Micronutrient Deficiencies and Anemia in Children with Inflammatory Bowel Disease

Julie Rempel,Wael El-Matary,Kanika Grover

doi:10.3390/nu13010236

Abstract

Children with inflammatory bowel disease (IBD) are at risk of developing nutrition deficiencies, particularly because of reduced intake, restrictive diets, malabsorption, and excessive nutrient loss. The aim of this study was to determine the prevalence and predictors of anemia and micronutrient deficiencies at diagnosis and one year follow up in children and adolescents with inflammatory bowel disease (IBD). Children and young adults diagnosed with IBD before the age of 17 years between 2012 and 2018 were included. Laboratory measurements including serum levels of iron, ferritin, zinc, vitamin D, vitamin A, vitamin E, selenium, copper, vitamin B12, and red blood cell (RBC) folate at diagnosis and one-year follow-up were documented as part of the Manitoba Longitudinal Pediatric Inflammatory Bowel Disease (MALPID) Cohort. A total of 165 patients with IBD were included, 87 (53%) with Crohn’s disease (CD) and 78 (47%) with ulcerative colitis (UC). The prevalence of deficiencies in our cohort at diagnosis and one year follow-up, respectively, were iron (56% and 27%), ferritin (39% and 27%), zinc (10% and 6%), vitamin D (22% and 13%), vitamin A (25% and 25%), vitamin E (5% and 4%), selenium (10 and 7%), copper (17% and 27%), vitamin B12 (2% and 5%), and Red blood cell (RBC) folate (1% and 17%). Anemia was present in 57% and 25% at diagnosis and follow up respectively. In CD patients, age of diagnosis (15y–younger than 18y) was a predictor of moderate to severe anemia and albumin levels (<33 g/L) were protective against anemia. Many children with IBD suffer from anemia and micronutrient deficiencies at diagnosis and some fail to recover after one year despite being in clinical remission.

Highlights

Crohn’s disease (CD) and ulcerative colitis (UC), collectively known as inflammatory bowel disease (IBD), are non-curable chronic inflammatory disorders of the gastrointestinal tract
Many children with IBD suffer from anemia and micronutrient deficiencies at diagnosis and some fail to recover after one year despite being in clinical remission
Micronutrient deficiencies for all patients included at diagnosis and after one year were: iron (56% and 27%, p < 0.001), ferritin (39% and 27%, p = 0.004), vitamin D (22% and 13%, p = 0.013), vitamin A

Summary

Introduction

Crohn’s disease (CD) and ulcerative colitis (UC), collectively known as inflammatory bowel disease (IBD), are non-curable chronic inflammatory disorders of the gastrointestinal tract. Pediatric patients with active IBD are at higher risk for micronutrient deficiencies through several different mechanisms, including suboptimal oral intake, nutrient malabsorption, increased intestinal losses, systemic inflammation, hypermetabolic state, and medication’s adverse events [2,3,4]. Intestinal inflammation in pediatric IBD is associated with malabsorption, maldigestion, and gastrointestinal protein loss, contributing to deficiencies of energy, protein, and micronutrients [5]. Micronutrient deficiencies have been shown to have significant implications on the outcomes of patients with IBD especially in those with anemia with subsequent lower quality of life and cognitive dysfunction [9]. A recent systematic review, which included 39 pediatric studies, concluded that iron and vitamin D deficiencies are common in pediatric patients with IBD, whereas vitamin B12 and folate deficiencies are rare [10]. Zinc deficiency occurred at a higher rate in patients with CD than in healthy controls [11]

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