Inflammatory bowel disease (IBD) is characterized by inflammatory reactions, complications, extraintestinal manifestations and a loss of intestinal functions, for example, failures of absorption and secretion. According to intestinal dysfunction, a wide array of pathogenetic pathways is existing leading to iron deficiency and numerous vitamins as well as trace element deficiencies. Complications, symptoms and signs of those deficiencies are common in IBD with varying degrees of clinical significance. This review focuses on selected micronutrients including iron, zinc, magnesium and some vitamins. Epidemiology with respect to IBD, pathophysiology, diagnosis and clinical aspects are addressed. Finally, some suggestions for treatment of deficient situations are discussed. In conclusion, some micronutrients have significant impact on complications and quality of life in IBD. Deficiencies may even influence the course of the disease. Those deficiencies should be thoroughly supplemented.

1.
Filmann N, Rey J, Schneeweiss S, Ardizzone S, Bager P, Bergamaschi G, et al: Prevalence of anemia in inflammatory bowel diseases in European countries: a systematic review and individual patient data meta-analysis. Inflamm Bowel Dis 2014;20:936-945.
2.
Kaitha S, Bashir M, Ali T: Iron deficiency anemia in inflammatory bowel disease. World J Gastrointest Pathophysiol 2015;6:62-72.
3.
Ganz T: Molecular control of iron transport. J Am Soc Nephrol 2007;18:394-400.
4.
Stein J, Dignass AU: Management of iron deficiency anemia in inflammatory bowel disease - a practical approach. Ann Gastroenterol 2013;26:104-113.
5.
Stein J, Hartmann F, Dignass AU: Diagnosis and management of iron deficiency anemia in patients with IBD. Nat Rev Gastroenterol Hepatol 2010;7:599-610.
6.
Reinisch W, Staun M, Bhandari S, Muñoz M: State of the iron: how to diagnose and efficiently treat iron deficiency anemia in inflammatory bowel disease. J Crohns Colitis 2013;7:429-440.
7.
Werner T, Hoermannsperger G, Schuemann K, Hoelzlwimmer G, Tsuji S, Haller D: Intestinal epithelial cell proteome from wild-type and TNFDeltaARE/WT mice: effect of iron on the development of chronic ileitis. J Proteome Res 2009;8:3252-3264.
8.
Gasche C, Berstad A, Befrits R, Beglinger C, Dignass A, Erichsen K, et al: Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel disease. Inflamm Bowel Dis 2007;13:1545-1553.
9.
Lowe NM, Fekete K, Decsi T: Methods of assessment of zinc status in humans: a systematic review. Am J Clin Nutr 2009;89:2040S-2051S.
10.
Filippi J, Al-Jaouni R, Wiroth JB, et al: Nutritional deficiencies in patients with Crohn's disease in remission. Inflamm Bowel Dis 2006;12:185-191.
11.
Vagianos K, Bector S, McConnell J, Bernstein CN: Nutrition assessment of patients with inflammatory bowel disease. JPEN J Parenter Enteral Nutr 2007;31:311-319.
12.
Hambidge M: Human zinc deficiency. J Nutr 2000;130(5S suppl):1344S-1349S.
13.
Skrovanek S, DiGuilio K, Bailey R, Huntington W, Urbas R, Mayilvaganan B, Mercogliano G, Mullin JM: Zinc and gastrointestinal disease. World J Gastrointest Pathophysiol 2014;5:496-513.
14.
Kruis W, Rindfleisch GE, Weinzierl M: Zinc deficiency as a problem in patients with Crohn's disease and fistula formation. Hepatogastroenterology 1985;32:133-134.
15.
Myung SJ, Yang SK, Jung HY, Jung SA, Kang GH, Ha HK, Hong WS, Min YI: Zinc deficiency manifested by dermatitis and visual dysfunction in a patient with Crohn's disease. J Gastroenterol 1998;33:876-879.
16.
Hwang C, Ross V, Mahadevan U: Micronutrient deficiencies in inflammatory bowel disease: from A to zinc. Inflamm Bowel Dis 2012;18:1961-1981.
17.
De Baaij JHF, Hoenderop JGJ, Bindels RJM: Magnesium in man: implications for health and disease. Physiol Rev 2015;95:1-46.
18.
Ryzen E, Servis KL, DeRusso P, Kershaw A, Stephen T, Rude RK: Determination of intracellular free magnesium by nuclear magnetic resonance in human magnesium deficiency. J Am Coll Nutr 1989;8:580-587.
19.
Geerling BJ, Badart-Smook A, Stockbrügger RW, Brummer RJ: Comprehensive nutritional status in recently diagnosed patients with inflammatory bowel disease compared with population controls. Eur J Clin Nutr 2000;54:514-521.
20.
Galland L: Magnesium and inflammatory bowel disease. Magnesium 1988;7:78-83.
21.
van Langenberg DR, Della Gatta P, Warmington SA, Kidgell DJ, Gibson PR, Russel AP: Objectively measured muscle fatigue in Crohn's disease: correlation with self-reported fatigue and associated factors for clinical application. J Crohns Colitis 2014;8:137-146.
22.
Prezioso D, Strazzullo P, Lotti T, Bianchi G, Borghi L, et al: Dietary treatment of urinary risk factors for renal stone formation. A review of CLU working group. Arch Ital Urol Androl 2015;87:105-120.
23.
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.
24.
Yetley EA, Pfeiffer CM, Phinney KW, et al: Biomarkers of vitamin B-12 status in NHANES: a roundtable summary. Am J Clin Nutr 2011;94:313S-321S.
25.
Battat R, Kopylov U, Szilagyi A, Saxena S, Rosenblatt D, Warner M, Bessissow T, Seidman E, Bitton A: Vitamin B12 deficiency in inflammatory bowel disease: prevalence, risk factors, evaluation, and management. Inflamm Bowel Dis 2014;20:1120-1128.
26.
Stabler SP: Clinical practice. Vitamin B12 deficiency. N Engl J Med 2013;368:149-160.
27.
Mouli VP, Ananthakrishnan AN: Review article: vitamin D and inflammatory bowel diseases. Aliment Pharmacol Ther 2014;39:125-136.
28.
Ananthakrishnan AN, Cagan A, Gainer VS, Cai T, Cheng SC, Savova G, Chen P, et al: Normalization of plasma 25-hydroxy vitamin D is associated with reduced risk of surgery in Crohn's disease. Inflamm Bowel Dis 2013;19:1921-1927.
29.
Jorgensen SP, Agnholt J, Glerup H, Lyhne S, Villadsen GE, et al: Clinical trial; vitamin D3 treatment in Crohn's disease - a randomized double-blind placebo-controlled study. Aliment Pharmacol Ther 2010;332:377-383.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.