Review
Copyright ©The Author(s) 2016.
World J Gastroenterol. Sep 14, 2016; 22(34): 7625-7644
Published online Sep 14, 2016. doi: 10.3748/wjg.v22.i34.7625
Table 1 Pathogenesis of micronutrient deficiency in inflammatory bowel disease
Decreased food intake
Anorexia (TNF-mediated)
Mechanical (fistulas, post-operative)
Avoidance of high-residue food (can worsen abdominal pain/diarrhea)
Avoidance of lactose-containing foods (high rates of concomitant lactose intolerance)
Increased intestinal loss
Diarrhea (increased loss of Zn2+, K+, Mg2+)
Occult/overt blood loss (iron deficiency)
Exudative enteropathy (protein loss, and decrease in albumin-binding proteins)
Steatorrhea (fat and fat-soluble vitamins)
Malabsorption
Loss of intestinal surface area from active inflammation, resection, bypass or fistula
Terminal ileal disease associated with deficiencies in B12 and fat-soluble vitamins
Hypermetabolic state
Alterations of resting energy expenditure
Drug interactions
Sulfasalazine and methotrexate inhibits folate absorption
Glucocorticoids impair Ca2+, Zn2+, and phosphorus absorption, vitamin C losses and vitamin D resistance
Cholestyramine impairs absorption of fat-soluble vitamins, vitamin B12 and iron
Long-term total parenteral nutrition
Can occur with any micronutrient not added to TPN
Reported deficiencies include thiamine, vitamin, and trace elements Zn2+, Cu2+, selenium, chromium