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.

Key points:

• 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:

Vitamin B12:

• 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

Vitamin D:

• 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

Iron:

• 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.