Abstract Background IBD patients face a high risk of malnutrition, especially those with Crohn’s disease, where micronutrient absorption is often impaired. Deficiencies are common in both active and quiescent disease and are associated with poorer outcomes.1 Nutrition may also contribute to IBD onset and flares. IBD likely results from genetic, immune, microbial, and environmental interactions. Diet influences intestinal inflammation through effects on the microbiota, immune responses, and epithelial barrier.2 Thus, inadequate micronutrient intake may initiate a cycle in which low protective nutrient levels affect disease activity, while inflammation and malabsorption further worsen deficiencies. Methods A cross-sectional study was conducted in patients receiving ambulatory care at a day-care IBD unit, who were consecutively recruited. Dietary intake was assessed using a self-administered, semi-quantitative food frequency questionnaire validated for the adult Portuguese population.3,4 Blood and fecal samples were collected. The primary outcome was daily dietary intake of micronutrients (vitamins and minerals) according to disease activity. Clinical activity was assessed using the PMS for ulcerative colitis and the HBI for Crohn’s disease, and biological activity was evaluated via fecal calprotectin and C-reactive protein. Patients were considered in remission if PMS≤2 or HBI ≤4, fecal calprotectin 250µg/g, and C-reactive protein 0.5mg/L. Results A total of 89 IBD patients were included (55 CD 27 active; 34 UC 18 active). Baseline characteristics are presented in Table 1. Although daily intake of vitamin C, riboflavin, and vitamin B6 was within normal ranges overall, patients with active CD consumed significantly lower amounts of these vitamins compared to those in remission (vitamin C 66.00 ± 94.75 vs 109.60 ± 124.80mg/day, p = 0.024; riboflavin 1.60 ± 1.16 vs 1.63 ± 1.82mg/day, p = 0.049; vitamin B6 1.75 ± 1.23 vs 1.94 ± 1.65mg/day, p = 0.050). Daily vitamin B12 intake in active CD was below the recommended 2.4µg/day (1.27 ± 6.10µg/day). Folate intake was also below recommended values (400µg/day) in both active and remissive CD patients (211.50 ± 169.77 and 278.42 ± 331.17µg/day, respectively). In CD patients in remission, higher intake of vitamins A and K was associated with lower clinical activity scores (vitamin A p = 0.020, R=-0.438; vitamin K p = 0.037, R=-0.396). No significant associations were found for patients with UC. Conclusion Active Crohn’s disease is associated with lower intake of key vitamins, including C, B6, and B12, as well as folate deficiency, while higher intake of vitamins A and K in patients in remission correlates with lower disease activity indices, highlighting the potential role of micronutrients in disease management. References: (1) Gold SL, Rabinowitz LG, Manning L, et al. High prevalence of malnutrition and micronutrient deficiencies in patients with inflammatory bowel disease early in disease course. Inflamm Bowel Dis. 2023;29(3):423–429. doi:10.1093/ibd/izac102 (2) Adolph TE, Zhang J. Diet fuelling inflammatory bowel diseases: preclinical and clinical concepts. Gut. 2022 Dec;71(12):2574-2586. (3) Lopes C. Reprodutibilidade e Validação de um questionário semi-quantitativo de frequência alimentar. In: Alimentação e enfarte agudo do miocárdio: um estudo caso-controlo de base populacional. Tese de Doutoramento. Universidade do Porto 2000. p.79-115. (4) Lopes C, Aro A, Azevedo A, Ramos E, Barros H. Intake and adipose tissue composition of fatty acids and risk of myocardial infarction in a male Portuguese community sample. J Am Diet Assoc 2007; 107:276-286. Conflict of interest: Ms. Soares, Caroline: No conflicts Domingues, Ângela: No conflict of interest Gomes, Rute: None. Silva, Gonçalo: No conflict of interest Martins, Diana: No conflict of interest Sousa, Paula Cristina: Receipt of honoraria or consultation fees: Celltrion Participation in a company sponsored speaker’s bureau: Johnson & Johnson Support for attending meetings: Johnson & Johnson Dr. Falk Norgine Pfizer Abbvie. Cancela, Eugénia Maria: I haveńt conflits of interest Marques, Isabel: No conflict of interest Silva, Américo: No conflict of interest Ministro, Paula: I declare that I have served as a speaker and received honoraria from Ferring, Falk, MSD, Johnson and Johnson, AbbVie, Lilly, Celltrion, Takeda and Tillotts.
Soares et al. (Thu,) studied this question.