Lipid-Adjusted Vitamin E Status in Children with Chronic Liver Disease: Reclassification Patterns and Differences According to Cholestasis and Liver Transplantation.
4 affiliations
- 1"Iuliu Haţieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
- 22nd Pediatric Discipline, Department of Mother and Child, Faculty of Medicine, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
- 32nd Pediatric Clinic, Emergency Clinical Hospital for Children, 400124 Cluj-Napoca, Romania.
- 4HIVE Health Innovation Center, Babeș-Bolyai University, 400095 Cluj-Napoca, Romania.
Abstract
Background
Serum α-tocopherol depends on lipids, so absolute concentrations misclassify vitamin E status in children with chronic liver disease (CLD). The CALIPER program defined lipid-adjusted E:cholesterol (E:C) and E:triglyceride (E:TG) ratios, but their application in mixed-etiology pediatric CLD using immunoassay has not been reported.Methods
Exploratory single-center cross-sectional study of 66 children (observed age range 4 months-17.9 years) with mixed-etiology CLD. Retinol and total vitamin E were measured by ELISA, whereas the CALIPER reference intervals applied here were established for α-tocopherol measured by HPLC; the two platforms are not interchangeable, so every classification reported is an exploratory application of those cutoffs. Vitamin E status was classified by absolute concentration, E:C (<3.7) and E:TG (<8.5). Cholestatic (n = 15), non-cholestatic (n = 45) and post-transplant (n = 6) groups were compared.Results
Vitamin A was largely preserved (5.2% below WHO). Vitamin E was low in 45.3% by absolute concentration, 62.5% by E:C and 43.8% by E:TG. Of 35 children with a normal absolute vitamin E concentration, 11 (31.4%) were reclassified as low by E:C. Low E:C differed across groups (cholestatic 78.6%, non-cholestatic 63.6%, post-transplant 16.7%; p = 0.030). E:TG was inversely correlated with 25(OH)D (rho = -0.45; p < 0.001).Conclusions
Lipid-adjusted interpretation reclassified a substantial proportion of children whose absolute vitamin E concentration appeared adequate, and the prevalence of a low E:C ratio was lower among post-transplant participants than in the other two groups. In this exploratory cohort, the E:C ratio showed greater potential than the E:TG ratio for lipid-adjusted interpretation of vitamin E status; prospective validation against HPLC-based measurements and established functional indices is required before routine clinical adoption.
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BibTeX
@article{adam2026lipidadjusted,
title = {{Lipid-Adjusted Vitamin E Status in Children with Chronic Liver Disease: Reclassification Patterns and Differences According to Cholestasis and Liver Transplantation.}},
author = {Sorina Adam and Alina Grama and Alexandra Mititelu and Gabriel Bența and Răzvan M Cherecheș and Tudor Lucian Pop},
journal = {Nutrients},
year = {2026},
month = oct,
doi = {10.3390/nu18193283},
url = {https://europepmc.org/article/MED/42884734},
note = {CC BY},
}
RIS
TY - JOUR
TI - Lipid-Adjusted Vitamin E Status in Children with Chronic Liver Disease: Reclassification Patterns and Differences According to Cholestasis and Liver Transplantation.
AU - Sorina Adam
AU - Alina Grama
AU - Alexandra Mititelu
AU - Gabriel Bența
AU - Răzvan M Cherecheș
AU - Tudor Lucian Pop
PY - 2026
DA - 2026/10/06
JO - Nutrients
DO - 10.3390/nu18193283
UR - https://europepmc.org/article/MED/42884734
AB - Background Serum α-tocopherol depends on lipids, so absolute concentrations misclassify vitamin E status in children with chronic liver disease (CLD). The CALIPER program defined lipid-adjusted E:cholesterol (E:C) and E:triglyceride (E:TG) ratios, but their application in mixed-etiology pediatric CLD using immunoassay has not been reported.Methods Exploratory single-center cross-sectional study of 66 children (observed age range 4 months-17.9 years) with mixed-etiology CLD. Retinol and total vitamin E were measured by ELISA, whereas the CALIPER reference intervals applied here were established for α-tocopherol measured by HPLC; the two platforms are not interchangeable, so every classification reported is an exploratory application of those cutoffs. Vitamin E status was classified by absolute concentration, E:C (<3.7) and E:TG (<8.5). Cholestatic (n = 15), non-cholestatic (n = 45) and post-transplant (n = 6) groups were compared.Results Vitamin A was largely preserved (5.2% below WHO). Vitamin E was low in 45.3% by absolute concentration, 62.5% by E:C and 43.8% by E:TG. Of 35 children with a normal absolute vitamin E concentration, 11 (31.4%) were reclassified as low by E:C. Low E:C differed across groups (cholestatic 78.6%, non-cholestatic 63.6%, post-transplant 16.7%; p = 0.030). E:TG was inversely correlated with 25(OH)D (rho = -0.45; p < 0.001).Conclusions Lipid-adjusted interpretation reclassified a substantial proportion of children whose absolute vitamin E concentration appeared adequate, and the prevalence of a low E:C ratio was lower among post-transplant participants than in the other two groups. In this exploratory cohort, the E:C ratio showed greater potential than the E:TG ratio for lipid-adjusted interpretation of vitamin E status; prospective validation against HPLC-based measurements and established functional indices is required before routine clinical adoption.
SN - 2072-6643
ER -