Abstract
Rickets and osteopenia, common problems in chronic childhood cholestasis, have been attributed to vitamin D malabsorption leading to reduced serum levels of 25(OH)-vitamin D. d-α-Tocopheryl polyethylene glycol-1000 succinate (TPGS), a water-soluble form of vitamin E, forms micelles at low concentration. We evaluated the potential role of TPGS in enhancing vitamin D absorption in eight children (aged 5 mo to 19 y) with severe chronic cholestasis (three extrahepatic biliary atresia, three non-syndromic intrahepatic cholestasis, and two Alagille syndrome). To evaluate vitamin D absorption, the subjects received vitamin D3 1000 IU/kg (maximum dose of 50 000 IU); they then received the same dose of vitamin D3 mixed with TPGS (25 lU/kg). Serial serum vitamin D3 levels and areas under the curve were measured. All patients had enhanced absorption of vitamin D when it was administered in a mixture with TPGS. Mean area under the curve for serum vitamin D3 was 403.0 ± 83.1 nmol ± h/L (155.6 ± 32.1 ng ± h/mL), with a mean rise above baseline of 13.5 ± 1.8 nmol/L (5.2 ± 0.7 ng/mL) with vitamin D/TPGS compared with no rise when vitamin D was given alone (both p < 0.001). Seven patients have been followed for at least 3 mo while receiving the vitamin D/TPGS combination. Those with initially low serum 25(OH)-vitamin D levels (<37.5 nmol/L or 15 ng/mL) had normalization (range 37.5–146 nmol/L) within 1 mo, whereas those with initially normal levels remained normal. While the patients were receiving vitamin D/TPGS, serum vitamin E to total lipid ratio either normalized or remained normal. In conclusion, 1) TPGS enhances vitamin D absorption in infants and children with severe chronic cholestasis and 2) the enhanced absorption of both vitamins is sufficient to normalize or maintain adequate levels of serum 25(OH)-vitamin D and vitamin E to total lipid ratio.
Similar content being viewed by others
Article PDF
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Argao, E., Heubi, J., Hollis, B. et al. d-α-Tocopheryl Polyethylene Glycol-1000 Succinate Enhances the Absorption of Vitamin D in Chronic Cholestatic Liver Disease of Infancy and Childhood. Pediatr Res 31, 146–150 (1992). https://doi.org/10.1203/00006450-199202000-00011
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1203/00006450-199202000-00011
This article is cited by
-
Factors influencing the absorption of vitamin D in GIT: an overview
Journal of Food Science and Technology (2017)
-
Characterization of Heterogeneity and Spatial Distribution of Phases in Complex Solid Dispersions by Thermal Analysis by Structural Characterization and X-ray Micro Computed Tomography
Pharmaceutical Research (2017)
-
Effect of a vitamin/mineral supplement on children and adults with autism
BMC Pediatrics (2011)
-
Bioavailability of a Novel, Water-Soluble Vitamin E Formulation in Malabsorbing Patients
Digestive Diseases and Sciences (2007)
-
Treatment options for chronic cholestasis in infancy and childhood
Current Treatment Options in Gastroenterology (2005)