Micronutrient status in children with inflammatory bowel disease. True deficiencies or epiphenomenon of the systemic inflammatory response?

Gerasimidis, K. , Edwards, C. , Stefanowicz, F., Galloway, P., McGrogan, P., Duncan, A. and Talwar, D. (2013) Micronutrient status in children with inflammatory bowel disease. True deficiencies or epiphenomenon of the systemic inflammatory response? Journal of Pediatric Gastroenterology and Nutrition, 56(6), pp. 50-51. (doi: 10.1097/MPG.0b013e31828f1e86)

Abstract

In the January 2013 issue of JPGN, Alkhouri et al (1) assessed the micronutrient status in children with inflammatory bowel disease (IBD). They concluded that plasma vitamin B12 and folate “deficiencies” are rare at IBD diagnosis and question whether routine monitoring is warranted. Likewise they found that vitamin A and zinc “deficiencies” were common in their cohort and recommend that these should be routinely screened for so that nutritional repletion can commence. Because plasma concentrations of several micronutrients including vitamin A and zinc are known to be significantly influenced by the systemic inflammatory response (SIR) (2–5), these are unlikely to reflect true body stores in children with active IBD. Suboptimal plasma micronutrient concentrations are likely to result from redistribution and sequestration of micronutrients by tissues in the presence of a SIR (3). We have shown this for many micronutrients, and recently for vitamin D, in acute and chronic illness including in children with Crohn disease (2–7). Additionally, because vitamin B12 stores in the liver can last for >2 years, it is unlikely that a previously well child would develop vitamin B12 deficiency early on in IBD. Long-term monitoring is, therefore, essential. The authors’ interpretation of the findings is likely to mislead, resulting in unnecessary nutritional interventions with minimal clinical benefit. We propose that in conditions likely to be associated with SIR, assessment of micronutrient status in plasma should be interpreted in conjunction with measurements of C-reactive protein. Measurements in other cellular matrices (eg, erythrocytes) are likely to be a more reliable marker of body nutrient stores in acute and chronic illness

• Item Type: Articles (Letter)
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Galloway, Dr Peter and Gerasimidis, Professor Konstantinos and Edwards, Professor Christine
• Authors: Gerasimidis, K., Edwards, C., Stefanowicz, F., Galloway, P., McGrogan, P., Duncan, A., and Talwar, D.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Journal of Pediatric Gastroenterology and Nutrition
• Publisher: Ovid Technologies, Inc
• ISSN: 0277-2116
• ISSN (Online): 1536-4801
• Published Online: 10 April 2013