{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T10:57:31Z","timestamp":1791284251420,"version":"4.1.0"},"reference-count":28,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Iuliu Ha\u021bieganu University of Medicine and Pharmacy","award":["771\/60\/11.01.2023"],"award-info":[{"award-number":["771\/60\/11.01.2023"]}],"id":[{"id":"https:\/\/ror.org\/051h0cw83","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Iuliu Ha\u021bieganu University of Medicine and Pharmacy","award":["647\/53\/11.01.2024"],"award-info":[{"award-number":["647\/53\/11.01.2024"]}],"id":[{"id":"https:\/\/ror.org\/051h0cw83","id-type":"ROR","asserted-by":"crossref"}]},{"award":["771\/60\/11.01.2023"],"award-info":[{"award-number":["771\/60\/11.01.2023"]}],"id":[{"id":"https:\/\/ror.org\/051h0cw83","id-type":"ROR","asserted-by":"publisher"}]},{"award":["647\/53\/11.01.2024"],"award-info":[{"award-number":["647\/53\/11.01.2024"]}],"id":[{"id":"https:\/\/ror.org\/051h0cw83","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Ministry of Investments and European Projects","award":["100418\/29.08.2025"],"award-info":[{"award-number":["100418\/29.08.2025"]}]},{"name":"Ministry of Investments and European Projects","award":["350525"],"award-info":[{"award-number":["350525"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Serum \u03b1-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\u201317.9 years) with mixed-etiology CLD. Retinol and total vitamin E were measured by ELISA, whereas the CALIPER reference intervals applied here were established for \u03b1-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 (&lt;3.7) and E:TG (&lt;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 = \u22120.45; p &lt; 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.<\/jats:p>","DOI":"10.3390\/nu18193283","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T10:46:29Z","timestamp":1791283589000},"page":"3283","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lipid-Adjusted Vitamin E Status in Children with Chronic Liver Disease: Reclassification Patterns and Differences According to Cholestasis and Liver Transplantation"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2074-0714","authenticated-orcid":false,"given":"Sorina","family":"Adam","sequence":"first","affiliation":[{"name":"\u201cIuliu Ha\u0163ieganu\u201d University of 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400124 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2099-8379","authenticated-orcid":false,"given":"Gabriel","family":"Ben\u021ba","sequence":"additional","affiliation":[{"name":"2nd Pediatric Discipline, Department of Mother and Child, Faculty of Medicine, \u201cIuliu Ha\u0163ieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"},{"name":"2nd Pediatric Clinic, Emergency Clinical Hospital for Children, 400124 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"R\u0103zvan M.","family":"Chereche\u0219","sequence":"additional","affiliation":[{"name":"HIVE Health 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Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Degrassi, I., Leonardi, C., Di Profio, E., Montanari, C., Zuccotti, G., and Verduci, E. (2023). Fat-soluble vitamins deficiency in pediatric cholestasis: A scoping review. Nutrients, 15.","DOI":"10.3390\/nu15112491"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1177\/0884533610374198","article-title":"Update in pediatrics: Focus on fat-soluble vitamins","volume":"25","author":"Sathe","year":"2010","journal-title":"Nutr. Clin. Pract."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1016\/j.gtc.2025.06.003","article-title":"Nutritional Considerations for Children with Liver Disease","volume":"54","author":"Boster","year":"2025","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.dld.2019.10.005","article-title":"Fat-soluble vitamins deficiency in pediatric chronic liver disease: The impact of liver transplantation","volume":"52","author":"Veraldi","year":"2020","journal-title":"Dig. Liver Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1002\/lt.23646","article-title":"High prevalence of vitamin A deficiency and vitamin D deficiency in patients evaluated for liver transplantation","volume":"19","author":"Venu","year":"2013","journal-title":"Liver Transpl."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1056\/NEJM198405103101901","article-title":"Vitamin E deficiency with normal serum vitamin E concentrations in children with chronic cholestasis","volume":"310","author":"Sokol","year":"1984","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1017\/S0954422422000142","article-title":"Vitamin E deficiency in childhood: A narrative review","volume":"36","year":"2023","journal-title":"Nutr. Res. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1056\/NEJM198102263040902","article-title":"A progressive neurologic syndrome in children with chronic liver disease","volume":"304","author":"Rosenblum","year":"1981","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1111\/j.1749-6632.1972.tb27878.x","article-title":"Relationship between tocopherol and serum lipid levels for determination of nutritional adequacy","volume":"203","author":"Horwitt","year":"1972","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1177\/000456328602300505","article-title":"The use of different lipids to express serum tocopherol:Lipid ratios for the measurement of vitamin E status","volume":"23","author":"Thurnham","year":"1986","journal-title":"Ann. Clin. Biochem."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1016\/j.clinbiochem.2014.03.025","article-title":"Pediatric reference value distributions for vitamins A and E in the CALIPER cohort and establishment of age-stratified reference intervals","volume":"47","author":"Raizman","year":"2014","journal-title":"Clin. Biochem."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1002\/hep.20864","article-title":"Comparison of indices of vitamin A status in children with chronic liver disease","volume":"42","author":"Feranchak","year":"2005","journal-title":"Hepatology"},{"key":"ref_14","unstructured":"World Health Organization (2011). Serum Retinol Concentrations for Determining the Prevalence of Vitamin A Deficiency in Populations (WHO\/NMH\/NHD\/MNM\/11.3), WHO. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/85859."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Peng, C.H., Lee, H.C., Jiang, C.B., Hsu, C.K., Yeung, C.Y., Chan, W.T., Chang, S.-W., and Weng, S.-C. (2019). Serum vitamin D level is inversely associated with liver fibrosis in post Kasai\u2019s portoenterostomy biliary atresia patients living with native liver. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0218896"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1097\/MPG.0000000000001958","article-title":"Systematic review: The epidemiology, natural history, and burden of Alagille syndrome","volume":"67","author":"Kamath","year":"2018","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2024). EASL Clinical Practice Guidelines on genetic cholestatic liver diseases. J. Hepatol., 81, 303\u2013325.","DOI":"10.1016\/j.jhep.2024.04.006"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1097\/MPG.0000000000001334","article-title":"Guideline for the evaluation of cholestatic jaundice in infants: Joint recommendations of NASPGHAN and ESPGHAN","volume":"64","author":"Fawaz","year":"2017","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.freeradbiomed.2007.03.024","article-title":"Vitamin E, antioxidant and nothing more","volume":"43","author":"Traber","year":"2007","journal-title":"Free Radic. Biol. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e70225","DOI":"10.1111\/bcpt.70225","article-title":"Pharmacology of Vitamin E","volume":"138","author":"Traber","year":"2026","journal-title":"Basic Clin. Pharmacol. Toxicol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA), Turck, D., Bohn, T., Castenmiller, J., de Henauw, S., Hirsch-Ernst, K.-I., Knutsen, H.K., Maciuk, A., and Mangelsdorf, I. (2024). Scientific opinion on the tolerable upper intake level for vitamin E. EFSA J., 22, e8953.","DOI":"10.2903\/j.efsa.2024.8814"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1093\/ajcn\/84.2.375","article-title":"Distribution of serum concentrations of alpha-tocopherol and gamma-tocopherol in the US population","volume":"84","author":"Ford","year":"2006","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1007\/s12072-020-10112-3","article-title":"Vitamin A levels reflect disease severity and portal hypertension in patients with cirrhosis","volume":"14","author":"Simbrunner","year":"2020","journal-title":"Hepatol. Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1093\/ajcn\/41.1.66","article-title":"Vitamin E deficiency in adults with chronic liver disease","volume":"41","author":"Sokol","year":"1985","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1097\/MPG.0000000000002443","article-title":"Nutrition support of children with chronic liver diseases: A joint position paper of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition","volume":"69","author":"Mouzaki","year":"2019","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.dld.2026.05.006","article-title":"Nutrition support of children with chronic liver disease: A rapid review and consensus statements from Australasian society of parenteral and enteral nutrition (AuSPEN) Paediatric liver group","volume":"58","author":"Burgess","year":"2026","journal-title":"Dig. Liver Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1944","DOI":"10.1093\/eurheartj\/ehw152","article-title":"Fasting is not routinely required for determination of a lipid profile: Clinical and laboratory implications including flagging at desirable concentration cut-points\u2014A joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine","volume":"37","author":"Nordestgaard","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1016\/j.clnu.2024.01.030","article-title":"ESPEN practical short micronutrient guideline","volume":"43","author":"Berger","year":"2024","journal-title":"Clin. 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