Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2022; 28(33): 4834-4845
Published online Sep 7, 2022. doi: 10.3748/wjg.v28.i33.4834
Prevalence and factors associated with vitamin C deficiency in inflammatory bowel disease
Benjamin Langan Gordon, Jonathan S Galati, Stevie Yang, Randy S Longman, Dana Lukin, Ellen J Scherl, Robert Battat
Benjamin Langan Gordon, Jonathan S Galati, Department of Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10065, United States
Stevie Yang, Randy S Longman, Dana Lukin, Ellen J Scherl, Robert Battat, Department of Gastroenterology and Hepatology, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10021, United States
Author contributions: Battat R is the guarantor of the article; Gordon BL, Galati JS, Longman RS, Lukin D, Scherl EJ and Battat R contributed to the design of the study; Gordon BL, Galati JS, and Yang S collected the data; Gordon BL and Battat R analyzed the data; Gordon BL, Scherl EJ, Lukin D and Battat R wrote the paper; and all authors read and approved the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the institutional review board at Weill Cornell Medicine.
Informed consent statement: This study was conducted retrospectively from data obtained for clinical purposes. The study was approved by the institutional review board at Weill Cornell Medicine, who confirmed that no ethical approval or informed consent was required.
Conflict-of-interest statement: Gordon BL, Galati JS, Yang S have none to report; Longman RS consulted Pfizer, Bristol Myers Squibb; Lukin D consults for Boehringer Ingelheim, Palatin Technologies, Pfizer; research support: AbbVie, Janssen, Kenneth Rainin Foundation, Takeda; Scherl EJ consulted AbbVie, Crohn’s and Colitis Foundation of America (CCFA), Entera Health, Evidera, GI Health Foundation, Janssen, Protagonist, Seres, Takeda, Bristol Myers Squibb; research support: AbbVie, AstraZeneca, CCFA, Janssen, Pfizer, National Institute of Health, New York Crohn’s Foundation, UCSF-CCFA Clinical Research Alliance, Genentech, Seres, Celgene, UCB, Johns Hopkins University, National Institute of Diabetes and Digestive and Kidney; Shareholder: Gilead; Honoraria: GI Health Foundation, Janssen; Battat R provide research support, fund for the Future Award and Jill Roberts Funds at the Department of Medicine, Weill Cornell Medicine.
Data sharing statement: The datasets used and analyzed in this current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Robert Battat, MD, Assistant Professor, Department of Gastroenterology and Hepatology, New York Presbyterian/Weill Cornell Medical Center, 1315 York Avenue, Mezzanine, New York, NY 10021, United States. rbattat20@icloud.com
Received: March 14, 2022
Peer-review started: March 14, 2022
First decision: May 9, 2022
Revised: May 23, 2022
Accepted: August 6, 2022
Article in press: August 6, 2022
Published online: September 7, 2022
Processing time: 169 Days and 16.6 Hours
Abstract
BACKGROUND

Patients with inflammatory bowel disease (IBD) are prone to several nutritional deficiencies. However, data are lacking on vitamin C deficiency in Crohn’s disease (CD) and ulcerative colitis (UC) patients, as well as the impact of clinical, biomarker and endoscopic disease severity on the development of vitamin C deficiency.

AIM

To determine proportions and factors associated with vitamin C deficiency in CD and UC patients.

METHODS

In this retrospective study, we obtained clinical, laboratory and endoscopic data from CD and UC patients presenting to the IBD clinic at a single tertiary care center from 2014 to 2019. All patients had an available plasma vitamin C level. Of 353 subjects who met initial search criteria using a cohort discovery tool, 301 ultimately met criteria for inclusion in the study. The primary aim described vitamin C deficiency (≤ 11.4 μmol/L) rates in IBD. Secondary analyses compared proportions with deficiency between active and inactive IBD. Multivariate logistic regression analysis evaluated factors associated with deficiency.

RESULTS

Of 301 IBD patients, 21.6% had deficiency, including 24.4% of CD patients and 16.0% of UC patients. Patients with elevated C-reactive protein (CRP) (39.1% vs 16.9%, P < 0.001) and fecal calprotectin (50.0% vs 20.0%, P = 0.009) had significantly higher proportions of deficiency compared to those without. Penetrating disease (P = 0.03), obesity (P = 0.02) and current biologic use (P = 0.006) were also associated with deficiency on univariate analysis. On multivariate analysis, the objective inflammatory marker utilized for analysis (elevated CRP) was the only factor associated with deficiency (odds ratio = 3.1, 95% confidence interval: 1.5-6.6, P = 0.003). There was no difference in the presence of clinical symptoms of scurvy in those with vitamin C deficiency and those without.

CONCLUSION

Vitamin C deficiency was common in IBD. Patients with elevated inflammatory markers and penetrating disease had higher rates of vitamin C deficiency.

Keywords: Inflammatory bowel disease; Crohn’s disease; Ulcerative colitis; Vitamin C deficiency; Scurvy; Malnutrition

Core Tip: This study aimed to determine proportions and factors associated with vitamin C deficiency in inflammatory bowel disease (IBD) patients. In 301 patients, 21.6% had vitamin C deficiency, including 24.4% of Crohn’s disease and 16.0% of ulcerative colitis patients. Patients with elevated C-reactive protein (39.1% vs 16.9%) and fecal calprotectin (50.0% vs 20.0%) had higher proportions of deficiency compared to those without, as did patients with penetrating disease (36.2% vs 20.8%). This study provides the largest data on vitamin C deficiency in IBD, and demonstrates that deficiency is common in this population, particularly those with markers of active luminal or penetrating disease.