The Relationship Between Nutritional Status, Micronutrient Deficiency, and Disease Activity in IBD Patients: A Multicenter Cross-Sectional Study

Abstract

Background and aim: Inflammatory bowel diseases (IBD) are chronic conditions that affect the gastrointestinal tract. The chronic inflammatory state promotes a catabolic environment that contributes to undernutrition, while mucosal damage often impairs nutrient absorption. The aim of this study is to evaluate the relationship between nutritional status-including micronutrient deficiencies-and clinical as well as laboratoristics disease activity in a cohort of patients with IBD.

Methods: This is a cross-sectional study conducted across three care centers in Italy. Baseline data, clinical disease activity, and laboratory test results were collected. Micronutrient evaluation included measurements of iron, ferritin, vitamin B12, vitamin D, and folate. In addition, hemoglobin and albumin levels were assessed. Pearson correlation analysis was performed to explore the relationship between disease activity and nutritional status. Additionally, receiver operating characteristics (ROC) analysis were performed to identify patients with active diseases.

Results: 110 IBD patients (40 Crohn Disease; 70 Ulcerative Colitis) were included. The serum level of Hb, iron, ferritin and vitamin D was different among the active and inactive group (p: 0.007; p: 0.001; p: 0.005; p: 0.003) while no difference was found among the other micronutrients evaluated (folic acid, vitamin B12) and albumin. Iron and vitamin D levels demonstrated the highest accuracy in the ROC analysis, with Area Under the Curve (AUC) of 0.76 (p < 0.001) and 0.68 (p = 0.013), respectively. Vitamin D and Ferritin showed the better performance (based on calprotectin levels). However, their AUC were sub-optimal (AUC 0.68; p < 0.001; AUC 0.66; p = 0.19.

Conclusions: Hemoglobin, iron, ferritin, and vitamin D were associated with disease activity status. However, despite this correlation, their accuracy in discriminating between active and inactive disease appeared to be suboptimal. Folic acid, vitamin B12, and albumin showed poor concordance with disease activity status.

Keywords: ferritin; inflammatory bowel disease; iron; micronutrients; nutrition; vitamin D.

Figure 1

The boxplot shows the mean serum level of ferritin, iron, vitamin D and Hemoglobin among active and inactive groups.

Figure 2

The receiver operating characteristic (ROC) curve shown accuracy of micronutrients and hemoglobin to identify patients with active diseases based on clinical activity. AUC: Area Under the Curve.

Figure 3

The receiver operating characteristic (ROC) curve shown accuracy of micronutrients and hemoglobin to identify patients with active diseases based on calprotectin value. AUC: Area Under the Curve.