From the Guidelines
Patients with chronic pancreatitis should receive supplementation with fat-soluble vitamins A, D, E, and K, as well as B vitamins, to prevent deficiencies and improve quality of life, as recommended by the most recent guidelines 1. The prevalence of biochemical vitamin deficiency in chronic pancreatitis differs widely between studies and countries, with vitamin A deficiency ranging from 3% to 40% and vitamin E deficiency ranging from 25% to 75% 1.
- Fat-soluble vitamins, such as vitamins A, D, E, and K, are particularly affected due to pancreatic enzyme insufficiency leading to fat malabsorption.
- B vitamins, especially B12, are also commonly depleted in patients with chronic pancreatitis, often due to alcoholism or malabsorption.
- Standard supplementation should include a daily multivitamin plus specific fat-soluble vitamin supplements:
- vitamin A (10,000-25,000 IU daily)
- vitamin D (1,000-2,000 IU daily)
- vitamin E (400-800 IU daily)
- vitamin K (2.5-25 mg weekly)
- B12 supplementation (1,000 mcg monthly by injection or 1,000-2,000 mcg daily orally)
- Patients should take these supplements with meals and alongside prescribed pancreatic enzyme replacement therapy (PERT) to maximize absorption, as recommended by the AGA clinical practice update 1.
- Regular monitoring of vitamin levels every 6-12 months is essential to adjust dosing as needed, with measures of successful treatment including reduction in steatorrhea, improvement in fat-soluble vitamin levels, and gain in weight and muscle mass 1.
- Baseline measurements of nutritional status, including body mass index, quality-of-life measures, and fat-soluble vitamin levels, should be obtained, along with a baseline dual-energy x-ray absorptiometry scan to assess bone density, which should be repeated every 1-2 years 1.
From the Research
Vitamin Deficiencies in Chronic Pancreatitis
- Fat-soluble vitamins (A, D, E, and K) are at risk of deficiency in patients with chronic pancreatitis (CP) due to exocrine pancreatic insufficiency (EPI) 2, 3, 4, 5.
- The prevalence of fat-soluble vitamin deficiency in CP patients varies, with vitamin D deficiency being the most common, affecting up to 57.6% of patients 4.
- Vitamin E deficiency is also common, with a pooled prevalence rate of 29.2% 4, and is closely related to a dysfunction of fat digestion 2.
- Vitamins A and K deficiencies are less common, but still significant, with pooled prevalence rates of 16.8% and unknown, respectively 4.
- The use of different cut-offs and the rate of pancreatic exocrine insufficiency can influence the results and heterogeneity of fat-soluble vitamin deficiency in CP patients 4.
- Treatment with specific vitamin supplements can correct fat-soluble vitamin deficiencies in CP patients 5.
- Individual supplementation with oral vitamin D can increase serum 25(OH)D concentrations into the normal range in CP patients 6.
- Clinicians should consider periodically screening for fat-soluble vitamin deficiencies in all patients with CP, regardless of EPI, to avoid associated health effects of vitamin depletion 3.