J Bone Metab.  2014 Aug;21(3):195-203. 10.11005/jbm.2014.21.3.195.

Nutrient Intake and Bone Mineral Density by Nutritional Status in Patients with Inflammatory Bowel Disease

• Lim H
• Kim HJ
• Hong SJ
• Kim S

• KMID: 2286289
• DOI: http://doi.org/10.11005/jbm.2014.21.3.195

Abstract

BACKGROUND
Malnutrition among inflammatory bowel disease (IBD) may arise from factors including inadequate dietary intake, malabsorption, and progression of disease. IBD has been reported an increased prevalence of low bone mass. The aims of the present study were to evaluate the nutritional status and to investigate the correlation between bone mineral density (BMD) and nutrient factors in patients with IBD.
METHODS
A total of 41 subjects were classified into normal group (n=21) and malnourished group (n=20) by the subjective global assessment result. We surveyed the dietary habit, nutrient intake, and BMD.
RESULTS
Subjects' average age was 36.7 years old, and included 26 ulcerative colitis and 15 Crohn's disease. The serum C-reactive protein (CRP) was significantly higher and serum calcium was significantly lower in the malnourished group. Lower bone density subjects were more in the malnourished group but no significant difference. Intake of energy, protein, carbohydrate, fiber, iron, sodium, potassium, zinc, vitamin B6, vitamin C and folate were significantly lower in the malnourished group. The BMD of malnourished group showed correlation with triceps skin fold thickness (TSF), CRP, dietary calcium, phosphorous, iron, animal iron, zinc and vitamin.
CONCLUSIONS
The results suggested that adequate intake of nutrients is important to prevent bone loss and systemic education programs are need for IBD patients.

Keyword

Bone density; Inflammatory bowel diseases; Nutritional status

MeSH Terms

Animals
Ascorbic Acid
Bone Density*
C-Reactive Protein
Calcium
Calcium, Dietary
Colitis, Ulcerative
Crohn Disease
Education
Folic Acid
Food Habits
Humans
Inflammatory Bowel Diseases*
Iron
Malnutrition
Nutritional Status*
Potassium
Prevalence
Skin
Sodium
Vitamin B 6
Vitamins
Zinc
Ascorbic Acid
C-Reactive Protein
Calcium
Calcium, Dietary
Folic Acid
Iron
Potassium
Sodium
Vitamin B 6
Vitamins
Zinc

Reference

1. Ali T, Lam D, Bronze MS, et al. Osteoporosis in inflammatory bowel disease. Am J Med. 2009; 122:599–604.

2. Cosnes J, Gower-Rousseau C, Seksik P, et al. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011; 140:1785–1794.

3. Ghishan FK, Kiela PR. Advances in the understanding of mineral and bone metabolism in inflammatory bowel diseases. Am J Physiol Gastrointest Liver Physiol. 2011; 300:G191–G201.

4. Song YJ, Paik HY, Yu CH. Factors affecting bone mineral density by dietary pattern group for some Korean college women. Korean J Nutr. 2006; 39:460–466.

5. Lee KM. Nutrition in inflammatory bowel disease. Korean J Gastroenterol. 2008; 52:1–8.

6. Prince A, Whelan K, Moosa A, et al. Nutritional problems in inflammatory bowel disease: the patient perspective. J Crohns Colitis. 2011; 5:443–450.

7. D'Haens G, Sandborn WJ, Feagan BG, et al. A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis. Gastroenterology. 2007; 132:763–786.

8. Stange EF, Travis SP, Vermeire S, et al. European evidence based consensus on the diagnosis and management of Crohn's disease: definitions and diagnosis. Gut. 2006; 55:Suppl 1. i1–i15.

9. Detsky AS, McLaughlin JR, Baker JP, et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr. 1987; 11:8–13.

10. Kanis JA, Melton LJ 3rd, Christiansen C, et al. The diagnosis of osteoporosis. J Bone Miner Res. 1994; 9:1137–1141.

11. The Korean Nutrition Society. Dietary reference intakes for Koreans: first revision 2010. Seoul: The Korean Nutrition Society, Ministry of Health & Welfare, Ministry of Food and Drug Safety;2010.

12. Prideaux L, Kamm MA, De Cruz PP, et al. Inflammatory bowel disease in Asia: a systematic review. J Gastroenterol Hepatol. 2012; 27:1266–1280.

13. Massironi S, Rossi RE, Cavalcoli FA, et al. Nutritional deficiencies in inflammatory bowel disease: therapeutic approaches. Clin Nutr. 2013; 32:904–910.

14. Carter MJ, Lobo AJ, Travis SP. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2004; 53:Suppl 5. V1–V16.

15. Gomollon F, Gisbert JP. Anemia and inflammatory bowel diseases. World J Gastroenterol. 2009; 15:4659–4665.

16. Gasche C, Lomer MC, Cavill I, et al. Iron, anaemia, and inflammatory bowel diseases. Gut. 2004; 53:1190–1197.

17. Bernstein CN, Seeger LL, Sayre JW, et al. Decreased bone density in inflammatory bowel disease is related to corticosteroid use and not disease diagnosis. J Bone Miner Res. 1995; 10:250–256.

18. Jahnsen J, Falch JA, Aadland E, et al. Bone mineral density is reduced in patients with Crohn's disease but not in patients with ulcerative colitis: a population based study. Gut. 1997; 40:313–319.

19. American Gastroenterological Association. American Gastroenterological Association medical position statement: guidelines on osteoporosis in gastrointestinal diseases. Gastroenterology. 2003; 124:791–794.

20. Park JJ, Jung SA, Noh YW, et al. Analysis of risk factors for low bone mineral density in patients with inflammatory bowel disease. Korean J Gastroenterol. 2010; 55:237–244.

21. Cosnes J. Smoking, physical activity, nutrition and lifestyle: environmental factors and their impact on IBD. Dig Dis. 2010; 28:411–417.

22. Russel MG, Volovics A, Schoon EJ, et al. European Collaborative IBD Study Group. Inflammatory bowel disease: is there any relation between smoking status and disease presentation? Inflamm Bowel Dis. 1998; 4:182–186.

23. Kang EH. Nutritional state of the patients with Crohn's disease in Korea [master's thesis]. Seoul: Ewha Womans University;2002.

24. Vagianos K, Bector S, McConnell J, et al. Nutrition assessment of patients with inflammatory bowel disease. JPEN J Parenter Enteral Nutr. 2007; 31:311–319.

25. Tighe MP, Cummings JR, Afzal NA. Nutrition and inflammatory bowel disease: primary or adjuvant therapy. Curr Opin Clin Nutr Metab Care. 2011; 14:491–496.

26. Hartman C, Eliakim R, Shamir R. Nutritional status and nutritional therapy in inflammatory bowel diseases. World J Gastroenterol. 2009; 15:2570–2578.

27. Silvennoinen JA, Karttunen TJ, Niemelä SE, et al. A controlled study of bone mineral density in patients with inflammatory bowel disease. Gut. 1995; 37:71–76.

28. Bernstein CN, Bector S, Leslie WD. Lack of relationship of calcium and vitamin D intake to bone mineral density in premenopausal women with inflammatory bowel disease. Am J Gastroenterol. 2003; 98:2468–2473.

29. Rodríguez-Bores L, Barahona-Garrido J, Yamamoto-Furusho JK. Basic and clinical aspects of osteoporosis in inflammatory bowel disease. World J Gastroenterol. 2007; 13:6156–6165.