Adequacy of serum concentrations of vitamin and trace element preparations in treating patients with inflammatory bowel disease receiving long-term, home parenteral nutrition

Objectives: Home parenteral nutrition (HPN) is occasionally used for inflammatory bowel disease (IBD) after extensive small-bowel resection. However, vitamin or trace element deficiencies may occur in patients with enterostomy and intestinal inflammation. To determine whether vitamin or trace element content of supplemental total parenteral nutrition (TPN) preparations was adequate, we evaluated serum of IBD patients receiving long-term HPN. Methods: Four IBD patients (3 Crohn's disease and 1 intestinal Behçet's disease) on HPN, who had extensive small-bowel resections, were included in the present study. Three patients had ileostomies. Serum levels of vitamins B1, B6, C, K, folic acid, iron, zinc, copper, and manganese were measured at baseline, and at 2, 4, and 6 months and compared to reference ranges. Results: Throughout follow-up, vitamins B1, B6, and folic acid concentrations were within or above reference ranges. In 3 patients, vitamin C concentrations were in the low range; one 6-month value was below range. Vitamin K concentrations were well above range in 3 patients; levels in the fourth patient were also above range. Zinc and copper concentrations were mostly within range, but iron was low in 1 patient and manganese in another. Conclusions: Vitamin C should be increased and vitamin K decreased in multivitamin preparations for TPN.