The value of severe vitamin D deficiency in predicting the mortality risk of patients with liver cirrhosis: A meta-analysis

Yang, Fuwei; Ren, Huina; Gao, Yue; Zhu, Yali; Huang, Wenxiang

doi:10.1016/j.clinre.2019.03.001

Cited by 15 publications

(13 citation statements)

References 36 publications

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“…Of note, comparisons to other studies regarding the prevalence of VitD Def are difficult to draw, as there are considerable differences in cut-offs and patient characteristics, however, other studies have demonstrated similar results [11,12]. As indicated previously, a recent meta-analysis confirmed the association between VitD deficiency and mortality in patients with cirrhosis [13].…”

Section: Discussionmentioning

confidence: 63%

“…Alcohol-related liver disease (ALD; n = 96, 41%) and viral hepatitis (n = 47, 20%) represented the predominant ACLD etiologies. Median HVPG was 18 (12)(13)(14)(15)(16)(17)(18)(19)(20) mmHg, and 202 (86%) patients had clinically significant portal hypertension (CSPH, i.e. an HVPG ≥ 10 mmHg).…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…Importantly, a previous study on patients with cirrhosis displayed a link between severe vitamin D deficiency (VitD Def ) and increased levels of inflammatory biomarkers as well as the risk of hepatic decompensation [11]. Similarly, disease severity and mortality were associated with VitD Def [12,13].…”

Section: Introductionmentioning

confidence: 97%

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Vitamin A levels reflect disease severity and portal hypertension in patients with cirrhosis

et al. 2020

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Background and Aims The liver plays a key role in the storage, metabolism and homeostasis of fat-soluble vitamins. We investigated the relation of Vitamin(Vit)A/D/E serum levels with severity of liver disease and portal hypertension (PHT). Methods VitA/D/E serum levels were assessed in 234 patients with advanced chronic liver disease (ACLD, i.e. hepatic venous pressure gradient [HVPG] ≥ 6 mmHg). Patients with hepatocellular carcinoma, pre-/post-hepatic PHT, TIPS or liver transplantation were excluded. Results Most patients were male (n = 153; 65%) with a median age of 57.6 (49.7–64.5) years. Thirty-two (14%) patients had HVPG 6–9 mmHg, 66 (28%) 10-15 mmHg, and 136 (58%) ≥ 16 mmHg, respectively. VitD deficiency (25-OH-vitamin-D <50 nmol/L) was found in 133 (57%) with higher prevalence in Child-Turcotte-Pugh (CTP)-C: 85% vs. B: 66% vs. A: 47% (p < 0.001). VitD levels displayed significant but weak correlations with hepatic dysfunction and PHT. VitE levels were normal in 227 (97%) patients and displayed no relevant association with hepatic dysfunction or PHT. Only 63 (27%) patients had normal (>1.05 µmol/L) VitA levels, while 58 (25%) had mild (0.70–1.04 µmol/L), 71 (30%) moderate (0.35–0.69 µmol/L), and 42(18%) severe(<0.35 µmol/L) VitA deficiency. VitA correlated with HVPG (Rho = −0.409), CTP score (Rho = −0.646), and serum bile acid levels (Rho = −0.531; all p < 0.001). The prevalence of decompensated ACLD (dACLD) continuously increased with severity of VitA deficiency (no: 40% vs. mild: 51% vs. moderate: 67% vs. severe: 91% had dACLD; p < 0.001). CTP score (per point; OR 2.46; 95%CI 1.80–3.37; p <0.001), age (per year; OR 0.95; 95%CI 0.92–0.98; p = 0.001) and elevated bile acid levels(>10 µmol/L; OR 3.62; 95%CI 1.61–8.14; p = 0.002) were independently associated with VitA deficiency. Conclusion VitA and VitD but not VitE deficiencies are highly prevalent in ACLD. VitA deficiency strongly correlates with hepatic dysfunction, PHT and bile acid levels and is associated with decompensated ACLD. Trial registration number NCT03267615.

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Section: Discussionmentioning

confidence: 63%

Section: Patient Characteristicsmentioning

confidence: 99%

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Vitamin A levels reflect disease severity and portal hypertension in patients with cirrhosis

et al. 2020

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“…Zinc supplementation (150‐200 mg/d taken with a meal to decrease the potential side effect of nausea) has shown to at least improve taste sensation in cirrhosis . Likewise, the data on vitamin D supplementation in improving outcomes are not robust but the data regarding poor outcomes in cirrhosis with vitamin D deficiency are compelling . Research experience in the elderly suggests that vitamin D supplementation may have benefits on musculoskeletal system (eg increased bone density, muscle strength and physical activity); however, whether these findings can be extrapolated for those with cirrhosis is unknown.…”

Section: Management Of Malnutrition and Sarcopenia In Cirrhosismentioning

confidence: 99%

Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis

Bunchorntavakul

Reddy

2019

Aliment Pharmacol Ther

148

131

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Summary Background Malnutrition/sarcopenia and frailty are common in patients with cirrhosis and are associated with poor outcomes. Aim To provide an overview of data on the importance, assessment and management of malnutrition/sarcopenia and frailty in cirrhosis. Methods A literature search was conducted in PubMed and other sources, using the search terms “sarcopenia,” “muscle,” “malnutrition,” “cirrhosis,” “liver” and “frailty” from inception to April 2019, to identify the relevant studies and international guidelines. Results The prevalence of malnutrition/sarcopenia in cirrhosis is 23%‐60%. Frailty generally overlaps with malnutrition/sarcopenia in cirrhosis, leading to increased morbidity and mortality. Rapid nutritional screening assessment should be performed in all patients with cirrhosis, and more specific tests for sarcopenia should be performed in those at high risk. The pathogenesis of malnutrition/sarcopenia in cirrhosis is complex/multifactorial and not just reduction in protein/calorie intake. Hyperammonemia appears to be the main driver of sarcopenia in cirrhosis through several molecular signalling pathways. Nutritional management in malnourished patients with cirrhosis should be undertaken by a multidisciplinary team to achieve adequate protein/calorie intake. While the role of branched‐chained amino acids remains somewhat contentious in achieving a global benefit of decreasing mortality‐ and liver‐related events, they, and vitamin supplements, are recommended for those with advanced liver disease. Novel strategies to reverse sarcopenia such as hormone supplementation, long‐term ammonia‐lowering agents and myostatin antagonists, are currently under investigation. Conclusions Malnutrition/sarcopenia and frailty are unique, inter‐related and multi‐dimensional problems in cirrhosis which require special attention, prompt assessment and appropriate management as they significantly impact morbidity and mortality.

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“…A meta-analysis of eight studies published between March 2013 and January 2019 involved 1339 patients with liver cirrhosis and mean 25(OH)D concentrations between 7 and 15 ng/mL. Having a 25(OH)D concentration <10 ng/mL was associated with an increased risk of mortality in patients with liver cirrhosis (risk ratio (RR) = 1.79 (95% CI, 1.44 to 2.22; p < 0.01)) [85] and adjustment for publication bias reduced the RR, though it remained significant at 1.62 (95% CI, 1.32 to 1.99; p < 0.01).…”

Section: Resultsmentioning

confidence: 99%

A Review of the Potential Benefits of Increasing Vitamin D Status in Mongolian Adults through Food Fortification and Vitamin D Supplementation

Grant

Boucher

2019

Nutrients

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Serum 25-hydroxyvitamin D (25(OH)D) concentrations are low in Mongolia, averaging 22 ng/mL in summer and only 8 ng/mL in winter. Mongolians have high incidence and/or prevalence of several diseases linked to low 25(OH)D concentrations, including ischemic heart disease, malignant neoplasms, cirrhosis of the liver, ischemic stroke, lower respiratory tract infections, preterm birth complications, and diabetes mellitus. Fortifying regularly consumed foods such as flour, milk, and edible oils with vitamin D3 could raise 25(OH)D concentrations by about 10 ng/mL. However, to achieve 25(OH)D concentrations of 30–40 ng/mL in adults, vitamin D intakes of 1000 to 4000 IU/day would be required, making personal supplement use necessary. On the basis of prospective observational studies and clinical trials of disease incidence or known mortality rates and adverse pregnancy and birth outcomes, raising mean serum 25(OH)D concentrations to 40 ng/mL would likely reduce incidence and mortality rates for those and other diseases, reduce the rate of adverse pregnancy and birth outcomes, and increase mean life expectancy by one year or more.

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The value of severe vitamin D deficiency in predicting the mortality risk of patients with liver cirrhosis: A meta-analysis

Cited by 15 publications

References 36 publications

Vitamin A levels reflect disease severity and portal hypertension in patients with cirrhosis

Vitamin A levels reflect disease severity and portal hypertension in patients with cirrhosis

Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis

A Review of the Potential Benefits of Increasing Vitamin D Status in Mongolian Adults through Food Fortification and Vitamin D Supplementation

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