and Nutrition Section, Hospital Central de Asturias, 33011 Oviedo, Spain; (C.M.-S.); (C.B.-G.); (D.G.-J.)
- Correspondence:
| | - Carlos Bousoño-García
- Pediatric Gastroenterology and Nutrition Section, Hospital Central de Asturias, 33011 Oviedo, Spain; (C.M.-S.); (C.B.-G.); (D.G.-J.)
| | - David González-Jiménez
- Pediatric Gastroenterology and Nutrition Section, Hospital Central de Asturias, 33011 Oviedo, Spain; (C.M.-S.); (C.B.-G.); (D.G.-J.)
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A Clinician’s guide to vitamin D supplementation for patients with cystic fibrosis. J Clin Transl Endocrinol 2021; 26:100273. [PMID: 34815946 PMCID: PMC8593649 DOI: 10.1016/j.jcte.2021.100273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/14/2021] [Accepted: 10/26/2021] [Indexed: 11/20/2022] Open
Abstract
Vitamin D deficiency is multifactorial in the cystic fibrosis population. Vitamin D deficiency can adversely affect multiple organ systems in the cystic fibrosis population. In the cystic fibrosis population in the United States, we aim to treat to serum 25-hydroxyvitamin D levels over 30 ng/ml. Cholecalciferol is used in preference to ergocalciferol. Daily or once weekly dosing regimens are chosen according to patient preference and compliance.
Vitamin D deficiency is common in the general population, and even more so in patients with cystic fibrosis. Deficiency is exacerbated in cystic fibrosis patients because of a myriad of causes including malabsorption, decreased fat mass, reduced 25-hydroxylation of vitamin D, reduced exposure to sunlight, decreased vitamin D binding protein, and exposure to drugs that increase catabolism. In turn, vitamin D deficiency can contribute to poor bone health. Additionally, it may contribute to pulmonary decline in the form of worsening pulmonary function, increased colonization with pathogens, and increased pulmonary exacerbation. Because vitamin D deficiency is correlated with negative clinical effects in multiple organ systems of patients with cystic fibrosis, it is important to screen for and treat deficiency in these patients. The Cystic Fibrosis Foundation has issued guidelines for the treatment of vitamin D deficiency, targeting serum levels of 25-hydroxyvitamin D of at least 30 ng/ml. The guidelines offer age-specific escalating dose regimens depending on serum vitamin D levels, with monitoring at 12- week intervals after changing therapy. They address the literature on alternative vitamin D sources, such as UV lamps, ideal formulations (cholecalciferol in preference to ergocalciferol), and optimal vehicles of administration. Despite these detailed recommendations, most centers are still unable to achieve in-target serum vitamin D levels for many of their patients. Future research examining ideal treatment regimens to achieve serum targets and maximize clinical effects are needed. Moreover, it is unknown whether vitamin D sufficiency will be easier to achieve on new triple therapy cystic fibrosis drug combinations, and how these drugs will contribute to vitamin D-related clinical outcomes.
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Maes K, Serré J, Mathyssen C, Janssens W, Gayan-Ramirez G. Targeting Vitamin D Deficiency to Limit Exacerbations in Respiratory Diseases: Utopia or Strategy With Potential? Calcif Tissue Int 2020; 106:76-87. [PMID: 31350569 DOI: 10.1007/s00223-019-00591-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/18/2019] [Indexed: 12/16/2022]
Abstract
Patients with respiratory diseases such as cystic fibrosis, chronic obstructive pulmonary disease, or asthma often experience an acute worsening of respiratory symptoms, termed exacerbations. Although the course of exacerbations is disease specific, they are mostly triggered by a respiratory infection. Exacerbations often require hospitalization and are an important cause of mortality. Treatments of exacerbations aim to minimize the negative impact and to prevent subsequent events. Despite many existing therapy options, many patients do not benefit from therapy and suffer from recurrent events. Vitamin D deficiency is a worldwide problem and is extremely prevalent in these patients. Vitamin D, known for its calcemic effects, also has immunomodulatory and anti-infectious actions and can therefore be a possible agent to treat or prevent exacerbations. This review will focus on vitamin D as a potential candidate to treat or prevent exacerbations in CF, COPD, and asthma.
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Colombo C, Nobili RM, Alicandro G. Challenges with optimizing nutrition in cystic fibrosis. Expert Rev Respir Med 2019; 13:533-544. [PMID: 31094240 DOI: 10.1080/17476348.2019.1614917] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction. Optimizing nutrition remains the cornerstone of therapy for patients with cystic fibrosis (CF) since it is associated with better pulmonary function and survival. However, a significant proportion of patients still fail to achieve normal growth and nutritional status. Areas covered. This review describes the current challenges in providing effective nutritional therapy in CF with a focus on the current issues related to energy imbalance, dietary composition, adherence to nutritional recommendations, pancreatic enzyme replacement therapy, and the effects of modulators of the CF transmembrane conductance regulator. Expert opinion. CF is a multisystemic disease that requires a personalized nutritional approach with accurate evaluation of energy balance. There is an urgent need for evidence-based recommendations on the dietary composition, in consideration of the increasing prevalence of overweight, diabetes and the potential effects of fatty acids on inflammation and immune response. More research into new pancreatic enzyme formulations is also required.
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Affiliation(s)
- Carla Colombo
- a Department of Pathophysiology and Transplantation , Università degli Studi di Milano , Milan , Italy.,b Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre , Milan , Italy
| | - Rita Maria Nobili
- b Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre , Milan , Italy
| | - Gianfranco Alicandro
- c Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milano , Italy
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