Frequency of Micronutrient Deficiencies in Mexican Patients With Inflammatory Bowel Disease

Abstract

BACKGROUND: Inflammatory Bowel Disease (IBD), which includes Ulcerative Colitis (UC) and Crohn's Disease (CD), carries an increased risk of micronutrient deficiencies, such as Vitamin D (VD), Cobalamine (Cbl), Zinc, and Folic Acid (B9), which sometimes can be related to severity of IBD and increased number of hospitalizations. There are no previous data that describe the frequency of these micronutrients deficiencies in Mexican patients with IBD. The aim of this study is to describe the frequency of VD, Cbl, Zinc and folic acid deficiencies in Mexican patients with IBD. METHODS: We reviewed medical records of 270 patients with IBD histopathological diagnosis from the IBD Clinic of the National Institute of Medical Science and Nutrition Salvador Zubirán, between January 2014 and June 2017. Clinical and sociodemographical data from the 30 days around the day of the sample collection were registered in a database using SPSS v.24, using the following cutpoints to classify serum levels of each micronutrient: VD insufficiency (21-29 ng/mL), VD deficiency (<20 ng/mL), Cbl deficiency (<180 pg/mL), Zinc deficiency (<60 μg/dl) and folic acid deficiency (<6ng/ml). Statistical analysis was performed using mean and median as measures of central tendency to describe data, and Chi squared, Mann-Whitney U test, Spearman's correlation and MANOVA were further used accordingly. A value of P ≤ 0.05 was considered statistically significant. RESULTS: A total of 270 patients were studied, 224 had UC (82.96%) and 46 (17.03%) CD; 156 (57.77%) women and 114 (42.22%) men; with an average age ± standard deviation of 47.77 ± 15.19 at the time of evaluation for this study, with a median (range) of years of evolution of IBD of 10 years (1-43). 225 (83.33%) patients had VD registered measures, from them, 108 (48%) had VD insufficiency and 76 (33.8%) VD deficiency: high smoking rate showed a tendency to statistical significance regarding low VD levels (P=0.052); VD levels where significantly lower when measured during the months of autumn and winter (P=0.004). 159 (58.9%) patients had registered Cbl levels, from them, 22 (13.8%) showed deficient levels; CD patients with deficient levels of Cbl (n=10, 45.5%) had more years of evolution compared to patients with normal levels (10 (6-27 years) vs 5 (1-20 years), P=0.01). Of the 71 (26.29%) patients with zinc serum levels, 5 (7%) presented deficiency. From the 166 (61.48%) patients with folic acid levels, the deficiency was found in 5 (3.01%) of them. No associations were evaluated due to the low number of deficiency cases for zinc and folic acid. CONCLUSION(S): The frequency of micronutrients deficiencies in Mexican IBD patients was: 48% for VD insufficiency, 33.8% for VD deficiency; 13.8% for Cbl deficiency, 7% for Zinc deficiency and 3.01% for folic acid deficiency. A significant trend of significance was found between high smoking rate and low VD levels (P=0.052); VD levels where significantly lower when measured during the months of autumn and winter (P=0.004). CD patients with deficient Cbl levels had long-term disease duration compared to patients with normal levels (P=0.01).