With ImproveCareNow, there have been efforts to minimize variation in care. As such, there have been suggestions to monitor labs like vitamin D, vitamin B12, and folate routinely. I have voiced concern that some of this testing is unnecessary. For vitamin B12, deficiency in pediatrics is rare; at risk populations include those with extensive small bowel resections, gastric resections or strict vegan diet.
A recent article (J Fritz et al. Inflamm Bowel Dis 2019; 25: 445-59) which is a systematic review of micronutrients in pediatric inflammatory bowel disease provides further support for the approach of less testing.
- A total of 39 studies were included in the final review (2903 subjects, 1115 controls)
- Iron deficiency and vitamin D deficiency are common in pediatric patients with IBD
- Vitamin B12 and folate deficiency are rare
- Zinc deficiency is uncommon but increased in patients with Crohn’s disease compared to healthy controls.
- The authors recommend routine (at least yearly) testing for iron, vitamin D and zinc and that there is “insufficient evidence to support routine screening for other micronutrient deficiencies.”
My take: Except in patients with surgical resections and in those with unusual diets (eg. vegan), routinely checking vitamin B12, folate and most other micronutrients is unnecessary & low value care.
Related blog posts:
- Methylmalonic Acid as a Biomarker of Vitamin B12 deficiency
- What I didn’t know about Vitamin B12 deficiency and Crohn’s disease (consider Vitamin B12 deficiency if ileal resection >20-30 cm)
- Risk of Vitamin B12 Deficiency with Persistent PPI Usage
- Are we missing Vitamin B12? | gutsandgrowth
- N2U -Part 2: Poor Growth and Short Bowel Syndrome | gutsandgrowth
- Why I Don’t Check Vitamin D Levels During an IBD Flareup
- Understanding Why Vitamin D deficiency is Not So Common Afterall
- Common to be “D-ficient” | gutsandgrowth
- Explaining the Vitamin D Paradox | gutsandgrowth
- Why Adding Vitamin D May Not Help IBD | gutsandgrowth
- The Search for a Dietary Culprit in IBD | gutsandgrowth
- Vitamin D, IBD, and Causality | gutsandgrowth
- Single High-Dose Oral Vitamin D Therapy … – gutsandgrowth
- Be Aggressive! Treating Anemia Related to IBD
- Is It Right? Anti-TNF Therapy Does Not Fix IBD-Related Anemia
- Microcytic Anemia Review | gutsandgrowth
- IBD Update January 2015 (Part 2) | gutsandgrowth
- Help with hepcidin | gutsandgrowth
- Inadequate treatment of anemia in IBD | gutsandgrowth
Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications/diets (along with potential adverse effects) should be confirmed by prescribing physician/nutritionist. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.