This leaflet provides information on fat soluble vitamin supplements for children with CF.
What are fat soluble vitamins?
Vitamins A, E, D and K are fat soluble vitamins. They are found naturally in some foods and present in certain dietary supplements. These vitamins dissolve in fats and oils and are absorbed alongside fats in the diet, they are subsequently stored in the body's fatty tissue and in the liver.
Why are fat soluble vitamins important?
Vitamin A plays a crucial role in vision (especially in low light), maintaining healthy skin and mucous membranes, supporting the immune system and fighting infection.
Vitamin D is needed to help the body absorb calcium and develop strong, dense bones. Vitamin D is also thought to play a part in regulating inflammation and maintaining a healthy immune system. Vitamin D may also play a role in improved lung function in CF.
Vitamin E supports the immune system helping the body fight off infection. Vitamin E is also needed for healthy skin, nails and hair and helps to protect the heart and eyes.
Vitamin K is needed to help with blood clotting and for building strong bones.
Why are higher amounts needed in CF?
In children with CF who are pancreatic insufficient and need to take enzymes the absorption of these fat soluble vitamins is reduced. This can lead to low blood levels and symptoms of vitamin deficiency.
Low levels of vitamin D can also be due to a lack of sunlight exposure and/or very high or low body weight. A low body weight reduces the amount of Vitamin D that can be stored in the bodies’ tissues. In children with a high body weight vitamin D is stored in fat tissue and this makes it less available for use by the body.
Taking antibiotics can lead to lower levels of vitamin K as they can disrupt the beneficial gut bacteria that produce this. This is especially true with prolonged use of antibiotics, as the bacteria essential for synthesising vitamin K are subsequently reduced.
| Vitamin A |
Animal foods including liver, oily fish, eggs, butter, margarine, cheese, yoghurt, full fat and semi skimmed milk Dark green vegetables (e.g. spinach, broccoli and kale) Red,orange and yellow fruits and vegetables (e.g. carrots, tomatoes, peppers, sweet potatoes, mangoes and apricots) |
|---|---|
| Vitamin D |
Small amounts are found in fortified margarine, full fat milk, eggs, oily fish, liver, fortified dairy products, some breads and breakfast cereals. Vitamin D is also produced by the skin using the sun’s ultra violet light (UVB) rays. |
| Vitamin E | Vegetable oils, margarine, oily fish, nuts, seeds, egg yolk, avocado. |
| Vitamin K |
Leafy green vegetables (lettuce, cabbage, broccoli, cauliflower, spinach and kale) *Liver particularly beef liver Small amounts are found in some other animal products (eggs, milk, cheese) Vitamin K is naturally produced by the beneficial bacteria in our guts. |
* Liver and liver products such as liver pâté – are particularly rich sources of vitamin A. Speak to your dietitian if you have these more than once a week
When are supplements needed?
All infants and children with CF who need to take enzymes (Creon) are advised to take fat soluble vitamin supplements, these are usually started at the time of diagnosis with CF.
Which supplements are needed?
Your child’s medical team will advise on the most suitable fat soluble vitamin supplements for your child. Some children take multivitamin supplements aimed specifically at children with CF, some children may be advised to take individual vitamin supplements.
When is the best time to give supplements?
Fat soluble vitamin supplements should be taken at the same time as food and enzymes (Creon), this helps the body to absorb the vitamins
Can high vitamin levels be harmful?
Fat soluble vitamins are stored in the body. High levels of Vitamin A can be harmful. Very high levels of Vitamin D and E may also be harmful in the longer term, however toxic levels are very rare. There are no known harmful effects of high Vitamin K levels.
Can my child take other vitamins or health supplements?
It can be harmful if your child takes too many vitamins, therefore please consult your dietitian, doctor or pharmacist if you are considering offering your child any additional vitamins or health supplements.
How are vitamin levels checked?
Your child’s fat soluble vitamin levels will be checked at least once year (usually at your child’s CF annual review). The aim is to keep vitamin levels within their target ranges and prevent them going too high or too low. Levels may need to be checked more frequently if this is advised by the doctor or dietitian.
Which vitamin levels are measured?
| Vitamin A | This measures the total amount of Vitamin A circulating in the blood |
|---|---|
|
Total Vitamin D (25OH) |
This is the total combined amount of Vitamin D2 and Vitamin D3 (from dietary sources, sunlight and supplements). |
| Vitamin E |
This is measured for information only. Vitamin E is best assessed using the Vitamin E to cholesterol ratio |
|
Vitamin E to Cholesterol ratio |
This is the best measure of Vitamin E as Vitamin E is transported in the blood attached to cholesterol. |
| Vitamin K | This gives an indication of the body’s tissue stores of Vitamin K |
| PIVKA II | This stands for ‘protein induced in Vitamin K absence’ and gives an indication of how effectively the body uses Vitamin K for blood clotting; a high level may suggest a deficiency in Vitamin K. |
The Vitamin D levels are analysed at Addenbrooke’s hospital, the results usually take around a week to come back. Vitamin A, E and K levels are analysed at external laboratories, the results usually take around four to six weeks to come back.
The Dietitian and CF consultant will look at the blood levels and write to you with the results. If any changes to fat soluble vitamin supplements are needed the Dietitian will contact you and discuss any adjustments required.
Who can I contact for further information?
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