An evaluation of plasma vitamin C concentrations in individuals requiring home parenteral nutrition

Abstract

Background Ascorbic acid (VitC) is an essential coenzyme to maintain health, but there are minimal data on the adequacy of VitC supply in patients requiring home parenteral nutrition (HPN). Methods A prospective pilot study was carried out measuring plasma VitC, serum vitamins A, D and E, and the minerals zinc, copper, selenium and magnesium in 28 adult HPN‐dependent (≥6 months) patients. Results Fifty‐seven percent of patients had insufficient VitC status. There was a strong, positive correlation between HPN provision of VitC and plasma VitC concentrations (rs = 0.663, p = 0.00) with an 83% insufficiency rate below a provision of 800 mg week–1. There was no association seen between plasma VitC and number of HPN days week–1 (p = 0.539), number of months on HPN (p = 0.773) or dependency on HPN (86% ± 31% of energy requirements met via HPN (77% ± 23%, p = 0.39). Conclusions VitC insufficiency is prevalent in HPN‐dependent patients. Our data highlight the need for regular monitoring of VitC in those living with type III intestinal failure.

A scoping review of parenteral requirements (macronutrients, fluid, electrolytes and micronutrients) in adults with chronic intestinal failure receiving home parenteral nutrition

“…The results were variable, with not all studies showing an association between dose and serum levels. All three studies that evaluated serum vitamin C levels showed an association between parenteral dose when subgroups were compared; however, in contrast to the other two studies, 21,65 Stevens 18 found a higher dose in those with a serum level <26.1 μmol compared to those with in‐range levels. This may reflect the study design with multiple samples reported per participant in the study by Stevens 18 , and vitamin C dose may have been increased in response to a previous low serum level, which remained low on repeated testing.…”

“…Five of the nine studies assessing serum 25‐hydroxy‐vitamin D levels reported dose administered, with four of these also reporting other sources. When HPN intake was compared, this was not associated with a difference in serum level 18,21 . Tee et al23 compared those receiving HPN vitamin D only ( n = 162) with those ( n = 13) receiving three monthly intramuscular injections (median (CI) with serum levels 52.0 (54.8, 65.4) compared to 70.0 (55.2–109.6) nmol/L ( p = 0.023); however, the duration of supplementation was not reported.…”

“…Seven studies were cohorts: two prospective 12,13 and five retrospective 14–18 . Twenty‐seven were published in full, with a further one as a PhD thesis 19 and seven as conference abstracts 12,13,16,20–23 …”

“…The relationship between serum levels and HPN dose was evaluated in nine studies 15,18,19,21,22,68,72,74 . The results were variable, with not all studies showing an association between dose and serum levels.…”

“…This in part is likely to reflect whether an average daily amount (taking into consideration the number of HPN infusions per week) or amount per HPN bag was reported. Vitamin C is highly suspectable to degradation; however, it was not clear from reporting what additional amounts were provided in the studies evaluating vitamin C status and the impact of this on serum levels 21,24,65 …”