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P328 Low vitamin K, vitamin D and calcium dietary intake in IBD patients represents a potentially reversible risk factor for osteoporosis

N. S. Bertetti1, G. Burrelli Scotti1, M. T. Afferri1, V. Casali1, E. Cuofano1, C. Tortoriello1, A. De Carolis1, P. Vernia*1

1Sapienza University of Rome, Department of Internal Medicine and Medical Specialties, Gastroenterology, Rome, Italy

Background

Patients with inflammatory bowel diseases (IBD) are at increased risk of osteoporosis due to chronic inflammation, corticosteroids, surgery and deficiency of micronutrients. Inadequate intake of calcium and vitamin D (VitD) are frequent and represent easily reversible risk factors. More recently attention has been focussed on the role of vitamin K (VitK) in the alterations of bone metabolism, but few data are available on the dietary intake of VitK in IBD. The aim of the study was to assess the dietary intake of VitK, VitD and Calcium in IBD and seek correlations with demographics and disease characteristics.

Methods

A food frequency questionnaire, validated for calcium intake, integrated with questions on the main dietary sources of VitD and VitK, was administered to 208 IBD patients (90 Crohn’s disease (CD) and 118 ulcerative colitis (UC), 112 males and 96 females, mean age 50 years) and 195 controls. Data were compared with Institute of Medicine’s Dietary reference intakes: Recommended Dietary Allowance (RDA) for Calcium and VitD and Adequate Intake (AI) for VitK.

Results

The dietary intake of VitK, VitD and calcium expressed as per cent of RDA/AI was significantly lower (p < 0.01) in IBD than in controls. The risk of inadequate VitD and VitK intake was higher in IBD than in controls: 91.8% vs. 84.1% and 55.8% vs. 30.3% (OR 2.1, 95% CI 1.1–4, p = 0.0186 and OR 2.9, 1.9–4.4, p < 0.001, respectively).

IBD males had reduced intake of all micronutrients compared with controls, while in females the difference was significant only for VitK. The difference vs. controls was significant in all age groups for VitK (p < 0.01) and in patients ageing > 40 years for calcium. VitD intake showed a no significant trend. No differences between Crohn’s disease and Ulcerative colitis were observed.The difference of VitD dietary intakes between active and inactive IBD was significant (46.5% vs. 57.2%, p = 0.015). The intake of VitD was lower in IBD patients ageing >60 years, compared with other age groups. Conversely, the calcium and VitK intakes were similar.

Conclusion

Dietary calcium, VitK and VitD intakes were significantly reduced in IBD vs. controls. IBD patients with active IBD had lower VitD intake than those in remission. The correction of dietary habits may reverse some risk factors for osteoporosis in a large proportion of IBD patients. Focussing attention on micronutrients may help identifying those patients who may profit from calcium, VitD and VitK supplementation, and prompt effective dietary counselling.