Selenium and zinc deficiencies linked to adverse clinical outcomes in IBD patients on biologic therapy

A recent study has reported the prevalence of micronutrient deficiencies in the blood of a large group of adults with IBD who were being treated with biologic therapies. The study then explored the relationship between these deficiencies and adverse disease outcomes within 12 months of follow-up. The results showed that certain micronutrient deficiencies were common, with the most common deficiencies in plasma in vitamin C, folate, zinc, selenium, and ferritin. They also found that trace element deficiency of zinc and selenium was also related to adverse disease outcomes, including an induction course with steroid use and surgery. These effects persisted even after adjusting for potential confounders, indicating their independent impact on clinical outcomes. The study "Micronutrient Status and Prediction of Disease Outcome in Adults With Inflammatory Bowel Disease Receiving Biologic Therapy" is led by Emily Brownson and is published in Inflammatory Bowel Diseases.

In IBD patients, Micronutrient deficiencies are common, but there is a scarcity of data relating deficiency to the disease outcomes. Investigating further, researchers assessed the micronutrient status of adults with IBD on treatment with biologic therapies and explored predictive relationships with disease outcomes.

The team explained the study method: "We included Seventeen micronutrients (blood) in 216 adults who had IBD and were on biologic therapy. Nearly 58 % had Crohn's disease (CD), and 70 % received infliximab treatment.

These patients were followed for 12 months. We recorded the onset of adverse clinical outcomes like a requirement for treatment with corticosteroids, hospitalization, or surgical intervention and their relation to micronutrient status.

The key results of the study are:

• The common deficiencies were for vitamin C, ferritin, folate and zinc, constituting 16.5 %, 14.3 %, 14 % and 12.9 % in 35, 27, 24 and 27 patients, respectively.
• During follow-up, 10% of the 216 patients developed one or more adverse clinical outcomes.
• Patients with CD and zinc deficiency required surgery or corticosteroid treatment.
• Those with ulcerative colitis and selenium deficiency had a clinical flare of the disease. This was not recorded in patients with CD.
• Even after adjustment for confounders, the relationship with selenium remained significant.

We recorded a new finding in our study, they said. Low selenium increased disease severity in ulcerative colitis patients, while those with low zinc had complications of Crohn's disease.

Further investigations are warranted if this is a cause or consequence of the dysbiosis due to active IBD.

The study justified the routine testing of micronutrients in these patients.

Further reading:

https://academic.oup.com/ibdjournal/advance-article/doi/10.1093/ibd/izad174/7249102