Micronutrient deficiencies in inflammatory bowel disease: trivial or crucial?

increased intestinal loss, malabsorption, hypermeta-bolic state, drug interactions, and long-term total parenteral nutrition (TPN). 4 Numerous vitamin and mineral deficiencies have been reported in IBD patients, with varying degrees of clinical significance. 2 Vitamins and minerals are naturally occurring compounds that are required for diverse bodily functions, and must be obtained from the diet as they are not sufficiently synthesized by humans. Vitamins are organic compounds that can be classified as either water-soluble or fat-soluble. Water-soluble vitamins include thiamine (B1), riboflavin (B2), nicotinic acid/niacin (B3), pyridoxine (B6), cobalamin (B12), biotin, pantothenic acid, folic acid, and vitamin C (ascorbic acid). The fat-soluble vitamins (A, D, E, and K) are hydrophobic substances that are dissolved within fat drop-lets and must be broken down by lipases and combined with bile salts in the duodenum to form mixed micelles. 3 In the current article, the authors reported two patients with CD who developed Wernicke's encephalopathy (WE) after prolonged TPN. 5 WE is a serious neurologic complication due to vitamin B1 (thiamine) deficiency. Thiamine deficiency also can cause peripheral neuropathy and car-diomyopathy. Thiamine is found in multiple dietary sources (eggs, meats, bread, and nuts), and its absorption mainly occurs in the jejunum through varying degrees of active and passive transport, depending on body stores and the luminal concentrations of the vitamin. 3 A recent study showed that thiamine deficiency may be more common in CD patients than in controls. 6 This study was performed on 54 CD patients whose disease was in clinical remission, and were compared with 25 healthy controls. In CD patients, dietary Patients with IBD, especially those with CD, are at a risk for a variety of nutritional deficiencies because of reduced nutrient intake or absorption, or increased nutrient losses. 1 Nutritional deficiencies in IBD patients can be divided into those involving macronutrients (nutrients needed in large amounts) and those involving micronutrients (nutrients required in small quantities). 2 In adults, deficiencies of micro-nutrients, including several water-and fat-soluble vitamins, and minerals including calcium, iron, and other trace minerals , are a common problem. 3 Although the nutritional issues in IBD have become less common with advances in treatment and the greater proportions of patients attaining clinical remission, micronutrient deficiencies are still relatively common, particularly in CD patients with active small bowel disease or multiple resec-tions. The major micronutrient deficiencies in IBD patients are associated with anemia (iron, folate, and vitamin B12), bone disease …