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Obesity attenuates serum 25-hydroxyvitamin D response to cholecalciferol therapy in critically ill patients

Dickerson, Roland N., Holmes, Whitney L., Maish, George O., Croce, Martin A., Minard, Gayle
Nutrition 2019 v.63-64 pp. 120-125
adults, bioavailability, blood serum, calcium, cholecalciferol, hypercalcemia, liquids, obesity, patients, retrospective studies, therapeutics, vitamin D deficiency
The presence of obesity may confound cholecalciferol dosing in vitamin D–deficient patients owing to potentially decreased bioavailability. The aim of this retrospective study was to evaluate cholecalciferol therapy in vitamin D-deficient, critically ill trauma patients with and without obesity.Adult patients with severe traumatic injuries who had a serum 25-hydroxyvitamin D (25-OH vit D) <50nmol/L were prescribed 10 000 IU of liquid cholecalciferol daily. Efficacy was defined as achievement of a 25-OH vit D of 75 to 200nmol/L. Safety was evaluated by the presence of hypercalcemia (serum ionized calcium >1.32 mmol/L). Fifty-three patients (18 obese, 35 non-obese) were identified for study.Despite similar baseline concentrations (36 ± 7 versus 37 ± 7 nmol/L; P = NS), 25-OH vit D response was attenuated for those with obesity after 1 and 2 wk of cholecalciferol therapy (51 ± 18 versus 66 ± 27nmol/L, P < 0.01; 68 ± 19 versus 92 ± 25nmol/L, P < 0.01, respectively). Patients with obesity also tended to experience less hypercalcemia (22% versus 49% of patients, respectively) post-cholecalciferol therapy.Obesity alters the response to cholecalciferol therapy in critically ill patients with severe traumatic injuries.