Vitamin deficiency in cystic fibrosis

Case details

A 30-month-old female child whose growth rate has been in the lower 10th percentile over the last year presents with chronic, nonproductive cough and diarrhea with foul-smelling stools. She is diagnosed as having cystic fibrosis (figure-1).

Cystic fibrosis

For which of the following vitamins is this child most likely to be at risk of deficiency?
A. Ascorbic acid (vitamin C)
B. Biotin
C. Folic acid
D. Retinol (vitamin A)
E. Riboflavin (vitamin B2)

Answer- D.

Because cystic fibrosis leads to pancreatic damage and diminution of the ability to secrete HCO3 ions and pancreatic digestive enzymes with the result that fat and protein are absorbed poorly (Figure-2). Lipid malabsorption reduces the absorption of fat soluble vitamins.

Lipid absorption

Figure-2-Role of pancreatic lipase in lipid digestion and absorption.

Retinol is a fat soluble vitamin that must be absorbed along with lipid micelles (figure) ; other fat-soluble vitamins are E, D, and K. The patients of cystic fibrosis usually manifest signs and symptoms of deficiencies of fat soluble vitamins.

The other vitamins listed are water-soluble and their absorption is not significantly affected.

 

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