Fat-soluble vitamin levels in patients with primary biliary cirrhosis
Abstract
OBJECTIVE: To determine the occurrence of fat-soluble vitamin deficiencies and to identify clinical factors that may predict vitamin deficiency in patients with primary biliary cirrhosis (PBC). METHODS: Review of our data from a randomized, placebo-controlled trial that evaluated the efficacy of UDCA in 180 patients with PBC. We use the first available measurements of vitamin levels in each study participant. Vitamin levels for A, D, and E were measured in serum. The prothrombin time (PT) was used as a surrogate marker for vitamin K. RESULTS: The proportion of patients with fat-soluble vitamin deficiencies in the treatment and placebo groups was similar and the data sets were combined. The proportion with vitamin A, D, E or K deficiency was 33.5%, 13.2%, 1.9%, and 7.8%, respectively. In multivariate analysis, the Mayo risk score, advanced histological stage, and total cholesterol were independently associated with vitamin A deficiency whereas serum albumin levels was independently associated with vitamin D deficiency. No factors were associated with vitamin E or K deficiency in multivariate analysis owing to the few vitamin E and K deficient patients. Factors predictive of vitamin K deficiency by univariate analysis included Mayo risk score, advanced histological stage, HDL, total bilirubin, AST, and albumin. The cut-off value of the Mayo risk score with the highest sensitivity and specificity for vitamin A deficiency was 5.0. CONCLUSION: Other than deficiency of vitamin A, deficiency of fat-soluble vitamins occurs uncommonly in patients with PBC. A Mayo risk score > or = 5 helps in selecting patients with PBC for surveillance for vitamin A deficiency.
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Overt fat-soluble vitamin deficiency is rare but well described in those with chronic cholestasis, particularly once individuals become jaundiced.
“While it is rare for patients to develop overt fat-soluble vitamin (vitamin A, D, E, and K) deficiency, this is well described in those with chronic cholestasis, particularly once individuals become jaundiced.250 251”
From The British Society of Gastroenterology/UK-PBC primary biliary cholangitis treatment and management guidelines (2018) · cites this paper as [251]
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“Impaired digestion and absorption from bile salt deficiency, altered motility, and bacterial overgrowth may cause nutrient loss (10,11).”
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Rogalska, M., Rogalski, P., Andrzejuk, A., Błachnio-Zabielska, A. U., Zabielski, P., & Flisiak, R. (2026) · Lipids in Health and Disease · doi:10.1186/s12944-026-02887-5 · Cited by 1 · see citing works
“However, according to available research, deficiencies of these vitamins become clinically significant only in the advanced stages of cirrhosis or in cases of prolonged jaundice, and are relatively rare in the course of PBC [25, 26].”
Fikret, C. Z., Avcı, E., Ucgun, N., Yildirim, B., Yıldırım, F., & Hamaci, M. (2022) · Turkish Journal of Biochemistry · doi:10.1515/tjb-2022-0064 · Cited by 1 · see citing works
Primary biliary cirrhosis and primary sclerosing cholangitis and nutrition
Natasha, A. (2014) · doi:10.1002/9781118872796.ch4.2 · Cited by 1 · see citing works
Nutrition in Children with Liver Disease: Evaluation and Management
Hardy, S., Tanpowpong, P., & Kleinman, R. (2014) · doi:10.1007/978-1-4614-9005-0_27 · Cited by 1
Vitamin D supplementation in dogs with chronic biliary tract diseases.
Habermaass, V., Cogozzo, A., Bartoli, F., Rocca, D. J., Dini, R., Puccinelli, C., & Marchetti, V. (2026) · The Veterinary Journal · doi:10.1016/j.tvjl.2026.106925
General Hepatology Concerns for the Patient with Cholestatic Liver Disease.
Deeb, M., & Ma, M. (2026) · Clinical Liver Disease · doi:10.1016/j.cld.2026.04.007
Mammadov, R. A., Roest, H. P., van der Laan, L. J. W., & Peppelenbosch, M. P. (2025) · Journal of Nutrition · doi:10.1016/j.tjnut.2025.10.041
“Several vitamins with antioxidant, immunomodulatory, and metabolic effects have been investigated in autoimmune liver diseases, including PSC [111].”
Kamel, A. Y., Shah, P., Pipek, L. Z., Shah, A., & Kandiah, P. (2025) · Current Surgery Reports · doi:10.1007/s40137-025-00465-9
Abulitifu, Y., Maimaiti, M., Zhao, F., Adilijiang, M., Qian, W., & Zhang, Y.-P. (2025) · BMC Gastroenterology · doi:10.1186/s12876-025-04118-0
“VitD deficiency is common in patients with PBC (13.2% in the Mayo Clinic cohort) [17], is associated with the stage of PBC and ALP levels [18], and independently predicts poor response to UDCA [7].”
InfluentialPractical Approach to Malnutrition and Weight Loss in SSc
Bagnato, G., & del Galdo, F. (2020) · In Clinical Practice · doi:10.1007/978-3-030-53736-4_20
Nutrition in Cholestatic Liver Disease
Goyes, D., Danford, C., Trivedi, H. D., & Bonder, A. (2020) · Current Hepatology Reports · doi:10.1007/s11901-020-00511-3
Night Blindness Induced by Long-term External Bile Drainage
Lee, S.-M., Choi, J.-Y., Ho, J., Ji, H.-S., Park, S. J., Yoo, S., & Park, Y. M. (2015) · Ewha Medical Journal · doi:10.12771/emj.2015.38.1.42
“치료는 통상적으로 경구 비타민 A 제제를 매일 25,000 IU씩 4~12주간 투여하는 것인데 저용량의 비타민 A 투여도 효과적이 다[7].”
Response: Primary biliary cirrhosis is associated with falls and significant fall related injury.
Boucher, B. J. (2010) · QJM : monthly journal of the Association of Physicians · doi:10.1093/qjmed/hcq050
“Although vitamin D deficiency is the second most common fat-soluble vitamin deficiency in PBC, it is uncommon and absorption from the gut is not affected until there is severe cholestasis.(6,7) The majority of those in our study had early stages of liver disease and none of our participants had evidence of cholestasis.”
BackgroundDiseases of the Liver: Primary Biliary Cholangitis
Phillips, P. K., & Said, A. (2019) · Springer eBooks · doi:10.1007/978-3-030-25626-5_7
- Authors
- Phillips, J. R., Angulo, P., Petterson, T., & Lindor, K. D.
- Affiliations
- Mayo Clinic (US)
- Venue
- The American Journal of Gastroenterology
- Published
- 2001-09
- Volume
- 96
- Issue
- 9
- Pages
- 2745-2750
- ISSN
- 0002-9270 (ISSN-L)
- 1572-0241
- OpenAlex
- W2039181976
- Cited by
- 118
- References
- 0
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 2 · 2023: 4 · 2022: 4 · 2021: 4 · 2020: 4 · 2019: 4 · 2018: 10 · 2017: 9 · 2016: 6 · 2015: 4 · 2014: 5 · 2013: 4 · 2012: 6
- FWCI
- 2.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Surgery › Pediatric Hepatobiliary Diseases and Treatments
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- primary biliary cirrhosis, fat-soluble vitamin deficiency, vitamin A deficiency, vitamin D deficiency, vitamin E deficiency, vitamin K deficiency, Mayo risk score, ursodeoxycholic acid, serum albumin, prothrombin time
- MeSH terms
- Adult, Aged, Humans, Liver Cirrhosis, Biliary, Middle Aged, Regression Analysis, Solubility, Vitamin A, Vitamin D, Vitamin E, Vitamin K
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