Prevalence of fat-soluble vitamins deficiency in patients with post hepaticoportoenterostomy biliary atresia

Abstract

Background: One of the under-recognized complications in children with extrahepatic biliary atresia (EHBA) is fat-soluble vitamins (FSV) deficiency, which if left untreated, inevitably compromises long-term clinical outcomes, including liver transplantation (LT).

Objectives: To primarily evaluate the prevalence of fat-soluble vitamins (FSV) deficiency in children with EHBA. The secondary objective was to explore any possible associated risk factors.

Methods:.The.data.were.collected.from.patients.diagnosed.with.EHBA.who.underwent.hepaticoportoenterostomy (HPE) via a cross-sectional study conducted from February 2022 to June 2023. FSV deficiency was diagnosed if there was one of the followings: 1) vitamin A level < 0.7 micromol/L, 2) serum 25-OH D < 20 ng/mL, 3) vitamin E to cholesterol ratio < 2.22 micromol/mmol, or 4) INR > 1.5 correctable with parenteral vitamin K administration. The prevalence of FSV deficiency was presented as frequency and percentage.

Results: Thirty EHBA patients (13 males) with an average age of 7.9 years old were consecutively enrolled. The prevalence of at least one FSV deficiency was 36.7% (95% CI 18.4, 54.9), in which the most common one was vitamin A deficiency (36.7%), followed by the deficiency of vitamin D, E, and K, respectively. Univariate analysis showed statistically significant differences in success rate of Kasai’s operation, hepatomegaly, albumin, total bilirubin, direct bilirubin, hemoglobin level, anemia for ages, ESR, CRP, BUN, creatinine level, and PELD score between those with and without any FSV deficiency.

Conclusion: Vitamin A deficiency was the most frequently observed. Adequate vitamin supplementation should be carefully reviewed to prevent its deficiency, particularly in EHBA patients with high PELD scores, potentially indicative of LT.