I agree with the sentiments about implementation of "guidelines" which are
not evidence based without any consultation.
However, I wouldn't personally have a huge problem with annual or possibly
less frequent measurement of 25(OH)Vitamin D in patients with CF, so long as
this doesn't escalate in frequency (as these things do).
25(OH)D deficiency is not all that common in CF (probably not markedly
different from that in the population of ill young patients in general).
Most Vitamin D is derived from sunshine and not from diet - although at
least in theory, ADEK malabsorption can lead to loss of sunshine-induced
vitamin from the enterohepatic cycle. Nevertheless, given the multiple
causes of bone disease in CF, monitoring this one remediable factor is
perhaps not unreasonable.
Aubrey Blumsohn
University of Sheffield
----- Original Message -----
From: <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, August 14, 2002 2:00 PM
Subject: Re: Vitamin D requests in cystic fibrosis patients
> Vitamin D is not the only analyte that appears to be added to the ever
> growing list for CF monitoring. We have had HbA1c, insulin and c-
> peptide requests added to our annual assessments. Of course the
> clinicians have not approached us and we are simply returning the
> requests as 'not indicated'. I know that some our colleagues will do
> these things for an easy life but they are not cheap tests and without
> the evidence base as with Vit D they should not be added to the list.
>
> Nutrition is clearly a major problem in patients with CF. The argument
> as to whether one can monitor nutrition with a few arbitrarily chosen
> substances is far from clear especially in patients who almost certainly
> have chronic inflammation or infection and an acute phase response.
> If one takes for example Vitamin A then the literature is certainly
> contradictory. Perhaps it would just be easier to give all CF patients
> adequate dietary supplements than to try and infer nutritional status
> from plasma measurements. It would be interesting to know which
> clinical biochemist or chemical pathologist advised the CF Trust before
> they drew up their recommendations
>
> MikeDr G.Michael Addison
> Royal Manchester Children's Hospital
> Pendlebury
> Manchester M27 4HA
> United Kingdom
>
> Tel 0161-727-2250(AM)or 0161-220-5342(PM)
> FAX 0161-727-2249
> Email [log in to unmask]
>
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