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Deficiency of fat-soluble vitamins in chronic pancreatitis: A systematic review and meta-analysis.

Abstract

BACKGROUND AND AIMS

Chronic pancreatitis (CP) patients are at risk for fat-soluble vitamins (A, D, E, K) deficiency, but available studies are small and heterogeneous. We conducted a systematic review and meta-analysis to determine the prevalence of fat-soluble vitamins deficiency in CP patients.

METHODS

Medline was searched up to January 2016 for case series and case-control studies reporting prevalence of fat-soluble vitamin deficiency in CP patients. The prevalent deficiency rate was pooled for included studies, and deficiency rate between CP and controls, with relative odds ratio (OR) and 95% confidence interval (CI) calculated for case-control studies.

RESULTS

Twelve studies including 548 patients included. With a random-effect model, the pooled prevalence rate of vitamin A, D and E deficiency were 16.8% (95%CI 6.9-35.7), 57.6% (95%CI 43.9-70.4) and 29.2% (95%CI 8.6-64.5) respectively, with considerable heterogeneity (I2 = 75%, 87.1% and 92%). Only one study evaluated vitamin K deficiency. The pooled OR for vitamin D deficiency in CP cases compared with controls was 1.17 (95% CI 0.77-1.78). Sensitivity analyses showed lower prevalence of vitamin A and E, and higher prevalence of vitamin D deficiency in high-quality studies. The rate of pancreatic exocrine insufficiency did not seem affect the deficiency rates, while the use of different cut-offs influences results and heterogeneity for vitamin E, but not A.

CONCLUSIONS

Fat-soluble vitamins deficiency is frequent in CP patients, with considerable heterogeneity. There is, however, no apparent increased risk of vitamin D deficiency in CP compared to controls. Larger, high-quality studies are necessary to better estimate the prevalence of fat-soluble vitamins deficiency, including vitamin K.

Links

Authors+Show Affiliations

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Gastroenterology Department, Hospital Universitario Cruces, Barakaldo-Bizkaia, Spain.

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Digestive & Liver Disease Unit, S. Andrea Hospital, University "Sapienza", Rome, Italy.

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Karolinska University Hospital, Sweden.

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Department of Digestive Tract Diseases, University Hospital, Lodz, Poland.

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Department of Endocrinology and Gastroenterology, Tartu University Hospital, University of Tartu, Estonia.

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Department for Internal Medicine I, University Hospital Regensburg, Germany.

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Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.

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Department of Medicine A, Ernst-Moritz-Arndt-University Greifswald, Germany.

Digestive & Liver Disease Unit, S. Andrea Hospital, University "Sapienza", Rome, Italy. Electronic address: gabriele.capurso@gmail.com.

Source

MeSH

Avitaminosis
Humans
Pancreatitis, Chronic
Prevalence
Vitamin A Deficiency
Vitamin D Deficiency
Vitamin E Deficiency
Vitamin K Deficiency

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

27681502

Citation

Martínez-Moneo, Emma, et al. "Deficiency of Fat-soluble Vitamins in Chronic Pancreatitis: a Systematic Review and Meta-analysis." Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.], vol. 16, no. 6, 2016, pp. 988-994.
Martínez-Moneo E, Stigliano S, Hedström A, et al. Deficiency of fat-soluble vitamins in chronic pancreatitis: A systematic review and meta-analysis. Pancreatology. 2016;16(6):988-994.
Martínez-Moneo, E., Stigliano, S., Hedström, A., Kaczka, A., Malvik, M., Waldthaler, A., ... Capurso, G. (2016). Deficiency of fat-soluble vitamins in chronic pancreatitis: A systematic review and meta-analysis. Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.], 16(6), pp. 988-994. doi:10.1016/j.pan.2016.09.008.
Martínez-Moneo E, et al. Deficiency of Fat-soluble Vitamins in Chronic Pancreatitis: a Systematic Review and Meta-analysis. Pancreatology. 2016;16(6):988-994. PubMed PMID: 27681502.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Deficiency of fat-soluble vitamins in chronic pancreatitis: A systematic review and meta-analysis. AU - Martínez-Moneo,Emma, AU - Stigliano,Serena, AU - Hedström,Aleksandra, AU - Kaczka,Aleksandra, AU - Malvik,Marko, AU - Waldthaler,Alexander, AU - Maisonneuve,Patrick, AU - Simon,Peter, AU - Capurso,Gabriele, Y1 - 2016/09/20/ PY - 2016/07/12/received PY - 2016/09/08/revised PY - 2016/09/20/accepted PY - 2016/9/30/pubmed PY - 2017/4/5/medline PY - 2016/9/30/entrez KW - Chronic pancreatitis KW - Fat-soluble vitamins KW - Meta-analysis KW - Vitamin A KW - Vitamin D KW - Vitamin E KW - Vitamin K SP - 988 EP - 994 JF - Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] JO - Pancreatology VL - 16 IS - 6 N2 - BACKGROUND AND AIMS: Chronic pancreatitis (CP) patients are at risk for fat-soluble vitamins (A, D, E, K) deficiency, but available studies are small and heterogeneous. We conducted a systematic review and meta-analysis to determine the prevalence of fat-soluble vitamins deficiency in CP patients. METHODS: Medline was searched up to January 2016 for case series and case-control studies reporting prevalence of fat-soluble vitamin deficiency in CP patients. The prevalent deficiency rate was pooled for included studies, and deficiency rate between CP and controls, with relative odds ratio (OR) and 95% confidence interval (CI) calculated for case-control studies. RESULTS: Twelve studies including 548 patients included. With a random-effect model, the pooled prevalence rate of vitamin A, D and E deficiency were 16.8% (95%CI 6.9-35.7), 57.6% (95%CI 43.9-70.4) and 29.2% (95%CI 8.6-64.5) respectively, with considerable heterogeneity (I2 = 75%, 87.1% and 92%). Only one study evaluated vitamin K deficiency. The pooled OR for vitamin D deficiency in CP cases compared with controls was 1.17 (95% CI 0.77-1.78). Sensitivity analyses showed lower prevalence of vitamin A and E, and higher prevalence of vitamin D deficiency in high-quality studies. The rate of pancreatic exocrine insufficiency did not seem affect the deficiency rates, while the use of different cut-offs influences results and heterogeneity for vitamin E, but not A. CONCLUSIONS: Fat-soluble vitamins deficiency is frequent in CP patients, with considerable heterogeneity. There is, however, no apparent increased risk of vitamin D deficiency in CP compared to controls. Larger, high-quality studies are necessary to better estimate the prevalence of fat-soluble vitamins deficiency, including vitamin K. SN - 1424-3911 UR - https://www.unboundmedicine.com/medline/citation/27681502/full_citation DB - PRIME DP - Unbound Medicine ER -