Patients with chronic liver disease (CLD) often experience hypozincemia. The clinical factors associated with hypozincemia have not been established. We investigated clinical factors that may be useful to predict hypozincemia in patients with CLD. The serum zinc levels CLD patients were measured; Study 1 investigated the predictive factors of hypozincemia, and Study 2 was performed to validate the factors identified in Study 1. Study 1 included 197 participants, of whom 28 and 106 had serum zinc levels <60 µg/dL and <80 µg/dL, respectively. A multivariate analysis revealed that serum zinc levels <60 µg/dL or <80 µg/dL were associated with the albumin–bilirubin (ALBI) score and serum albumin level. A receiver operating characteristic curve analysis revealed that the ALBI score ≥ −1.83 and the serum albumin level ≤3.3 g/dL were the cut-off values for a serum zinc level <60 µg/dL, whereas the ALBI score ≥ −2.44 and the serum albumin level ≤3.6 g/dL were the cut-off values for a serum zinc level <80 µg/dL. In Study 2 (n = 177), the diagnostic accuracy rates for serum zinc <60 µg/dL were 81.9% for the ALBI score and 75.1% for the serum albumin level, and those for serum zinc <80 µg/dL were 70.1% for both parameters. Together these findings indicate that the ALBI score may serve as a predictive factor of hypozincemia in CLD patients.

Despite the multiple advantages of 25-hydroxyvitamin D (calcifediol or 25(OH)D) compared to cholecalciferol, it is used sparingly. This study was planned to assess the safety and efficacy of supplementing daily 25 µg of calcifediol capsules vis-a-vis 100 µg (4000 IU) of cholecalciferol sachets in apparently healthy individuals with vitamin D deficiency in Chandigarh, India (latitude 30.7° North, 76.8° East). It was a prospective, interventional study to evaluate the effects of calcifediol vis-a-vis cholecalciferol. Following initial screening of 70 subjects in each group, 62 were included in the calcifediol and 41 in the cholecalciferol group. Forty-six from calcifediol and 37 from cholecalciferol group completed the 6-month follow up. There was a significant increase in serum 25(OH)D (355% in cholecalciferol & 574% in calcifediol groups, respectively, p < 0.001) and 1,25 (OH)2D (p < 0.001) with a marked decrease in iPTH (p < 0.001) and ALP (p = 0.016) in both groups. Though serum ALP decreased significantly more in the calcifediol group than the cholecalciferol group, no appreciable difference in other biochemical parameters was noted between the groups. No episodes of hypercalcaemia or incidence of new renal stone disease were observed during follow-up. However, hypercalciuria (spot urine calcium creatinine > 0.2 mg/mg) was noted in 8/46 individuals in the calcifediol group and 5/37 individuals in the cholecalciferol group at final visit with no significant difference between two groups. This study establishes the efficacy and safety of correcting vitamin D deficiency with daily 25 µg calcifediol capsules as an alternative to 4000 IU (100 µg) cholecalciferol sachets.