P504 Prospective analysis of micronutrient status and disease course in Inflammatory Bowel Disease
Brownson, E.(1);Saunders, J.(1);Gerasimidis, K.(2);Karafoulidou, Z.(2);Seenan, J.P.(1);Macdonald, J.(1);
(1)NHS Greater Glasgow and Clyde, Gastroenterology, Glasgow, United Kingdom;(2)University of Glasgow, School of Medicine- Dentistry and Nursing, Glasgow, United Kingdom;
Background
Biochemical deficiencies of iron, B12, vitamin D, vitamin K, folic acid, selenium and zinc are common in patients with Inflammatory Bowel Disease (IBD) and some micronutrient deficiencies have been associated with adverse disease outcomes. This study describes the micronutrient status of a cohort of patients on biologic therapy for IBD and explores the relationship with disease activity.
Methods
Adult patients with IBD on biologic therapy attending the nurse specialist clinic had 16 serum micronutrients measured alongside routine biochemical screening for disease activity. 12 months of follow up data was collected using electronic patient records. Faecal calprotectin (FCP), albumin and CRP were measured at baseline - patients in whom these biomarkers were within normal range (i.e CRP <10mg/L, albumin >35g/L and FCP <250µg/g) were defined as being in biochemical remission. Disease relapse at follow-up was defined as escalation of maintenance therapy, use of corticosteroid, hospital admission or surgery.
Relationships between micronutrient status and time to disease relapse were explored.
Results
216 patients (42% female, median age 42, IQR: 30-57) were included. 128 patients had Crohn’s disease (CD). 97 patients were in biochemical remission at enrolment.
12.9% of the total cohort were zinc (Zn) deficient and 6.5% were selenium (Se) deficient. Deficiencies of folate, vitamin C, vitamin B12, vitamin B6 and vitamin D were also prevalent within the cohort.
Se deficiency was associated with high CRP (p=.001), low albumin (p=.022), and raised FCP (p=.002) at baseline. Zn deficiency was associated with high CRP (p<.001) and low albumin (p<.001). During the 12 month follow up period, 22/216 patients suffered a disease relapse.
Patients with low Zn or low Se levels at baseline were significantly more likely to relapse (p=.007 and p=.019 respectively). In subtype analysis, patients with CD and Zn deficiency were significantly more likely to relapse (p=.003) but this was not the case for UC patients. Patients with UC and Se deficiency were significantly more likely to relapse (p=.001) whereas those with CD were not.
Conclusion
Zn and Se biochemical deficiencies are common in our cohort of IBD patients on biologic therapy and are predictive of subsequent disease relapse. Whether these signals are causal or a secondary effect of disease activity needs to be explored in future intervention studies.