{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T01:08:21Z","timestamp":1776474501300,"version":"3.51.2"},"reference-count":26,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T00:00:00Z","timestamp":1698192000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Nutritional support is essential for patients with severe motor and intellectual disabilities (SMID) to ensure the smooth provision of medical care. These patients often require long-term tube feeding with enteral formulas, potentially leading to deficiencies in vitamins and trace elements. Additionally, frequent antibiotic use for infections often disrupts gut microbiota, inhibiting vitamin K2 production by intestinal bacteria. We assessed the serum protein induced by vitamin K absence or antagonists-II (PIVKA-II) and undercarboxylated osteocalcin (ucOC) levels to assess the vitamin K status in 20 patients with SMID (median age: 44.1 years, 11 men and 9 women) undergoing long-term tube feeding for durations ranging from 3 to 31 years. Thirteen (65%) and nine (45%) patients had elevated PIVKA-II (&lt;40 mAU\/mL) and serum ucOC levels (reference value &lt; 4.50 ng\/mL), respectively. Dietary vitamin K1 intake did not differ between patients with and without elevated PIVKA-II levels. Vitamin K2 supplementation for 3 months decreased serum PIVKA-II levels near those within the reference range. Approximately half of the patients with SMID on tube feeding had subclinical vitamin K deficiency. Further studies are needed to ascertain if long-term vitamin K2 supplementation effectively prevents vitamin K deficiency-induced hypercoagulation, osteoporosis, and vascular calcification in patients with SMID.<\/jats:p>","DOI":"10.3390\/nu15214525","type":"journal-article","created":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T09:54:08Z","timestamp":1698227648000},"page":"4525","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Effect of Vitamin K2 Supplementation on PIVKA-II Levels in Patients with Severe Motor and Intellectual Disabilities Undergoing Long-Term Tube Feeding"],"prefix":"10.3390","volume":"15","author":[{"given":"Hiromitsu","family":"Ohmori","sequence":"first","affiliation":[{"name":"Department of Pediatrics, National Hospital Organization Yanai Medical Center, 95 Ihonosho, Yanai 742-1352, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akihiko","family":"Kato","sequence":"additional","affiliation":[{"name":"Blood Purification Unit, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuka","family":"Shirai","sequence":"additional","affiliation":[{"name":"Clinical Nutrition Unit, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reiji","family":"Fukano","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube 755-8505, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akiko","family":"Nagae","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Biwako Gakuen Kusatsu Medical and Welfare Center for Children and Persons with Severe Motor and Intellectual Disabilities, 8-3-113 Kasayama, Kusatsu 525-0072, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masami","family":"Yamasaki","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Hospital Organization Yanai Medical Center, 95 Ihonosho, Yanai 742-1352, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junko","family":"Komenaka","sequence":"additional","affiliation":[{"name":"Department of Clinical Nutrition, National Hospital Organization Yanai Medical Center, 95 Ihonosho, Yanai 742-1352, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eiji","family":"Imamura","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Hospital Organization Yanai Medical Center, 95 Ihonosho, Yanai 742-1352, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masao","family":"Kumode","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Biwako Gakuen Kusatsu Medical and Welfare Center for Children and Persons with Severe Motor and Intellectual Disabilities, 8-3-113 Kasayama, Kusatsu 525-0072, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takafumi","family":"Miyachi","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Hospital Organization Yanai Medical Center, 95 Ihonosho, Yanai 742-1352, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e31","DOI":"10.1016\/j.clnme.2012.12.002","article-title":"Enteral nutrition and antibiotic use increase the risk for vitamin K deficiency in patients with severe motor and intellectual disabilities","volume":"8","author":"Nagae","year":"2013","journal-title":"e-SPEN J."},{"key":"ref_2","first-page":"113","article-title":"SMID and epilepsy","volume":"17","author":"Konishi","year":"2013","journal-title":"Epilepsy"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.jcma.2016.10.005","article-title":"A study of oxidative stress and the newer antiepileptic drugs in epilepsy associated with severe motor and intellectual disabilities","volume":"80","author":"Morimoto","year":"2017","journal-title":"J. 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