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Journal of Nutrition Research
An official journal of IAPEN India association

Article

Practical Recommendations on Micronutrient Deficiencies in Gastrointestinal Diseases
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Journal of Nutrition Research

DOI: 10.55289/jnutres/v11i2_23.18

Year: 2023, Volume: 11, Issue: 2, Pages: 53-61

Review Article

Practical Recommendations on Micronutrient Deficiencies in Gastrointestinal Diseases

Bidita Shah​ ✉ 1 , Saumin Shah 1

 
1 Gujarat Gastro and Vascular Hospital, Surat, Gujarat, India

Corresponding author ✉: [email protected]

Received Date:25 June 2023, Accepted Date:17 July 2023, Published Date:11 August 2023

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Almost all the micronutrients being absorbed in gastrointestinal tract, patients with gastrointestinal disorders are at highest risk of having multiple nutritional deficiencies including micronutrient deficiencies. Malnutrition and deficiencies can be prevented or treated by optimal medical nutrition therapy, yet limited specific knowledge about micronutrients remains among clinicians. Further knowledge on trace elements remains miniscule as compared to vitamins. Practical recommendations based on available micronutrient guidelines are therefore required regarding procedures for determination of requirements and, especially for gastrointestinal diseases as this is the commonest encountered problem that can impair enzymatic as well as biochemical processes and lead to multiple complications including death. Here we have tried to give consensus based recommendations to help practicing dieticians and clinicians making decision regarding specific micronutrient deficiencies and their implications in gastrointestinal diseases.

Keywords: Practical recommendations on micronutrient deficiencies in gastrointestinal diseases, Malnutrition, IAPEN INDIA consensus statement

References

  1. Opara EC, Rockway SW. Antioxidants and Micronutrients. Disease-a-Month. 2006;52(4):151–163. Available from: https://doi.org/10.1016/j.disamonth.2006.05.002
  2. Baik HW, Russell RM. Vitamin B12 deficiency in the elderly. Annual Review of Nutrition. 1999;19:357–377. Available from: https://doi.org/10.1146/annurev.nutr.19.1.357
  3. Prasad P, Kochhar A. Interplay of vitamin D and metabolic syndrome: A review. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2016;10(2):105–112. Available from: https://doi.org/10.1016/j.dsx.2015.02.014
  5. Holick MF. Vitamin D Deficiency. New England Journal of Medicine. 2007;357:266–281. Available from: https://www.nejm.org/doi/full/10.1056/nejmra070553
  6. Berger MM, Pantet O, Schneider AG, Ben-Hamouda N. Micronutrient Deficiencies in Medical and Surgical Inpatients. Journal of Clinical Medicine. 2019;8(7):1–17. Available from: https://www.researchgate.net/publication/334107320_Micronutrient_Deficiencies_in_Medical_and_Surgical_Inpatients
  7. Criteria IoM(CoSEoWNR. WIC Nutrition Risk Criteria: A Scientific Assessment. Washington (DC), USA. National Academies Press. 1996.
  9. Tijera FHdl, Servín-Caamaño AI, Serralde-Zúñiga AE, Cruz-Herrera J, Pérez-Torres E, Abdo-Francis JM, et al. Metadoxine improves the three- and six-month survival rates in patients with severe alcoholic hepatitis. World Journal of Gastroenterology. 2015;21(16):4975–4985. Available from: https://www.wjgnet.com/1007-9327/full/v21/i16/4975.htm
  10. Lan Y, Wu S, Wang Y, Chen S, WL, Zhang X, et al. Association between blood copper and nonalcoholic fatty liver disease according to sex. Clinical Nutrition. 2021;40(4):2045–2052. Available from: https://doi.org/10.1016/j.clnu.2020.09.026
  11. MK, RL, Kerner J, BP. Micronutrients in Liver Disease: Roles, Risk Factors for Deficiency, and Recommendations for Supplementation. Nutrition in Clinical Practice. 2020;35(1):50–62. Available from: https://doi.org/10.1002/ncp.10451
  13. Cavalcoli F, Zilli A, Conte D, Massironi S. Micronutrient deficiencies in patients with chronic atrophic autoimmune gastritis: A review. World Journal of Gastroenterology. 2017;23(4):563–572. Available from: https://www.wjgnet.com/1007-9327/full/v23/i4/563.htm
  14. RW, Chermesh I. Micronutrient deficiencies in inflammatory bowel disease. Current Opinion in Clinical Nutrition and Metabolic Care . 2015;18(6):576–581. Available from: https://doi.org/10.1097/MCO.0000000000000226
  15. Hwang C, Ross V, Mahadevan U. Micronutrient deficiencies in inflammatory bowel disease: from A to zinc. Inflammatory Bowel Diseases. 2012;18(10):1961–1981. Available from: https://doi.org/10.1002/ibd.22906
  16. Madanchi M, Fagagnini S, Fournier N, Biedermann L, Zeitz J, Battegay E, et al. The Relevance of Vitamin and Iron Deficiency in Patients with Inflammatory Bowel Diseases in Patients of the Swiss IBD Cohort. Inflammatory Bowel Diseases. 2018;24(8):1768–1779. Available from: https://doi.org/10.1093/ibd/izy054
  17. Adler A, Worley S, Radhakrishnan K. Increased Needs for Copper in Parenteral Nutrition for Children in the Neonatal Intensive Care Unit With an Ostomy. Nutrition in Clinical Practice. 2020;35(4):724–728. Available from: https://doi.org/10.1002/ncp.10365
  18. HPL, Nogueira PCK, Uchoa KMCB, Camargo MFCd. Copper Deficiency in Children With Intestinal Failure: Risk Factors and Influence on Hematological Cytopenias. Journal of Parenteral and Enteral Nutrition. 2021;45(1):57–64. Available from: https://aspenjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.1728
  19. Ammor N, Berthoud L, Gerber A, Giusti V. Nutritional deficiencies in candidates for bariatric surgery. Revue Médicale Suisse. 2009;5(196):676–679. Available from: https://pubmed.ncbi.nlm.nih.gov/19462611/
  20. Kaidar-Person O, Person B, Szomstein S, Rosenthal RJ. Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? Part A: vitamins. Obesity Surgery. 2008;18:870–876. Available from: https://doi.org/10.1007/s11695-007-9349-y
  21. MMB, AS, AS, Amrein K, MA, HKB, et al. ESPEN micronutrient guideline. Clinical Nutrition. 2022;41(6):1357–1424. Available from: https://doi.org/10.1016/j.clnu.2022.02.015
  22. Kaplan MM, Elta GH, Furie B, Sadowski JA, Russell RM. Fat-Soluble Vitamin Nutriture in primary Biliary Cirrhosis. Gastroenterology. 1988;95(3):787–792. Available from: https://doi.org/10.1016/S0016-5085(88)80029-5
  23. Sokol RJ, Kim YS, Hoofnagle JH, Heubi JE, Jones EA, Balistreri WF. Intestinal Malabsorption of Vitamin E in Primary Biliary Cirrhosis. Gastroenterology. 1989;96(2):479–486. Available from: https://www.gastrojournal.org/article/0016-5085(89)91574-6/pdf?referrer=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F
  24. Halsted CH, Villanueva JA, Devlin AM, Chandler CJ. Metabolic interactions of alcohol and folate. The Journal of Nutrition. 2002;132(8):2367S–2372S. Available from: https://doi.org/10.1093/jn/132.8.2367S
  25. Sriram K, Lonchyna VA. Micronutrient Supplementation in Adult Nutrition Therapy: Practical Considerations. Journal of Parenteral and Enteral Nutrition. 2009;33(5):548–562. Available from: https://doi.org/10.1177/0148607108328470
  26. Mehta Y, Sunavala JD, Zirpe K, Tyagi N, Garg S, Sinha S, et al. Practice Guidelines for Nutrition in Critically Ill Patients: A Relook for Indian Scenario. Indian Journal of Critical Care Medicine. 2018;22:263–273. Available from: https://www.ijccm.org/doi/pdf/10.4103/ijccm.IJCCM_3_18
  27. Micronutrients. World Health Organization. Available from: https://www.who.int/health-topics/micronutrients (accessed )
  28. Nutrient Requirements for Indians. (pp. 1-343) Hyderabad, India. ICMR - National Institute of Nutrition. 2020.
  29. Shenkin A. Micronutrients in adult nutritional support: requirements and benefits. Current Opinion in Clinical Nutrition and Metabolic Care. 1998;1(1):15–19. Available from: https://doi.org/10.1097/00075197-199801000-00004
  30. Manzanares W, Dhaliwal R, Jiang X, Murch L, Heyland DK. Antioxidant micronutrients in the critically ill: a systematic review and meta-analysis. Critical Care . 2012;16:1–13. Available from: https://doi.org/10.1186/cc11316
  31. KNJ, Duerksen DR. Malnutrition in Gastrointestinal Disorders: Detection and Nutritional Assessment. Gastroenterology Clinics of North America. 2018;47(1):1–22. Available from: https://doi.org/10.1016/j.gtc.2017.09.002
  32. Duncan A, Talwar D, McMillan DC, Stefanowicz F, O'Reilly DSJ. Quantitative data on the magnitude of the systemic inflammatory response and its effect on micronutrient status based on plasma measurements. The American Journal of Clinical Nutrition. 2012;95(1):64–71. Available from: https://doi.org/10.3945/ajcn.111.023812
  33. Shenkin A. Micronutrients in health and disease. Postgraduate Medical Journal. 2006;82(971):559–567. Available from: https://doi.org/10.1136/pgmj.2006.047670
  34. Berger MM, Berger-Gryllaki M, Wiesel PH, Revelly JPP, Hurni M, Cayeux C, et al. Intestinal absorption in patients after cardiac surgery. Critical Care Medicine. 2000;28(7):2217–2223. Available from: https://doi.org/10.1097/00003246-200007000-00006
  35. RS, Omar S, Sherwood RA, Raja K, Vincent RP. Clinical relevance of trace element measurement in patients on initiation of parenteral nutrition. Annals of Clinical Biochemistry: International Journal of Laboratory Medicine. 2016;53(6):680–685. Available from: https://doi.org/10.1177/0004563216633489
  36. Seidman EG. Nutritional management of inflammatory bowel disease. Gastroenterology Clinics of North America. 1989;18(1):129–155. Available from: https://pubmed.ncbi.nlm.nih.gov/2493426/
  38. Singer P, Berger MM, Berghe GVd, Biolo G, Calder P, Forbes A, et al. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clinical Nutrition. 2009;28(4):387–400. Available from: https://doi.org/10.1016/j.clnu.2009.04.024
  39. Kyle UG, Jetzer J, Schwarz G, Pichard C. P.70 Utilization of total parenteral nutrition (TPN) in auniversity hospital: a prospective quality control study in 180 patients. Clinical Nutrition. 1998;17(48 (Supplement 1)). Available from: https://doi.org/10.1016/S0261-5614(98)80226-4
  41. Battat R, Kopylov U, Byer J, Sewitch MJ, Rahme E, Nedjar H, et al. Vitamin B12 deficiency in inflammatory bowel disease: a prospective observational pilot study. European Journal of Gastroenterology & Hepatology . 2017;29(12):1361–1367. Available from: https://doi.org/10.1097/MEG.0000000000000970
  42. Pirlich M, Schütz T, Kemps M, Luhman N, GRB, Baumann G, et al. Prevalence of malnutrition in hospitalized medical patients: impact of underlying disease. Digestive Diseases. 2003;21(3):245–251. Available from: https://doi.org/10.1159/000073342
  43. Bischoff SC, WB, Dasarathy S, MM, LDP, Schütz T, et al. ESPEN practical guideline: Clinical nutrition in liver disease. Clinical Nutrition. 2020;39(12):3533–3562. Available from: https://doi.org/10.1016/j.clnu.2020.09.001
  44. Santucci NR, Alkhouri RH, Baker RD, Baker SS. Vitamin and Zinc Status Pretreatment and Posttreatment in Patients With Inflammatory Bowel Disease. Journal of Pediatric Gastroenterology & Nutrition. 2014;59(4):455–457. Available from: https://doi.org/10.1097/MPG.0000000000000477
  45. Sanyal AJ, Chalasani N, Kowdley KV, McCullough A, Diehl AM, Bass NM, et al. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. The New England Journal of Medicine. 2010;362:1675–1685. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa0907929
  46. Bayraktar UD, Bayraktar S. Treatment of iron deficiency anemia associated with gastrointestinal tract diseases. World Journal of Gastroenterology. 2010;16(22):2720–2725. Available from: https://www.wjgnet.com/1007-9327/full/v16/i22/2720.htm
  47. Lichtenstein GR. Management of bone loss in inflammatory bowel disease. Seminars in Gastrointestinal Disease. 2001;12(4):275–283. Available from: https://pubmed.ncbi.nlm.nih.gov/11726081/
  48. Hornung N, Ellingsen T, Stengaard-Pedersen K, Poulsen JH. Folate, homocysteine, and cobalamin status in patients with rheumatoid arthritis treated with methotrexate, and the effect of low dose folic acid supplement. The Journal of Rheumatology . 2004;31(12):2374–2381. Available from: https://www.jrheum.org/content/31/12/2374.long
  50. Angulo P. Nonalcoholic fatty liver disease. New England Journal of Medicine. 2002;346:1221–1231. Available from: https://www.nejm.org/doi/full/10.1056/NEJMra011775
  52. Flancbaum L, Belsley S, Drake V, Colarusso T, Tayler E. Preoperative Nutritional Status of Patients Undergoing Roux-en-Y Gastric Bypass for Morbid Obesity. Journal of Gastrointestinal Surgery. 2006;10(7):1033–1037. Available from: https://doi.org/10.1016/j.gassur.2006.03.004
  53. Crawford BA, Labio ED, Strasser SI, GWM. Vitamin D replacement for cirrhosis-related bone disease. Nature Clinical Practice Gastroenterology & Hepatology . 2006;3:689–699. Available from: https://doi.org/10.1038/ncpgasthep0637
  54. Mounach A, Ouzzif Z, Wariaghli G, Achemlal L, Benbaghdadi I, Aouragh A, et al. Primary biliary cirrhosis and osteoporosis: a case-control study. Journal of Bone and Mineral Metabolism. 2008;26(4):379–384. Available from: https://doi.org/10.1007/s00774-007-0833-1
  55. Jeong HM, Kim DJ. Bone Diseases in Patients with Chronic Liver Disease. International Journal of Molecular Sciences. 2019;20(17):1–27. Available from: https://doi.org/10.3390/ijms20174270
  57. Guichelaar MMJ, Kendall R, Malinchoc M, Hay JE. Bone mineral density before and after OLT: long-term follow-up and predictive factors. Liver Transplantation. 2006;12(9):1390–1402. Available from: https://doi.org/10.1002/lt.20874

Copyright

© This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Published By India Association for Parenteral and Enteral Nutrition (IAPEN)

  • 12 August 2023

Year: 2023, Volume: 11, Issue: 2


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