Effect of cholecalciferol recommended daily allowances on vitamin D status and fibroblast growth factor-23: an observational study in acute burn patients

Anne-Françoise Rousseau; Pierre Damas; Didier Ledoux; Etienne Cavalier

doi:10.1016/j.burns.2013.11.015

Effect of cholecalciferol recommended daily allowances on vitamin D status and fibroblast growth factor-23: an observational study in acute burn patients

Burns. 2014 Aug;40(5):865-70. doi: 10.1016/j.burns.2013.11.015. Epub 2014 Jan 23.

Authors

Anne-Françoise Rousseau¹, Pierre Damas², Didier Ledoux², Etienne Cavalier³

Affiliations

¹ Burn Centre and General Intensive Care Department, University of Liège, University Hospital, Sart-Tilman, Liège, Belgium. Electronic address: afrousseau@chu.ulg.ac.be.
² Burn Centre and General Intensive Care Department, University of Liège, University Hospital, Sart-Tilman, Liège, Belgium.
³ Clinical Chemistry Department, University of Liège, University Hospital, Sart-Tilman, Liège, Belgium.

PMID: 24462294
DOI: 10.1016/j.burns.2013.11.015

Abstract

Objective: Burn patients are at risk of hypovitaminosis D. Optimal vitamin D (VD) intakes are not defined in burn nutrition guidelines and studies mostly focused on ergocalciferol (VD2) supplementation in burn children. Aim of our study was to describe adult burns VD status, to measure effects of our cholecalciferol (VD3) supplementation on VD metabolism during acute burn care, and to assess correlation between FGF23 and C-reactive protein (CRP).

Design: Cohort study.

Methods: From March 2012 to January 2013, patients >18 years, admitted within 24 h after injury with burn surface area (BSA) ≥10% were included. Patients daily received VD3 from oral or enteral nutrition (400-600 IU) and from oral or intravenous multivitamin complex (200-220 IU). Serum levels of 25(OH)-D, 1-25(OH)2-D, 3rd generation PTH, C-terminal FGF23, total calcium, phosphate, albumin and CRP were measured at admission (D0) and every week during 4 weeks of follow-up. Data are expressed as percentage or median (min-max). Paired data were compared using Wilcoxon test. Correlation between CRP and FGF23 was assessed using nonparametric Spearman test. A p value <0.05 was considered to be statistically significant.

Results: We initially included 24 patients. Median age and BSA were, respectively, 46 [19-86] years and 15 [10-85]%. At D0, 75% presented a VD insufficiency (25(OH)-D 21-29 ng/ml) and 17% presented a deficiency (25(OH)-D ≤20 ng/ml). We followed 12 patients until day 28: 25(OH)-D was unchanged while 1-25(OH)2-D and FGF23 decreased without reaching significance. We observed a significant positive correlation between FGF23 and CRP (r=0.59, 95% CI: 0.22-0.82, p=0.0032).

Conclusions: Most of our adult burns presented hypovitaminosis D regardless of age. Nutrition supplemented with low dose of VD3 (intakes reaching recommended daily allowances) was insufficient to correct 25(OH)-D level. Moreover, an interesting correlation between CRP and FGF23 was found.

Keywords: 25-Hydroxyvitamin D; Burn; Cholecalciferol; Fibroblast growth factor-23.

Publication types

Observational Study

MeSH terms

Adult
Aged
Aged, 80 and over
Burns / blood
Burns / complications
Burns / therapy*
C-Reactive Protein / metabolism
Cholecalciferol / therapeutic use*
Cohort Studies
Dietary Supplements
Female
Fibroblast Growth Factor-23
Fibroblast Growth Factors / blood*
Humans
Male
Middle Aged
Recommended Dietary Allowances
Vitamin D / analogs & derivatives*
Vitamin D / blood
Vitamin D Deficiency / blood
Vitamin D Deficiency / complications
Vitamin D Deficiency / drug therapy*
Vitamins / therapeutic use*
Young Adult

Substances

FGF23 protein, human
Vitamins
Vitamin D
Cholecalciferol
Fibroblast Growth Factors
Fibroblast Growth Factor-23
C-Reactive Protein
25-hydroxyvitamin D