Journal of Shanghai Jiao Tong University (Medical Science) >

2026 , Vol. 46 >Issue 1: 54 - 59

DOI: https://doi.org/10.3969/j.issn.1674-8115.2026.01.006

Clinical research

High-dose vitamin D for pediatric short bowel syndrome with vitamin D insufficiency/deficiency

  • Wu Qingqing ,
  • Cao Yi ,
  • Lu Lina ,
  • Tao Yijing ,
  • Feng Haixia ,
  • Yan Weihui ,
  • Wang Ying
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  • 1.Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
    2.Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai 200092, China
First author contact:Wu Qingqing and Cao Yi designed the study. Wang Ying contributed to the conception and design of the research. Yan Weihui, Lu Lina, Tao Yijing, and Feng Haixia contributed to collection and analysis of the data. Wu Qingqing drafted the manuscript. Wang Yin and Yan Weihui revised the manuscript for important intellectual content. All authors have read the last version of paper and consented to submission.
Wang Ying, E-mail: wangying_ssmu@126.com.

Received date: 2025-05-05

  Accepted date: 2025-12-05

  Online published: 2026-01-30

Supported by

National Key Research and Development Program of China(2023YFC2706505);National Natural Science Foundation of China(82370525);Top-notch Project of Shanghai Oriental Talent Plan(BJWS2024033);Shanghai “Medical New Star” Outstanding Young Medical Talents Project(20234Z0004);“Two-hundred Talents”Program of Shanghai Jiao Tong University School of Medicine(2024-009)

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Abstract

Objective ·To explore the safety and efficacy of a single high-dose intramuscular injection of vitamin D in children with short bowel syndrome (SBS) complicated by vitamin D insufficiency/deficiency. Methods ·The retrospective study included 32 children with SBS complicated by vitamin D insufficiency/deficiency. When the serum 25-hydroxyvitamin D [25-(OH)D] concentration was lower than 50 nmol/L, a single intramuscular injection of 200 000 IU vitamin D2 was administered. Clinical data, including gender, age, primary disease, remaining length of the small intestine, presence of the ileocecal valve, and colonic integrity, were collected. Skin conditions at the intramuscular injection site and the levels of serum 25-(OH)D, calcium, phosphorus, and alkaline phosphatase before and one month after vitamin D supplementation were recorded. Results ·The median age at enrollment was 5.0 (3.0, 7.0) months. Intestinal atresia and necrotizing enterocolitis were the main causes of SBS, accounting for 28.13% and 21.88%, respectively. The average length of the remaining small intestine was (57.27±24.55) cm. Before vitamin D supplementation, 65.63% (21/32) of children had vitamin D deficiency and 34.38% (11/32) had vitamin D insufficiency. After supplementation, serum 25-(OH)D levels increased significantly compared with baseline (53.10 nmol/L vs. 28.87 nmol/L, P<0.001). In children with vitamin D insufficiency, the serum 25-(OH)D levels increased from 37.30 nmol/L to 58.51 nmol/L (P=0.010), while in those with vitamin D deficiency, the levels increased from 26.91 nmol/L to 44.82 nmol/L (P<0.001). Overall, 62.50% (20/32) of children achieved normal serum 25-(OH)D levels. Moreover, no complications, including vitamin D toxicity, hypercalcemia, skin induration, or local infection, were observed in any of the children. Conclusion ·A single high-dose (200 000 IU) intramuscular injection of vitamin D can safely and effectively improve the vitamin D level in children with SBS complicated by vitamin D insufficiency/deficiency.

Key words： short bowel syndrome (SBS); child; high-dose; vitamin D

Cite this article

Wu Qingqing , Cao Yi , Lu Lina , Tao Yijing , Feng Haixia , Yan Weihui , Wang Ying . High-dose vitamin D for pediatric short bowel syndrome with vitamin D insufficiency/deficiency[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026 , 46(1) : 54 -59 . DOI: 10.3969/j.issn.1674-8115.2026.01.006

References

[1] 中华医学会肠外肠内营养学分会儿科学组, 儿童短肠综合征诊断治疗专家共识工作组, 蔡威, 等. 儿童短肠综合征诊断治疗专家共识(2023版)[J]. 中国循证儿科杂志, 2024, 19(3): 161-172.
  Pediatrics Group of the Society for Parenteral and Enteral Nutrition of Chinese Medical Association, Expert Consensus Work Group on the Diagnosis and Treatment of Short Bowel Syndrome in Children, Cai W, et al. Expert Consensus on the Diagnosis and Treatment of Short Bowel Syndrome in Children (2023 Edition)[J]. Chinese Journal of Evidence-Based Pediatrics, 2024, 19(3): 161-172.
[2] Choi S J, Lee K J, Choi J S, et al. Poor prognostic factors in patients with parenteral nutrition-dependent pediatric intestinal failure[J]. Pediatr Gastroenterol Hepatol Nutr, 2016, 19(1): 44.
[3] Chandra R, Kesavan A. Current treatment paradigms in pediatric short bowel syndrome[J]. Clin J Gastroenterol, 2018, 11(2): 103-112.
[4] Lepus C A, Samela K, Emerick K M, et al. Vitamin D status in children with intestinal failure who have achieved enteral autonomy[J]. Nut Clin Prac, 2021, 36(6): 1284-1289.
[5] Namjoshi S S, Muradian S, Bechtold H, et al. Nutrition deficiencies in children with intestinal failure receiving chronic parenteral nutrition[J]. J Parenter Enteral Nutr, 2018, 42(2): 427-435.
[6] Grenade N, Kosar C, Steinberg K, et al. Use of a loading dose of vitamin D for treatment of vitamin D deficiency in patients with intestinal failure[J]. J Parenter Enteral Nutr, 2017, 41(3): 512-516.
[7] Wozniak L J, Bechtold H M, Reyen L E, et al. Vitamin D deficiency in children with intestinal failure receiving home parenteral nutrition[J]. J Parenter Enteral Nutr, 2015, 39(4): 471-475.
[8] Limketkai B N, Mullin G E, Limsui D, et al. Role of vitamin D in inflammatory bowel disease[J]. Nut Clin Prac, 2017, 32(3): 337-345.
[9] Holick M F. Vitamin D deficiency[J]. N Engl J Med, 2007, 357(3): 266-281.
[10] Rosen C J, Adams J S, Bikle D D, et al. The nonskeletal effects of vitamin D: an endocrine society scientific statement[J]. Endocr Rev, 2012, 33(3): 456-492.
[11] Svoren B M, Volkening L K, Wood J R, et al. Significant vitamin D deficiency in youth with type 1 diabetes mellitus[J]. J Pediatr, 2009, 154(1): 132-134.
[12] Mattila C, Knekt P, Ma?nnisto? S, et al. Serum 25-hydroxyvitamin D concentration and subsequent risk of type 2 diabetes[J]. Diabetes Care, 2007, 30(10): 2569-2570.
[13] Trasciatti S, Piras F, Bonaretti S, et al. Effect of oral cholecalciferol in a murine model of celiac disease: a dose ranging study[J]. J Steroid Biochem Mol Biol, 2022, 220: 106083.
[14] Ekwaru J P, Zwicker J D, Holick M F, et al. The importance of body weight for the dose response relationship of oral vitamin D supplementation and serum 25-hydroxyvitamin D in healthy volunteers[J]. PLoS One, 2014, 9(11): e111265.
[15] Holick M F, Binkley N C, Bischoff-Ferrari H A, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2011, 96(7): 1911-1930.
[16] Berger M M, Shenkin A, Schweinlin A, et al. ESPEN micronutrient guideline[J]. Clin Nutr, 2022, 41(6): 1357-1424.
[17] Khadilkar A, Khadilkar V, Chinnappa J, et al. Prevention and treatment of vitamin D and calcium deficiency in children and adolescents: Indian Academy of Pediatrics (IAP) guidelines[J]. Indian Pediatr, 2017, 54(7): 567-573.
[18] Munns C F, Shaw N, Kiely M, et al. Global consensus recommendations on prevention and management of nutritional rickets[J]. J Clin Endocrinol Metab, 2016, 101(2): 394-415.
[19] Salazar J A, Carey A N, Duggan C P. Nutritional and medical approaches to intestinal failure[J]. Curr Opin Clin Nutr Metab Care, 2023, 26(3): 201-209.
[20] Feng H X, Zhang T, Yan W H, et al. Micronutrient deficiencies in pediatric short bowel syndrome: a 10-year review from an intestinal rehabilitation center in China[J]. Pediatr Surg Int, 2020, 36(12): 1481-1487.
[21] Premkumar M H, Soraisham A, Bagga N, et al. Nutritional management of short bowel syndrome[J]. Clin Perinatol, 2022, 49(2): 557-572.
[22] Arnaud S B, Goldsmith R S, Lambert P W, et al. 25-hydroxyvitamin D3: evidence of an enterohepatic circulation in man[J]. Exp Biol Med, 1975, 149(2): 570-572.
[23] Kozanoglu E, Basaran S, Goncu M K. Proximal myopathy as an unusual presenting feature of celiac disease[J]. Clin Rheumatol, 2005, 24(1): 76-78.
[24] Kumar P R, Fenton T R, Shaheen A A, et al. Prevalence of vitamin D deficiency and response to oral vitamin D supplementation in patients receiving home parenteral nutrition[J]. J Parenter Enteral Nutr, 2012, 36(4): 463-469.
[25] Soliman A T, El-Dabbagh M, Adel A, et al. Clinical responses to a mega-dose of vitamin D3 in infants and toddlers with vitamin D deficiency rickets[J]. J Trop Pediatr, 2010, 56(1): 19-26.
[26] Mittal H, Rai S, Shah D, et al. 300, 000 IU or 600, 000 IU of oral vitamin D3 for treatment of nutritional rickets: a randomized controlled trial[J]. Indian Pediatr, 2014, 51(4): 265-272.
[27] Mondal K, Seth A, Marwaha R K, et al. A randomized controlled trial on safety and efficacy of single intramuscular versus staggered oral dose of 600 000IU vitamin D in treatment of nutritional rickets[J]. J Trop Pediatr, 2014, 60(3): 203-210.
[28] Mcnally J D, Iliriani K, Pojsupap S, et al. Rapid normalization of vitamin D levels: a meta-analysis[J]. Pediatrics, 2015, 135(1): e152-e166.
[29] Shepherd D, Day A S, Leach S T, et al. Single high-dose oral vitamin D3 therapy (stoss): a solution to vitamin D deficiency in children with inflammatory bowel disease?[J]. J Pediatr Gastroenterol Nutr, 2015, 61(4): 411-414.
[30] Emel T, Do?An D A, Erdem G, et al. Therapy strategies in vitamin D deficiency with or without rickets: efficiency of low-dose stoss therapy[J]. J Pediatr Endocrinol Metab, 2012, 25(1/2): 107-110.
[31] Taylor S N. Vitamin D in toddlers, preschool children, and adolescents[J]. Ann Nutr Metab, 2020, 76(Suppl. 2): 30-41.
[32] Galior K, Grebe S, Singh R. Development of vitamin D toxicity from overcorrection of vitamin D deficiency: a review of case reports[J]. Nutrients, 2018, 10(8): 953.
[33] Gertner J M, Domenech M. 25-Hydroxyvitamin D levels in patients treated with high-dosage ergo- and cholecalciferol[J]. J Clin Pathol, 1977, 30(2): 144-150.
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