Paediatric liver disease patients need long-term vitamin supplementation, even after surgery
BA is a childhood liver disease whereby the liver's bile ducts are unusually blocked, narrow, or even non-existent.
Researchers from China's Fudan University and Ministry of Health assessed 266 paediatric patients with obstructive jaundice, 221 of whom had BA and 45 of whom had cholestasis.
They found that the children with BA were significantly more deficient in overall fat-soluble vitamins, especially vitamin D (31.3% in the BA group versus 6.7% in the cholestasis group).
The patients underwent the Kasai procedure — a surgical treatment designed to facilitate bile drainage from the liver — but some of them were still deficient in fat-soluble vitamins afterwards.
However, this deficiency became less severe in BA patients as they grew older, possibly due to heightened knowledge of dietary supplementation, or their bodies’ own compensatory mechanisms.
The study stated that younger children with BA had a greater likelihood of vitamin D deficiency before surgery because of their "relatively small reserve" of the vitamin. But as they grew older, their parents would usually provide them with suitable vitamin supplementation, resulting in a decrease in vitamin D deficiency.
This led the researchers to assert that "preoperative vitamin supplementation is necessary for young infants with an early clinical diagnosis".
Additionally, both groups experienced liver function impairment, but it was more severe in the children with BA. As such, the researchers hypothesised that there might be a correlation between fat-soluble vitamin deficiency and liver function impairment.
Though the surgery improved bile drainage in some patients, their liver function was only partially restored, and vitamin uptake and metabolic disorders persisted, resulting in a "high incidence of fat-soluble vitamin deficiency within a short period of time".
However, evidence of a link between liver function and pre-surgery vitamin levels is still lacking, due to insufficient data regarding specific findings. As such, more research is needed to affirm the study’s results.
The paper concluded that ongoing vitamin A and D supplementation after surgery was required to combat persistent deficiencies, with a lack of the latter a particular concern in paediatric BA patients who also suffered from jaundice.
Source: Gastroenterology Research and Practice
"Fat-Soluble Vitamin Deficiency in Pediatric Patients with Biliary Atresia"
Authors: Rui Dong, et al.