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- Original Article Status of serum vitamin B12 and folate in patients with inflammatory bowel disease in China
- Shaozhong Huang, Jiayi Ma, Mingming Zhu, Zhihua Ran
-
Intestinal Research 2017;15(1):103-108.
DOI: https://doi.org/10.5217/ir.2017.15.1.103
Published online: January 31, 2017
Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. JFIF d d Ducky d qhttp://ns.adobe.com/xap/1.0/ |er˭|I|-fGK.rΛp8XV1%K6mvG+tc+qE &ǸC_Nm:l=_/m5^[dߌڇ.c<%:)tQ$Ow~-aY;UJ >=F)2[nk؆?훐 M=l6[4(O.]2#-H^n#->&mp5~Fӛ+|| S,xag% qkEUzUgæBhߕP(7]kFnq?֖Cpru Z6*rEڊtS|*tI*E}7R<,nUU֫^I7Q*mSly%rdȓd8hE<9oHhMfNSRj[i7D[Rj݊+kდq{"$$H?p \̅S?㭻;t~ R߁ )^/>Qj`yt[w ԛ;² ~+ ߔ_ YW~|o] ?x^ᯛ `ʼn;g)T@vWn]>&4l p+$D̢1l|ȨF%-} .9[}w~
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- Correspondence to Zhihua Ran, Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Inflammatory Bowel Disease Research Center, 145 Middle Shandong Road, Shanghai 200001, China. Tel: +86-21-68383114, Fax: +86-21-68383114, zhihuaran2015@163.com
• Received: July 21, 2016 • Revised: September 20, 2016 • Accepted: September 26, 2016
© Copyright 2017. Korean Association for the Study of Intestinal Diseases.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
-
Background/Aims
- Inflammatory bowel disease (IBD) primarily involves the intestinal tract and can affect vitamin absorption. This study was designed to assess the prevalence of vitamin B12 and folate deficiencies in patients with IBD, and to identify the risk factors associated with abnormal serum vitamin B12 and folate levels.
-
Methods
- We evaluated the medical records of 195 patients with Crohn's disease (CD) and 62 patients with ulcerative colitis (UC), and selected 118 healthy subjects for the control group.
-
Results
- There were more CD patients with vitamin B12 deficiency than UC patients (14.9% vs. 3.2%, P=0.014) and controls (14.9% vs. 4.2%, P=0.003). The prevalence of folate deficiency was higher in CD patients than in controls (13.3% vs. 3.4%, P=0.004). There were no significant differences in the serum vitamin B12 and folate statuses of the UC and control groups. Patients with prior ileal or ileocolic resection showed a higher prevalence of abnormal vitamin B12 levels than those without prior resection (n=6/16, n=23/179; P=0.018). A disease duration within 5 years was a risk factor of abnormal folate levels in CD patients.
-
Conclusions
- This study showed that vitamin B12 and folate deficiencies were more common in patients with CD than in UC patients and controls. Prior ileal or ileocolonic resection was a risk factor of serum vitamin B12 abnormalities, and a disease duration within 5 years was a risk factor of low serum folate levels in CD patients.
INTRODUCTION
METHODS
RESULTS
DISCUSSION
-
Financial support: This study was supported by National Natural Science Foundation of China (number: 81500422).
-
Conflict of interest: None.
NOTES
- 1. O'Leary F, Samman S. Vitamin B12 in health and disease. Nutrients 2010;2:299–316.PMID: 22254022.ArticlePubMedPMC
- 2. Krishnaswamy K, Madhavan Nair K. Importance of folate in human nutrition. Br J Nutr 2001;85(Suppl 2): S115–S124.PMID: 11509099.ArticlePubMed
- 3. Yakut M, Ustün Y, Kabaçam G, Soykan I. Serum vitamin B12 and folate status in patients with inflammatory bowel diseases. Eur J Intern Med 2010;21:320–323.PMID: 20603044.ArticlePubMed
- 4. Bermejo F, Algaba A, Guerra I, et al. Should we monitor vitamin B12 and folate levels in Crohn's disease patients? Scand J Gastroenterol 2013;48:1272–1277.PMID: 24063425.ArticlePubMed
- 5. Headstrom PD, Rulyak SJ, Lee SD. Prevalence of and risk factors for vitamin B(12) deficiency in patients with Crohn's disease. Inflamm Bowel Dis 2008;14:217–223.PMID: 17886286.ArticlePubMed
- 6. Hughes CF, Ward M, Hoey L, McNulty H. Vitamin B12 and ageing: current issues and interaction with folate. Ann Clin Biochem 2013;50(Pt 4): 315–329.PMID: 23592803.ArticlePubMed
- 7. Nazki FH, Sameer AS, Ganaie BA. Folate: metabolism, genes, polymorphisms and the associated diseases. Gene 2014;533:11–20.PMID: 24091066.ArticlePubMed
- 8. Pohl C, Hombach A, Kruis W. Chronic inflammatory bowel disease and cancer. Hepatogastroenterology 2000;47:57–70.PMID: 10690586.PubMed
- 9. Weiss G, Gasche C. Pathogenesis and treatment of anemia in inflammatory bowel disease. Haematologica 2010;95:175–178.PMID: 20139387.ArticlePubMedPMC
- 10. Vagianos K, Bernstein CN. Homocysteinemia and B vitamin status among adult patients with inflammatory bowel disease: a one-year prospective follow-up study. Inflamm Bowel Dis 2012;18:718–724.PMID: 21604334.ArticlePubMed
- 11. Erzin Y, Uzun H, Celik AF, Aydin S, Dirican A, Uzunismail H. Hyperhomocysteinemia in inflammatory bowel disease patients without past intestinal resections: correlations with cobalamin, pyridoxine, folate concentrations, acute phase reactants, disease activity, and prior thromboembolic complications. J Clin Gastroenterol 2008;42:481–486.PMID: 18344891.ArticlePubMed
- 12. Jayaprakash A, Creed T, Stewart L, et al. Should we monitor vitamin B12 levels in patients who have had end-ileostomy for inflammatory bowel disease? Int J Colorectal Dis 2004;19:316–318.PMID: 14618349.ArticlePubMed
- 13. Battat R, Kopylov U, Szilagyi A, et al. Vitamin B12 deficiency in inflammatory bowel disease: prevalence, risk factors, evaluation, and management. Inflamm Bowel Dis 2014;20:1120–1128.PMID: 24739632.ArticlePubMed
- 14. Lambert D, Benhayoun S, Adjalla C, et al. Crohn's disease and vitamin B12 metabolism. Dig Dis Sci 1996;41:1417–1422.PMID: 8689919.ArticlePubMed
- 15. Kallel L, Feki M, Sekri W, et al. Prevalence and risk factors of hyperhomocysteinemia in Tunisian patients with Crohn's disease. J Crohns Colitis 2011;5:110–114.PMID: 21453879.ArticlePubMedPDF
- 16. Ward MG, Kariyawasam VC, Mogan SB, et al. Prevalence and risk factors for functional vitamin B12 deficiency in patients with Crohn's disease. Inflamm Bowel Dis 2015;21:2839–2847.PMID: 26296064.ArticlePubMed
- 17. Behrend C, Jeppesen PB, Mortensen PB. Vitamin B12 absorption after ileorectal anastomosis for Crohn's disease: effect of ileal resection and time span after surgery. Eur J Gastroenterol Hepatol 1995;7:397–400.PMID: 7614100.PubMed
- 18. Hoffbrand AV, Stewart JS, Booth CC, Mollin DL. Folate deficiency in Crohn's disease: incidence, pathogenesis, and treatment. Br Med J 1968;2:71–75.PMID: 5646094.ArticlePubMedPMC
- 19. Hwang C, Ross V, Mahadevan U. Micronutrient deficiencies in inflammatory bowel disease: from A to zinc. Inflamm Bowel Dis 2012;18:1961–1981.PMID: 22488830.ArticlePubMed
- 20. Mullin GE. Micronutrients and inflammatory bowel disease. Nutr Clin Pract 2012;27:136–137.PMID: 22223669.ArticlePubMed
REFERENCES
Fig. 1
Serum vitamin B12 and folate status in IBD patients and controls. (A) The mean serum vitamin B12 concentrations of CD patients was 359.53±170.08 pg/mL, This was significantly lower than in UC patients and controls. (B) The mean serum folate concentrations of CD patients was 7.11±4.75 ng/mL, This was significantly lower than in UC patients and controls. (C) The prevalence of vitamin B12 deficiency was significantly higher in CD patients than in UC patients (14.9% vs. 3.2%, P=0.014) and controls (14.9% vs. 4.2%, P=0.003). (D) The prevalence of folate deficiency was higher in CD patients than in controls (13.3% vs. 3.4%, P=0.004). there was no significant difference between the CD and UC groups (13.3% vs. 9.7%, P=0.448). aP<0.05; bP<0.01; cP<0.001.
Table 1
![ir-15-103-i001.jpg]()
Demographic and Clinical Characteristics of Patients with IBD
Table 2
![ir-15-103-i002.jpg]()
Risk Factors of Vitamin Abnormality in CD Based on Univariate Analysis
Figure & Data
REFERENCES
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Status of serum vitamin B12 and folate in patients with inflammatory bowel disease in China
Fig. 1 Serum vitamin B12 and folate status in IBD patients and controls. (A) The mean serum vitamin B12 concentrations of CD patients was 359.53±170.08 pg/mL, This was significantly lower than in UC patients and controls. (B) The mean serum folate concentrations of CD patients was 7.11±4.75 ng/mL, This was significantly lower than in UC patients and controls. (C) The prevalence of vitamin B12 deficiency was significantly higher in CD patients than in UC patients (14.9% vs. 3.2%, P=0.014) and controls (14.9% vs. 4.2%, P=0.003). (D) The prevalence of folate deficiency was higher in CD patients than in controls (13.3% vs. 3.4%, P=0.004). there was no significant difference between the CD and UC groups (13.3% vs. 9.7%, P=0.448). aP<0.05; bP<0.01; cP<0.001.
Fig. 1
Status of serum vitamin B12 and folate in patients with inflammatory bowel disease in China
Demographic and Clinical Characteristics of Patients with IBD
| Variable | CD (n=195) | UC (n=62) | Control group (n=118) |
|---|---|---|---|
| Sex | |||
| Male | 136 (69.7) | 37 (59.6) | 72 (61.0) |
| Female | 59 (30.3) | 25 (40.4) | 46 (39.0) |
| Age (yr) | |||
| <20 | 19 (9.7) | 3 (4.8) | 6 (6.7) |
| 20–39 | 130 (66.7) | 24 (38.7) | 47 (39.8) |
| 40–59 | 37 (19.0) | 22 (35.9) | 42 (35.6) |
| ≥60 | 9 (4.6) | 13 (21.0) | 23 (19.5) |
| Duration of disease (yr) | - | ||
| 0–2 | 71 (36.4) | 20 (32.3) | |
| 2–5 | 56 (28.7) | 16 (25.8) | |
| 5–10 | 47 (24.1) | 17 (27.4) | |
| >10 | 21 (10.8) | 9 (14.5) | |
| Extent of UC | - | ||
| E1 proctitis | - | 18 (29.0) | |
| E2 left-sided colitis | - | 14 (22.6) | |
| E3 extensive colitis | - | 30 (48.4) | |
| Location of CD | - | ||
| L1 ileal | 75 (38.5) | - | |
| L2 colonic | 22 (11.3) | - | |
| L3 ileocolic | 95 (48.7) | - | |
| L4 upper gastrointestinal | 3 (1.5) | - | |
| Behavior of CD | - | ||
| B1 nonstricturing, nonpenetrating | 100 (51.3) | - | |
| B2 stricturing | 71 (36.4) | - | |
| B3 penetrating | 24 (12.3) | - | |
| Prior ileal or ileocolic resection | 16 (8.2) | 0 | - |
| Treatment of IBD | - | ||
| 5-ASA | 130 (66.7) | 55 (88.7) | |
| Steroid | 80 (41.0) | 33 (53.2) | |
| Immunosuppressant | 59 (30.3) | 7 (11.3) | |
| Biologics | 18 (9.2) | 4 (6.5) | |
| Anemia | 103 (52.8) | 31 (50.0) | - |
| Macrocytosis | 3 (1.5) | 0 | - |
| Elevated CRP (mg/L) | - | ||
| <10 | 72 (36.9) | 37 (59.7) | |
| ≥10 | 123 (63.1) | 25 (40.3) |
Values are presented as number (%).
5-ASA, 5-aminosalicylic acid.
Risk Factors of Vitamin Abnormality in CD Based on Univariate Analysis
| Item | Risk factors of vitamin B12 abnormality (P-value) | Risk factors of folate abnormality (P-value) |
|---|---|---|
| Sex | ||
| Male | 0.591 | 0.691 |
| Female | ||
| Duration of disease (yr) | ||
| <5 | 0.223 | 0.007 |
| ≥5 | ||
| Location | ||
| L1 ileal | 0.301 | 0.912 |
| L2 colonic | ||
| L3 ileocolic | ||
| Behavior | 0.960 | 0.629 |
| B1 nonstricturing, nonpenetrating | ||
| B2 stricturing | ||
| B3 penetrating | ||
| Prior ileal or ileocolic resection | 0.018 | 0.701 |
| Elevated CRP (mg/L) | ||
| <10 | 0.339 | 0.256 |
| ≥10 |
Table 1 Demographic and Clinical Characteristics of Patients with IBD
Values are presented as number (%). 5-ASA, 5-aminosalicylic acid.
Table 2 Risk Factors of Vitamin Abnormality in CD Based on Univariate Analysis
