Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2022; 28(33): 4834-4845
Published online Sep 7, 2022. doi: 10.3748/wjg.v28.i33.4834
Prevalence and factors associated with vitamin C deficiency in inflammatory bowel disease
Benjamin Langan Gordon, Jonathan S Galati, Stevie Yang, Randy S Longman, Dana Lukin, Ellen J Scherl, Robert Battat
Benjamin Langan Gordon, Jonathan S Galati, Department of Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10065, United States
Stevie Yang, Randy S Longman, Dana Lukin, Ellen J Scherl, Robert Battat, Department of Gastroenterology and Hepatology, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10021, United States
Author contributions: Battat R is the guarantor of the article; Gordon BL, Galati JS, Longman RS, Lukin D, Scherl EJ and Battat R contributed to the design of the study; Gordon BL, Galati JS, and Yang S collected the data; Gordon BL and Battat R analyzed the data; Gordon BL, Scherl EJ, Lukin D and Battat R wrote the paper; and all authors read and approved the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the institutional review board at Weill Cornell Medicine.
Informed consent statement: This study was conducted retrospectively from data obtained for clinical purposes. The study was approved by the institutional review board at Weill Cornell Medicine, who confirmed that no ethical approval or informed consent was required.
Conflict-of-interest statement: Gordon BL, Galati JS, Yang S have none to report; Longman RS consulted Pfizer, Bristol Myers Squibb; Lukin D consults for Boehringer Ingelheim, Palatin Technologies, Pfizer; research support: AbbVie, Janssen, Kenneth Rainin Foundation, Takeda; Scherl EJ consulted AbbVie, Crohn’s and Colitis Foundation of America (CCFA), Entera Health, Evidera, GI Health Foundation, Janssen, Protagonist, Seres, Takeda, Bristol Myers Squibb; research support: AbbVie, AstraZeneca, CCFA, Janssen, Pfizer, National Institute of Health, New York Crohn’s Foundation, UCSF-CCFA Clinical Research Alliance, Genentech, Seres, Celgene, UCB, Johns Hopkins University, National Institute of Diabetes and Digestive and Kidney; Shareholder: Gilead; Honoraria: GI Health Foundation, Janssen; Battat R provide research support, fund for the Future Award and Jill Roberts Funds at the Department of Medicine, Weill Cornell Medicine.
Data sharing statement: The datasets used and analyzed in this current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Robert Battat, MD, Assistant Professor, Department of Gastroenterology and Hepatology, New York Presbyterian/Weill Cornell Medical Center, 1315 York Avenue, Mezzanine, New York, NY 10021, United States. rbattat20@icloud.com
Received: March 14, 2022
Peer-review started: March 14, 2022
First decision: May 9, 2022
Revised: May 23, 2022
Accepted: August 6, 2022
Article in press: August 6, 2022
Published online: September 7, 2022
ARTICLE HIGHLIGHTS
Research background

Patients with inflammatory bowel disease (IBD) are prone to several nutritional deficiencies, including iron, vitamin B12 and vitamin D. However, there is a lack of data on vitamin C deficiency in this population, as well as the impact of clinical, biomarker and endoscopic disease severity on the development of vitamin C deficiency.

Research motivation

As IBD patients are already at risk of malnutrition and as vitamin C deficiency is an easily reversible condition, it would be valuable to understand the prevalence of and factors associated with vitamin C deficiency in this population.

Research objectives

The primary objective assessed the prevalence of vitamin C deficiency in IBD patients. Secondary objectives evaluated proportions with deficiency between active and inactive IBD - using clinical, laboratory and endoscopic data - to better identify those at risk of deficiency.

Research methods

In this retrospective study, clinical, laboratory and endoscopic data were collected from all Crohn’s disease (CD) and ulcerative colitis (UC) patients who had available plasma vitamin C levels presenting to the IBD clinic at a single tertiary care center from 2014 to 2019. Of 353 subjects who met initial search criteria using a cohort discovery tool, 301 ultimately met criteria for inclusion in the study. The primary aim described vitamin C deficiency (≤ 11.4 μmol/L) rates in IBD, with secondary analyses comparing proportions with deficiency between active and inactive IBD. Multivariate logistic regression analysis evaluated factors associated with deficiency.

Research results

In 301 IBD patients, 21.6% had vitamin C deficiency, including 24.4% of CD and 16.0% of UC patients. Patients with elevated C-reactive protein (CRP) (39.1% vs 16.9%, P < 0.001) and fecal calprotectin (50.0% vs 20.0%, P = 0.009) had higher proportions of deficiency compared to those without. Other factors associated with vitamin C deficiency included the presence of penetrating disease (P = 0.03), obesity (P = 0.02) and current biologic medication use (P = 0.006). On multivariable analysis, the objective inflammatory marker utilized for analysis (CRP) was the only factor associated with deficiency (odds ratio = 3.1, 95% confidence interval: 1.5-6.6, P = 0.003).

Research conclusions

This study provides the largest data on vitamin C deficiency in patients with IBD, uniquely assesses factors associated with deficiency and provides rigorous assessment of inflammatory status using objective markers. Vitamin C deficiency was common in IBD, particularly those with objective markers of active luminal or penetrating disease. As vitamin C deficiency exists in over one-fifth of IBD patients, it is essential to identify and treat this easily reversible condition in this population.

Research perspectives

Future prospective studies with well characterized cohorts, and data on diet, other micronutrient deficiencies, endoscopic assessment, and vitamin C supplementation, may be warranted to further elucidate factors associated with vitamin C deficiency and the impact of supplementation on clinical course in IBD patients.