Assessment of 3-epi-25-hydroxyvitamin D levels during cholecalciferol supplementation in adults with chronic liver diseases.

Nov 19, 2016Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme

Measuring 3-epi-25-hydroxyvitamin D levels during vitamin D supplementation in adults with chronic liver disease.

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Abstract

3-epi-25-hydroxyvitamin D (3-epi-25(OH)D) was detected in all 65 chronic liver disease patients receiving cholecalciferol supplementation.

Lower baseline vitamin D levels were associated with lower relative concentrations of 3-epi-25(OH)D.
In patients with severe vitamin D deficiency, 3-epi-25(OH)D constituted 2.4% of total vitamin D, compared to 4.8% in deficient, 5.2% in insufficient, and 5.8% in sufficient patients.
Relative concentrations of 3-epi-25(OH)D ranged from 4.3% to 7.1% in all supplemented patients, regardless of their initial vitamin D status.
Serum levels of 3-epi-25(OH)D significantly decreased in unsupplemented patients as serum 25(OH)D concentrations declined.
No significant differences in epimer concentrations were found between patients with or without cirrhosis.

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Recently, hepatic immaturity was cited as a possible reason for high levels of the C-3 epimer of 25-hydroxyvitamin (25(OH)D) in premature infants: however what role, if any, the liver plays in controlling epimer concentrations is unknown. This study assesses 3-epi-25-hydroxyvitamin D (3-epi-25(OH)D) levels during the course of cholecalciferol supplementation in adults with chronic liver diseases (CLD). Vitamin D metabolites were analyzed in 65 CLD patients with 25(OH)D <30 ng/mL who received 20 000 IU cholecalciferol/week for 6 months. The primary outcome assessed serum 25(OH)D and 3-epi-25(OH)D in response to supplementation. Corresponding values from 16 CLD patients with sufficient vitamin D levels receiving no supplementation were compared. The epimer was detected in all samples and at lower relative concentrations with lower vitamin D baseline status, i.e., severe vitamin D deficiency (<10 ng/mL) as compared with deficient (10-19.9 ng/mL), insufficient (20-29.9 ng/mL), or sufficient (≥30 ng/mL) vitamin D levels (2.4% vs. 4.8%, 5.2%, 5.8%, respectively; P < 0.001). Similar relative concentrations for 3-epi-25(OH)D, ranging from 4.3%-7.1% (absolute concentrations: 1.1-4.0 ng/mL; all P < 0.001), were obtained in response to cholecalciferol in all supplemented patients, regardless of inadequacy threshold. Epimer levels significantly decreased (P = 0.007) in unsupplemented patients, coinciding with decreasing serum 25(OH)D concentrations over time. No epimer differences between patients with (n = 17) or without (n = 48) cirrhosis were demonstrated. The 3-epi-25(OH)D was present in serum of all patients at comparable levels to those reported by others. Epimer levels increased linearly with increasing 25(OH)D levels after supplementation. However, no effect of cirrhosis on epimer concentrations was observed.

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