Intestinal Absorption and Vitamin Levels: Is a New Focus Needed?

Abstract

Vitamins are micronutrient chemical compounds that cannot be synthesized by an organism but are essential for human metabolism and life. They act as required intermediaries, cofactors or coenzymes in many of the reactions of normal metabolism. In addition, anti-inflammatory effects have been reported for specific vitamins. In inflammatory bowel disease (IBD), vitamin deficiency is often due to malnutrition (due to a decreased food intake) or malabsorption (due to inflamed, malfunctioning mucosa and diarrhea) which results in anemia. Vitamin B₁₂ and folic acid supplementation may be necessary in IBD patients, especially those with Crohn’s disease (CD) with either inflammation of the terminal ileum or after resection of the terminal ileum. It is also recommended during therapy with sulfasalazine as this compound inhibits the absorption of vitamin B₁₂. Patients with high or continuous inflammatory CD activity and frequent therapy with steroids have an increased risk of low bone mineral density and vitamin D deficiency. These should be monitored regularly and vitamin D should be supplemented. In a recent trial, a trend towards a reduced risk of relapses in CD patients treated with vitamin D was reported. Only limited studies and case reports exist on other vitamin deficiencies, e.g. vitamins A, B₁, B₂, niacine, B₆, C, E and K, found in IBD patients. These are summarized in this review. Regular nutritional monitoring in IBD patients is warranted and requires the special attention of treating physicians and dieticians.

Pediatric intestinal failure: Predictors of metabolic bone disease

“…This is interesting, as vitamin D and calcium malabsorption are described as principal components of the pathogenesis of MBD [12,13]. In a cohort of adult patients with small intestinal resection, Haderslev et al found that vitamin D deficiency correlated with decreased BMD values, as well as increased markers of bone resorption [32].…”

“…The malabsorption that defines IF is a result of decreased intestinal surface area, sometimes compounded by the loss of key, nutrientspecific absorptive regions of the intestinal tract, such as the terminal ileum [12]. Inadequate absorption of calcium, magnesium, and phosphorous engenders prolonged abnormal mineral homeostasis [13], contributing to decreased bone mineralization.…”

Dietary Habits and Nutrient Intake in Patients with Inflammatory Bowel Disease

“…malabsorption and maldigestion can interfere with nutrient uptake and nutrition. In particular, patients with active disease status may suffer from a nutrient deficiency [9][10][11][12][13][14]. Malnutrition can also be caused by a reduced food intake, e.g.…”

“…Malnutrition can also be caused by a reduced food intake, e.g. as a result of gastrointestinal discomfort, food intolerance or restrictive dietary advices, which further enhance the disease pathology [9,10]. IBD patients not only have an increased risk of malnutrition, but the diet itself seems to play a significant role in the course of the disease.…”

The Relevance of Vitamin and Iron Deficiency in Patients with Inflammatory Bowel Diseases in Patients of the Swiss IBD Cohort

“…1 In inflammatory bowel disease(IBD) patients, vitamin deficiencies are often due to malnutrition or malabsorption (due to inflamed, malfunctioning mucosa and diarrhea or specific diet changes), 2 which often results in anemia and negatively impacts quality of life. 1,[3][4][5] Iron plays an important role in the long-term management of IBD patients. A systematic review reported an overall prevalence of anemia occurring in 24% of IBD patients , in particular 27% in patients with CD and 21% in patients with UC.…”