*Note: CAVE Renal Insufficiency – administer lower protein amounts (see  Kidney Chapter). 

Vitamins, Minerals and Trace elements

• Coverage of daily vitamin and mineral requirements according to DACH recommendations
• High-dose supplementation of micronutrients only for specific deficiencies
• Due to impaired fat absorption and increased nutrient demands, CF patients, even those with a functioning pancreas, can develop deficiencies in vitamins A, D, E, and K. Since these deficiencies cannot be corrected through typical food intake, these vitamins must be taken daily as part of long-term therapy. Fat-soluble vitamins are usually taken with a fatty meal and enzymes, although special formulations allow for independent intake, regardless of meals.
• A worsening of lung function is also often associated with vitamin A deficiency. 
• A healthy vitamin D level ensures good calcium absorption in the intestine and has an anti-inflammatory effect. Good vitamin D levels in the blood are also associated with good lung function. 
• Vitamin E acts as an antioxidant and protects cell membranes from free radicals that arise in the body during infections and chronic inflammation. Therefore, the need for vitamin E increases with the frequency of respiratory infections and with age. 
• Vitamin K plays an important role in both blood clotting (vitamin K1) and bone metabolism (vitamin K2). 
• If there is a deficiency of the trace elements zinc, iron and selenium in the blood, the administration of organic compounds such as iron gluconate, zinc gluconate and selenomethionine is recommended, and dividing the daily dose into several doses is preferred. The simultaneous intake of high amounts of calcium (effervescent tablets, dairy products, mineral water rich in calcium) impairs the absorption of many trace elements. 
• Salt and electrolytes: A characteristic symptom of CF is the increased salt content in sweat, which is also used for diagnosis via a sweat test. The sometimes significantly increased need for salt must be compensated through food and drink. Salt requirements can be particularly high during physical activities, in warm weather, hot climates (such as vacations), and in cases of fever, vomiting, or gastrointestinal infections with diarrhea. This deficit should be promptly addressed to prevent dyselectrolytemia. Oral rehydration solutions (e.g., Elotrans®, Oralpädon®) can also help compensate for electrolyte losses. A homemade rehydration solution, prepared according to WHO guidelines, consists of: 1 level teaspoon of sugar, 1 level teaspoon of table salt, 0.75 teaspoon of baking soda, mixed with 1 liter of drinking water (or tea). Adding small amounts of fruit juice can enrich the solution with potassium and improve the taste. While a low-salt diet is generally recommended for healthy people, CF patients can and should consume foods high in salt. For patients on CFTR modulator therapy, salt requirements may be reduced. A sweat test can be helpful to determine individual needs, which should be adjusted in consultation with the treating physician. 
• Approximately two-thirds of adult CF patients (up to 65%) have reduced bone density and up to 25% have osteoporosis. It is estimated that the risk of fracture is twice as high as in the general population. 3 An adequate intake of calcium and vitamin D is essential for both the prevention and treatment of osteoporosis. The basic therapy for patients with exocrine pancreatic insufficiency includes fat-soluble vitamins in any case.