Preventive health measures in inflammatory bowel disease

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

Adapted from Hwang et al[21]. TNF: Tumor necrosis factor.