P576. Calcium intake in patients with IBD
P. Vernia1, P. Loizos1, I. Di Giuseppantonio1, B. Amore1, A. Chiappini1, S. Cannizzaro1, 1Sapienza Univerity of Rome, Medicina Interna e Specialità Mediche, Rome, Italy
Osteopenia, osteoporosis and increased risk for fractures are well-described in IBD. They are believed to result from several contributing factors, including the effects of pro-inflammatory cytokines, corticosteroids and inadequate intake/absorption of calcium. Aim of the study: to investigate the dietary intake of calcium in a large series of patients with IBD.
Patients: 187 IBD, 420 normal controls, 276 diseased controls (non-GI tract disease, lactose malabsorption, celiac disease). Methods: 22-item quantitative validated frequency food questionnaire, photographic atlas of serving size. Data of daily calcium intake were compared with gender and age-related recommended daily allowances-RDA. Statistical analysis: Mann–Whitney, chi-square- and T-tests.
The mean Ca intake was 991.0±536.0 (105.8% RDA) and 867.6±562.7 SD mg/day (93.8% RDA) in healthy and diseased controls, respectively, and 837.8±482.0 SD mg/day (92.7% RDA) in IBD, p < 0.001. Ca intake was high in celiac disease (1165.7±798.8 SD mg/day, 120% RDA), and non-significantly lower in UC than in CD (798.7±544.1 SD mg/day, 88.1% RDA vs 881.9±433.0, 96.8% RDA). CD and UC females had a mean Ca intake well under RDA (82.8% and 79.0%, respectively p < 0.05 vs controls). Significance was p < 0.01 in IBD females between 30–49 years and over 50. Ca intake was normal in males, in all study groups. The daily Ca intake was lower in pts believing that consumption of lactose-containing food was related to symptoms than in those who did not. This was true in all study groups (105.8% vs 114.3% RDA in normal controls; 88.7% vs 109.2% RDA in diseased controls, 100.4% vs 87.6% RDA in IBD.
In this study IBD patients had a significantly lower Ca intake than healthy controls. In accordance to previous studies, gender and age, more than diagnosis, are relevant factors in determining inadequate Ca intake. The trend is more marked in IBD, especially in postmenopausal women. Self-reported lactose intolerance, leading to dietary restrictions, is the single major determinant of low Ca intake in all pts groups, irrespective to diagnosis, age and gender. Inadequate Ca intake is observed in about one third of IBD pts and represents an easily reversible risk factor for osteoporosis. The observation that celiac patients on low gluten diet have a Ca intake well over RDA, further supports the need for tailored nutrition advice also in ulcerative colitis and Crohn's disease.