Fat-soluble vitamins in cystic fibrosis other than vitamin D: Daily intake and monitoring recommendations

Vitamin	Age group	Intake recommendations for CF patients	Monitoring recommendations
Vitamin A*
	1 to 12 months	450 micrograms (1500 units)	Annual measurement of serum retinol^[1,2] In the presence of liver disease, serum retinyl binding protein and retinyl esters should be measured annually in addition to serum retinol^[2]
	1 to 3 years	1500 micrograms (5000 units)
	4 to 8 years	1500 to 3000 micrograms (5000 to 10,000 units)
	>8 years	3000 micrograms (10,000 units)
	Adult	3000 micrograms (10,000 units)
Vitamin E^•
	1 to 12 months	40 to 50 mg	Annual measurement of serum alpha tocopherol^[1]
	1 to 3 years	80 to 150 mg
	4 to 8 years	100 to 200 mg
	9 to 18 years	200 to 400 mg
	Adult	200 to 400 mg^[2]
Vitamin K
	1 to 12 months	0.3 to 0.5 mg	Annual measurement of serum prothrombin time and PIVKA II Additional supplementation may be required during antibiotic therapy If found to be deficient, repeat measurement one to two months following therapy to confirm normalization
	1 to 3 years	0.3 to 0.5 mg
	4 to 8 years	0.3 to 0.5 mg
	9 to 18 years	0.3 to 0.5 mg
	Adult	2.5 to 5 mg/week

CF: cystic fibrosis; PIVKA: protein induced by vitamin K absence.
* Vitamin A doses given as retinol activity equivalents (RAE). 1 RAE = 3.33 units = 1 microgram retinol = 12 microgram beta-carotene.
• Vitamin E is measured as alpha-tocopherol; 1 mg alpha tocopherol = 1.47 units "natural source" vitamin E (RRR-alpha tocopherol), or 2.2 units synthetic vitamin E ("all-racemic" vitamin E).

References:

Borowitz D, Baker RD, Stallings V. Consensus report on nutrition for pediatric patients with cystic fibrosis. J Pediatr Gastroenterol Nutr 2002; 35:246.
Yankaskas JR, Marshall BC, Sufian B, et al. Cystic fibrosis adult care: consensus conference report. Chest 2004; 125 (1 Suppl):1S.

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