Fat-soluble vitamins deficiency in patients with cholestatic liver diseases
A.R. KIRSHINA¹, A.A. KIRSHIN²
¹Republic Сlinical Hospital, Kazan
²Republic Clinical Oncology Dispensary named after M.Z. Sigal, Kazan
Contact details:
Kirshina A.R. — gastroenterologist of the Gastroenterology Department
Address: 138 A Orenburgskiy trakt, 420000 Kazan, Russian Federation, tel.: +7 (843) 231-21-78, e-mail: aygulraisovna@gmail.com
Cholestatic liver diseases significantly impair quality of life and life expectancy, often necessitating liver transplantation. One of the approaches to medical management involves diagnosing and correcting fat-soluble vitamin deficiencies, which inevitably arise due to impaired bile metabolism.
The purpose is to assess the prevalence of fat-soluble vitamin deficiencies in patients with cholestasis, to evaluate diagnostic methods for hypovitaminosis, and to explore treatment strategies for their correction.
Key words: hypovitaminosis, fat-soluble vitamins, cholestasis.
REFERENCES
- Sherlock S. Nutritional complications of biliary cirrhosis. Chronic cholestasis. Am. J. Clin. Nutr, 1970, vol. 23 (5), pp. 640–644. DOI: 10.1093/ajcn/23.5.640
- Reshetnyak V.I. Concept on the pathogenesis and treatment of primary biliary cirrhosis. World J. Gastroenterol, 2006, vol. 12 (45), pp. 7250–7262. DOI: 10.3748/wjg.v12.i45.7250
- Reshetnyak V.I, Maev I.V. Mechanism for development of malnutrition in primary biliary cholangitis. World J. Meta-Analysis, 2022, vol. 10 (3), pp. 81–98. DOI: 10.13105/wjma.v10.i3.81
- Ahmed M. Functional, diagnostic and therapeutic aspects of bile. Clin. Exper. Gastroenterol, 2022, vol. 15, pp. 105–120. DOI: 10.2147/CEG.S360563
- Send S.R. Nutritional management of cholestasis. Clin. Liver Dis. (Hoboken), 2020, vol. 15 (1), pp. 9–12. DOI: 10.1002/cld.865
- McCray S., Parrish C.R. When chyle leaks: nutrition management options. Practical Gastroenterol, 2004, vol. 28, pp. 60–77.
- Shah N.D., Barritt A.S. 4th. Nutrition as therapy in liver disease. Clin. Ther, 2022, vol. 44 (5), pp. 682–696. DOI: 10.1016/j.clinthera.2022.04.012
- Tessitore M., Sorrentino E., Schiano Di Cola G., Colucci A., Vajro P., Mandato C. Malnutrition in pediatric chronic cholestatic disease: an up-to-date overview. Nutrients, 2021, vol. 13, p. 2785. DOI: 10.3390/nu13082785
- Phillips J.R., Angulo P., Petterson T., Lindor K.D. Fat-soluble vitamin levels in patients with primary biliary cirrhosis. Am. J. Gastroenterol, 2001, vol. 96 (9), pp. 2745–50. DOI: 10.1111/j.1572-0241.2001.04134.x
- Li J., Tian S., Ci B., Xi Y., Deng X. Serum vitamins and homocysteine levels in autoimmune liver disease: A systematic review and meta-analysis. Immun. Inflamm. Dis, 2024, vol. 12 (4), p. e1258. DOI: 10.1002/iid3.1258
- Lindor K.D., Gershwin M.E., Poupon R. et al. American Association for study of liver diseases. Primary biliary cirrhosis. Hepatology, 2009, vol. 50 (1), pp. 291–308.
- Klinicheskie rekomendatsii po nedostatochnosti vitamina D. 2021. FGBU “NMITs endokrinologii” Minzdrava Rossii [Clinical guidelines for vitamin D deficiency. 2021. Federal State Budgetary Institution «National Medical Research Center of Endocrinology» of the Ministry of Health of the Russian Federation].
- Assis D.N. Chronic complications of cholestasis: evaluation and management. Clin. Liver Dis, 2018, vol. 22 (3), pp. 533–544. DOI: 10.1016/j.cld.2018.03.014
- Guan ̃abens N., Cerda ́ D., Monegal A. et al. Low bone mass and severity of chole-stasis affect fracture risk in patients with primary biliary cirrhosis. Gastroenterology, 2010, vol. 138 (7), pp. 2348–2356.
- Janes C.H., Dickson E.R., Okazaki R. et al. Role of hyperbilirubinemia in the impair- ment of osteoblast proliferation associated with cholestatic jaundice. J. Clin. Invest, 1995, vol. 95 (6), pp. 2581–2186.
- Dubreuil M., Ruiz-Gaspa` S., Guan ̃abens N. et al. Ursodeoxycholic acid increases differentiation and mineralization and neutralizes the damaging effects of bilirubin on osteoblastic cells. Liver Int, 2013, vol. 33 (7), pp. 1029–1038.
- Shikh E.V., Makhova A.A., Alekseeva E.I. Essential triad of vitamins — A, C and D — for children of the first year of life. Voprosy sovremennoy pediatrii, 2019, vol. 18, no. 3, pp. 152–159 (in Russ.). DOI: 10.15690/vsp.v18i3.2031
- Chaves G.V., Peres W.A., Gonçalves J.C., Ramalho A. Vitamin A and retinol-binding protein deficiency among chronic liver disease patients. Nutrition, 2015, vol. 31 (5), pp. 664–648. DOI: 10.1016/j.nut.2014.10.016
- Sheftel J., Tanumihardjo S.A. Systematic review and meta-analysis of the relative dose-response tests to assess vitamin A status. Adv. Nutr, 2021, vol. 12 (3), pp. 904–941. DOI: 10.1093/advances/nmaa136
- Assis D.N. Chronic complications of cholestasis: evaluation and management. Clin. Liver Dis, 2018, vol. 22 (3), pp. 533–544. DOI: 10.1016/j.cld.2018.03.014
- Licata A., Zerbo M., Como S., Cammilleri M., Soresi M., Montalto G., Giannitrapani L. The Role of vitamin deficiency in liver disease: to supplement or not supplement? Nutrients, 2021, vol. 13 (11), p. 4014. DOI: 10.3390/nu13114014
- Welsh J., Bak M.J., Narvaez C.J. New insights into vitamin K biology with relevance to cancer. Trends Mol. Med, 2022, vol. 28 (10), pp. 864–881. DOI: 10.1016/j.molmed.2022.07.002
- Sultana H., Komai M., Shirakawa H. The role of vitamin K in cholestatic liver disease. Nutrients, 2021, vol. 13 (8), p. 2515. DOI: 10.3390/nu13082515
- Aldrich S.M., Regal R.E. Routine use of vitamin K in the treatment of cirrhosis-related coagulopathy: Is it A-O-K? Maybe Not, We Say. P. T, 2019, vol. 44 (3), pp. 131–136.
- O’Leary J.G., Greenberg C.S., Patton H.M., Caldwell S.H. AGA clinical practice update: coagulation in cirrhosis. Gastroenterology, 2019, vol. 157 (1), pp. 34–43.e1. DOI: 10.1053/j.gastro.2019.03.070
- Ivashkin V.T., Shirokova E.N., Maevskaya M.V. et al. Clinical guidelines of the Russian Gastroenterological Association and the Russian Society for the Study of the Liver for the diagnosis and treatment of cholestasis. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii, 2015, vol. 25, no. 2, pp. 41–57 (in Russ.).
- European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of cholestatic liver diseases. J. Hepatol, 2009, vol. 51 (2), pp. 237–267. DOI: 10.1016/j.jhep.2009.04.009
- Lin X., Brennan-Speranza T.C., Levinger I., Yeap B.B. Undercarboxylated osteocalcin: experimental and human evidence for a role in glucose homeostasis and muscle regulation of insulin sensitivity. Nutrients, 2018, vol. 10 (7), pp. 847. DOI: 10.3390/nu10070847
- Albahrani A.A., Greaves R.F. Fat-soluble vitamins: clinical indications and current challenges for chromatographic measurement. Clin. Biochem. Rev, 2016, vol. 37 (1), pp. 27–47.
- Nazrun A.S., Norazlina M., Norliza M., Nirwana S.I. The anti-inflammatory role of vitamin e in prevention of osteoporosis. Adv. Pharmacol. Sci, 2012, vol. 2012, pp. 142702. DOI: 10.1155/2012/142702
- Traber M.G. Vitamin E. In: Ross A.C., Caballero B., Cousins R.J., Tucker K.L., Ziegler T.R., eds. Modern Nutrition in Health and Disease. 11th ed. Philadelphia: Lippincott Williams & Wilkins, 2014. Pp. 293–304.
- Kamath B.M., Alonso E.M., Heubi J.E., Karpen S.J., Sundaram S.S., Shneider B.L., Sokol R.J. Fat soluble vitamin assessment and supplementation in cholestasis. Clin. Liver Dis, 2022, vol. 26 (3), pp. 537–553. DOI: 10.1016/j.cld.2022.03.011
- Sokol R.J. A new old treatment for vitamin e deficiency in cholestasis. J. Pediatr. Gastroenterol. Nutr, 2016, vol. 63 (6), pp. 577–578. DOI: 10.1097/MPG.0000000000001330
- Shul’pekova Yu.O., Shirokova E.N., Rusyaev V.Yu., Damulin I.V. Neurological manifestations of primary cholestatic liver diseases. Rossiyskiy meditsinskiy zhurnal, 2018, vol. 24, no. 4, pp. 213–219 (in Russ.). DOI: 10.18821/0869-2106-2018-24-4-213-219
- Khavkin A.I., Komarova O.N. Impaired absorption and prospects for the use of fat-soluble vitamins in liver diseases. Eksperimental’naya i klinicheskaya gastroenterologiya, 2016, no. 7, pp. 86–94 (in Russ.).


