Nutrient deficiencies in inflammatory bowel disease
- Jonathan E Teitelbaum, MD
Jonathan E Teitelbaum, MD
- Associate Professor of Pediatrics
- Drexel University School of Medicine
- Section Editors
- Paul Rutgeerts, MD, PhD, FRCP
Paul Rutgeerts, MD, PhD, FRCP
- Section Editor — Inflammatory Bowel Disease
- Emeritus Professor of Medicine
- University Hospital, Leuven, Belgium
- Timothy O Lipman, MD
Timothy O Lipman, MD
- Section Editor — Nutrition
- GI-Hepatology-Nutrition Section
- Washington DC Veterans Affairs Medical Center
- Kathleen J Motil, MD, PhD
Kathleen J Motil, MD, PhD
- Section Editor — Pediatric Nutrition
- Professor of Pediatric Nutrition
- Baylor College of Medicine
Individuals with inflammatory bowel disease (IBD) and, particularly, those with Crohn's disease (CD) are at risk for a variety of nutritional deficiencies because of decreased nutrient intake or absorption and/or increased losses. In adults, the most common problems are deficiencies of micronutrients (nutrients needed for life in small quantities) (table 1), including several water-soluble and fat-soluble vitamins, and minerals including calcium, iron, and other trace minerals.
Clinically important deficiencies in macronutrients (providing total energy and/or protein) are less common in adults. However, these are very important issues in children with IBD, as discussed in a separate topic review. (See "Growth failure and poor weight gain in children with inflammatory bowel disease".)
Micronutrient deficiencies in adults and children with inflammatory bowel disease will be reviewed here. Weight loss and other manifestations of macronutrient deficiency in adults will be mentioned briefly. Diet and Inflammatory Bowel Disease are discussed elsewhere. (See "Nutrition and dietary interventions in adults with inflammatory bowel disease".)
A combination of factors contributes to deficits in energy and protein in IBD. Reduced nutrient intake is common; it is associated with disease activity and may be mediated by proinflammatory cytokines, such as tumor necrosis factor alpha. Malabsorption, maldigestion, increased energy expenditure, and gastrointestinal protein loss also contribute to deficiencies of energy and protein, and are usually correlated with disease activity. These mechanisms are discussed in more detail separately. (See "Growth failure and poor weight gain in children with inflammatory bowel disease", section on 'Pathogenesis of growth failure'.)
Similar mechanisms also contribute to micronutrient deficiencies in IBD. In addition, because some nutrients are digested and absorbed within specific locations within the gastrointestinal tract, the activity and location of a patient's intestinal disease determines risk for specific micronutrient deficiencies. As examples, patients with disease of the terminal ileum are at risk for vitamin B12 deficiency, and those with disease of the proximal small intestine are more likely to malabsorb calcium and iron.
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- WATER-SOLUBLE VITAMINS
- Folic acid
- Vitamin B12
- FAT-SOLUBLE VITAMINS
- Vitamin A
- Vitamin D
- Vitamin E
- Vitamin K
- ANTIOXIDANT VITAMINS
- - Other causes of anemia
- - Assessment
- - Supplementation
- LABORATORY MEASURES
- SUMMARY AND RECOMMENDATIONS