A deficiency of vitamin E in a patient with cholestatic liver disease is related to which absorption requirement?

• A. Binding to cholesterol
• B. Conversion to active form by the liver
• C. Formation of micelles
• D. Absorption via intrinsic factor

Answer: (C)

Vitamin E is a fat-soluble vitamin, which means its absorption in the intestines is dependent on the presence of dietary fat. In the context of cholestatic liver disease, there is typically a disruption in fat digestion and absorption due to impaired bile secretion. Bile acids are essential for the emulsification and absorption of lipids and fat-soluble vitamins like vitamin E.

Formation of micelles is key to how fats and fat-soluble vitamins are absorbed in the small intestine. Bile salts help form micelles, which facilitate the absorption of lipids and vitamins into the enterocytes of the intestinal lining. A deficiency in vitamin E can occur when there is cholestasis because the bile salts are insufficient for forming the necessary micelles, leading to inadequate absorption of vitamin E and other lipophilic nutrients.

This is why the relationship between vitamin E deficiency and cholestatic liver disease is fundamentally tied to the process of micelle formation, which is essential for the absorption of lipids and fat-soluble vitamins from the diet.