Prospective analysis of serum carotenoids, vitamin A and tocopherols in adults with short bowel syndrome undergoing intestinal rehabilitation 1

• Authors: Menghua Luo, Emory University; Concepción F. Estívariz, Emory University; Rosemary L. Schleicher, Centers for Disease Control and Prevention; Niloofar Bazargan, Emory University; Lorraine M. Leader, Emory University; John R Galloway, Emory University; Thomas R. Ziegler, Emory University
• Journal Title: Nutrition
• Volume: Volume 25, Number 4
• Publisher: Elsevier: 12 months | 2009-04, Pages 400-407
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.nut.2008.10.003
• Subjects: Environmental Sciences
• Keywords: short bowel syndrome; carotenoids; vitamin A; tocopherols; parenteral nutrition

Abstract

Carotenoids, vitamin A and tocopherols serve important roles in many key body functions. However, availability of these compounds may be decreased in patients with short bowel syndrome (SBS) due to decreased oral intake of fruits and vegetables and/or decreased intestinal absorption. Little information is available on serum concentrations of carotenoids, vitamin A and tocopherols during chronic parenteral nutrition (PN) or during PN weaning. The aim of this study was to prospectively examine serum concentrations of a wide variety of carotenoids, vitamin A and tocopherols in SBS patients undergoing an intensive 12-week intestinal rehabilitation program. Twenty-one PN-dependent adult SBS patients were enrolled in a 12-week intestinal rehabilitation program, which included individualized dietary modification, multivitamin supplementation, and randomization to receive either s.c. placebo (n=9) or human growth hormone (GH, 0.1 mg/kg/day). PN weaning was initiated after week 4 and advanced as tolerated. Serum concentrations of carotenoids, vitamin A and tocopherols were determined at baseline and at weeks 4 and 12. Results showed that a significant % of subjects exhibited low serum concentrations for carotenoids and α-tocopherol at study entry, while a few subjects had low concentrations of retinol (5%). Serum α-tocopherol concentration was negatively associated with PN lipid dose (r = - 0.34, p < 0.008). We conclude that SBS patients are depleted in diet-derived carotenoids despite oral and intravenous multivitamin supplementation and dietary adjustment during intestinal rehabilitation and PN weaning. Reduction of PN lipid infusion may improve serum α-tocopherol concentrations.