Issue 16

Clinical Question

For which micronutrients should IBD patients routinely be monitored?

Editor’s Bottom Line

Pediatric IBD patients should be routinely monitored for iron and vitamin D deficiency and Crohn’s disease (CD) patients should be monitored for zinc deficiency.

Reference

Fritz J, Walia C, Elkadri A, et al. A Systematic Review of Micronutrient Deficiencies in Pediatric Inflammatory Bowel Disease. Inflamm Bowel Dis. 2018 Aug 21 [Epub ahead of print]; doi: 10.1093/ibd/izy271. https://www.ncbi.nlm.nih.gov/pubmed/30137322

Synopsis

Researchers examined 39 studies included in five databases that evaluated micronutrient deficiencies in pediatric IBD patients and analyzed the data according to specific micronutrients: vitamin B12, folate, vitamin D, iron, and vitamin A, C, E, K, other B vitamins as well as selenium and zinc.

Data analysis revealed that as many as 95% of pediatric IBD patients experienced iron deficiency at the time of diagnosis and up to 70% were deficient two years after diagnosis. Based on these findings, the authors recommended routine screening for iron deficiency in children with IBD using ferritin, iron and total iron binding capacity (TIBC).

Results also showed that as many as 98% of pediatric IBD patients had vitamin D deficiency or insufficiency, leading to a recommendation that providers monitor 25(OH) D at IBD diagnosis and at least annually thereafter.

Zinc deficiency was reported in 17% of patients included in the analysis, most commonly in CD patients. This finding led to a recommendation that patients with CD be screened for zinc deficiency at diagnosis and then annually.

Since less than 2% of IBD patients were found to have vitamin B12 and folate deficiency, the authors did not recommend routine testing for these micronutrients. Existing data on vitamin A, E, C and selenium deficiency also do not warrant routine monitoring for these micronutrients.

Details

Study Design: Systematic review
Funding: Unfunded
Allocation: Various
Setting: Various
Level of Evidence: 3a (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.