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To the Editor: The study by Dr Habu and colleagues¹ suggests that vitamin K₂ (menaquinone) supplementation prevents hepatocellular carcinoma in women with viral cirrhosis of the liver. Supplementation would be expected to be more beneficial in patients who have a vitamin K deficiency at the onset of the study, but the vitamin K status of the patients was not reported.

There are 2 plausible mechanisms that could lead to a vitamin K deficiency in patients with cirrhosis. First, because vitamin K is mainly produced by the gut microflora, a deficiency is known to occur in patients receiving broad-spectrum antibiotics.² Antibiotic prophylaxis is routinely used to prevent bacterial infections in patients with decompensated cirrhosis of the liver. Second, because vitamin K stores are located in the liver, advanced cirrhosis could account for a vitamin K deficiency.

The importance of a low serum albumin level as a prognostic factor for hepatocellular carcinoma . . . [Full Text of this Article]

Marie-Astrid Piquet, MD
piquet-ma@chu-caen.fr

Isabelle Hourmand-Ollivier, MD; Thông Dao, MD
Department of Hepatology and Nutrition
University Hospital
Caen, France

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