P1131 A snapshot of nutritional bloods in newly diagnosed paediatric patients with Crohn’s disease (CD), Ulcerative colitis (UC) and Early Onset IBD (EOIBD) and their follow up post treatment of nutrient deficiency
Authors: Arpe L , Kiparissi F , Williamson A 
Published: January 2025

Abstract

Background
Patients with IBD can present with low micronutrient levels due to inadequate intake /impaired absorption due to inflammation. Results should be interpreted alongside systematic inflammatory markers to avoid overdiagnosis of deficiency. Our aim was to evaluate the rate of micronutrient deficiency and their treatment.

Methods
We retrospectively reviewed newly diagnosed patients with CD, UC and EOIBD in clinic between January and February 2023. A retrospective review of records, which included demographics, nutritional bloods at diagnosis and post treatment if deficiencies were identified. The nutritional bloods included copper, zinc, selenium, Vitamin A+E, Vitamin D and Vitamin B12, as well as CRP. Treatment was exclusive enteral nutrition (EEN), dietary advice, multivitamins and/or prescription medication.

Results
A total of 37 patients were identified, 27 male, age range from 1 to 16 years with a median of 11 years. 24/37 had CD, 7/37 UC and 6/37 were diagnosed with EOIBD, age at diagnosis under 6 years of age. 15/37 were given EEN (CD n=11, UC n=1 and 3 EOIBD patients. 11/37 were given dietetic advice, CD n=7, US n=2, EOIBD n=2. 16/37 patients were given prescription treatment for micronutrients, CD n=11, UC n=3, EOIBD n=2. Patients with CD n=9 were given copper n=3, zinc n=4 and selenium n=2, patients with UC n=4 were given zinc n=3, selenium n=1, none with EOIBD. Normal CRP levels with low levels in CD were seen in patients with zinc levels n=2 and copper n=1, whereas with raised CRP in CD low levels were seen in zinc n=2, copper n=2 and selenium n=2. Normal CRP levels with low levels in UC were seen in no patients whereas with raised CRP in UC low levels were seen in zinc n3, and selenium n=1. A full range of all nutritional bloods were only found on in 14/37 patients. Vitamin D was taken in 37/37 patients, normal (&gt;50) in 17/37, insufficient (25-50) in 15/37 and deficient (&lt;25) 4/37 patients. 11/37 who had a normal CRP presented with the following deficiencies: Vitamin D (9/11) treated via high dose prescription, Vitamin E (1/11) with EEN, Copper (1/11) via high dose prescription and zinc (1/11) was corrected for the low albumin and was found to be within the normal range. Only 1/35 patients had a low Vitamin B12 level.

Conclusion
This snapshot case series showed that many patients had incomplete bundles. A raised CRP might show false levels due to the systematic response to inflammation and the redistribution of nutrients. Overall, at diagnosis 27/37 had some sort of deficiencies and only 2/14 (with a full bundle) had normal bloods. A larger cohort should be studies to identify further trends.

References
Gerasimidis K;Bronsky J;Catchpole A;Embleton N;Fewtrell M;Hojsak I;Indrio F;Hulst J;Köglmeier J;de Koning B;Lapillonne A;Molgaard C;Moltu SJ;Norsa L;Verduci E;Domellöf M; ; (2020) Assessment and interpretation of Vitamin and trace element status in sick children: A position paper from the European Society for Paediatric Gastroenterology Hepatology, and Nutrition Committee on Nutrition, Journal of pediatric gastroenterology and nutrition. Available at: https://pubmed.ncbi.nlm.nih.gov/32443051/ (Accessed: 26 September 2023)