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Intake of dietary iron is low in patients with Crohn's disease: a case–control study

Published online by Cambridge University Press:  09 March 2007

Miranda C. E. Lomer*
Affiliation:
Gastrointestinal Laboratory, The Rayne Institute, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK
Kamelia Kodjabashia
Affiliation:
Gastrointestinal Laboratory, The Rayne Institute, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK
Carol Hutchinson
Affiliation:
Department of Nutrition and Dietetics, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NN, UK
Simon M. Greenfield
Affiliation:
Department of Gastroenterology, Queen Elizabeth II Hospital, Howlands, Welwyn, Garden City, Hertfordshire AL7 4HQ, UK
Richard P. H. Thompson
Affiliation:
Gastrointestinal Laboratory, The Rayne Institute, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK
Jonathan J. Powell
Affiliation:
Department of Nutrition and Dietetics, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NN, UK
*
*Corresponding author: Dr Miranda C. E. Lomer, fax +44 20 7960 5710, email miranda.lomer@kcl.ac.uk
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Abstract

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Patients with Crohn's disease (CD) often experience Fe deficiency (ID) and frequently alter their diet to relieve abdominal symptoms. The present study set out to assess whether patients with CD have dietary habits that lead to low Fe intakes and/or reduced bioavailable Fe compared with control subjects. Patients with asymptomatic CD were matched to controls (n 91/group). Dietary intakes of Fe and contributions from different food groups were compared using a 7 d food diary. Promoters and inhibitors of non-haem Fe absorption were investigated and a recently published algorithm was applied to assess bioavailable Fe. Fewer patients than controls met the reference nutrient intake for Fe (32 % CD patients v. 42 % controls). Overall, patients had significantly lower mean Fe intakes (by 2·3 mg/d) and Fe density (by 0·26 mg/MJ (1·1 mg/1000 kcal)) compared with controls (both P<0·001). Differences were mainly due to a preference among CD patients for low-fibre non-Fe fortified cereals, particularly breakfast cereals. In particular, control subjects had higher Fe intakes than matched CD subjects for men (P<0·001) and women less than 50 years (P=0·03). Intakes of both ascorbic acid (P<0·001) and phytic acid (P<0·01), but not animal tissue (P=1·0), were lower in patients with CD, but these had no overall effect on the predicted percentage of bioavailable Fe. Thus total bioavailable Fe was reduced in patients with CD due to lower intakes (P<0·01). Dietary Fe intakes are low in CD patients, which may contribute to an increased risk of ID and anaemia. Changing dietary advice may compromise perceived symptoms of the disease so the need for Fe supplementation should be carefully considered.

Type
Research Article
Copyright
Copyright © The Nutrition Society 2004

References

Ballegaard, M, Bjergstrom, A, Brondum, S, Hylander, E, Jensen, L & Ladefoged, K (1997) Self-reported food intolerance in chronic inflammatory bowel disease. Scand J Gastroenterol 32, 569571.CrossRefGoogle ScholarPubMed
Bartels, U, Pedersen, NS & Jarnum, S (1978) Iron absorption and serum ferritin in chronic inflammatory bowel disease. Scand J Gastroenterol 13, 649656.CrossRefGoogle ScholarPubMed
Bingham, SA (1987) The dietary assessment of individuals; methods, accuracy, new techniques and recommendations. Nutr Abstr Rev 57A, 705742.Google Scholar
Bingham, SA, Gill, C & Welch, A (1997) Validation of dietary assessment methods in the UK arm of EPIC using weighed records, and 24-hour urinary nitrogen and potassium and serum vitamin C and carotenoids as biomarkers. Int J Epidemiol 26, S137S151.CrossRefGoogle ScholarPubMed
Buzzard, M (1998) 24-hour dietary recall and food record methods. In Nutritional Epidemiology, pp. 5073[Willett, WC, editor]. New York: Oxford University Press.Google Scholar
Child, JA, Brozovic, B, Dyer, NH, Mollin, DL & Dawson, AM (1973) The diagnosis of iron deficiency in patients with Crohn's disease. Gut 14, 642648.CrossRefGoogle Scholar
Department of Health (1991) Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. Report on Health and Social Subjects no. 41. London H.M.: Stationery Office.Google Scholar
De Silva, AD, Mylonaki, M & Rampton, DS (2001 a) Efficacy and usage of oral iron therapy in inflammatory bowel disease. Gastroenterology 120, 1393S.CrossRefGoogle Scholar
De Silva, AD, Mylonaki, M & Rampton, DS (2001 b) Prevalence of usage and tolerance of oral iron therapy in inflammatory bowel disease: are we using it appropriately and could we do better?. Gut 48, 333S.Google Scholar
Erichsen, K, Hausken, T, Ulvik, RJ, Svardal, A, Berstad, A & Berge, RK (2003) Ferrous fumerate deteriorated plasma antioxidant status in patients with Crohn disease. Scand J Gastroenterol 38, 543548.CrossRefGoogle Scholar
Faggiano, F, Vineis, P & Cravanzola, D (1992) Validation of a method for the estimation of food portion size. Epidemiology 3, 379382.CrossRefGoogle ScholarPubMed
Gasche, C, Dejaco, C, Waldhoer, T, et al. (1997) Intravenous iron and erythropoietin for anemia associated with Crohn disease. A randomized, controlled trial. Ann Intern Med 126, 782787.CrossRefGoogle ScholarPubMed
Gasche, C, Reinisch, W, Lochs, H, et al. (1994) Anemia in Crohn's disease. Importance of inadequate erythropoietin production and iron deficiency. Dig Dis Sci 39, 19301934.Google ScholarPubMed
Gasche, C, Waldhoer, T & Feichtenschlager, T (2001) Prediction of response to iron sucrose in inflammatory bowel disease-associated anemia. Am J Gastroenterol 96, 23822387.Google ScholarPubMed
Gee, MI, Grace, MG, Wensel, RH, Sherbaniuk, R & Thomson, AB (1985 a) Protein-energy malnutrition in gastroenterology outpatients: increased risk in Crohn's disease. J Am Diet Assoc 85, 14661474.Google ScholarPubMed
Gee, MI, Grace, MG, Wensel, RH, Sherbaniuk, RW & Thomson, AB (1985 b) Nutritional status of gastroenterology outpatients: comparison of inflammatory bowel disease with functional disorders. J Am Diet Assoc 85, 15911599.Google ScholarPubMed
Geerling, BJ, Badart-Smook, A, Stockbrugger, RW & Brummer, RJ (1998) Comprehensive nutritional status in patients with long-standing Crohn disease currently in remission. Am J Clin Nutr 67, 919926.CrossRefGoogle ScholarPubMed
Gibson, SA (1999) Iron intake and iron status of preschool children: associations with breakfast cereals, vitamin C and meat. Public Health Nutr 2, 521528.Google ScholarPubMed
Gregory, J, Foster, K, Tyler, H & Wiseman, M (1990) Dietary and Nutritional Survey of British Adults. London HM: Stationery Office.Google Scholar
Hallberg, L & Hulthen, L (2000) Prediction of dietary iron absorption: an algorithm for calculating absorption and bioavailability of dietary iron. Am J Clin Nutr 71, 11471160.CrossRefGoogle ScholarPubMed
Harland, BF & Oberleas, D (1987) Phytate in foods. World Rev Nutr Diet 52, 235259.CrossRefGoogle ScholarPubMed
Harvey, RS, Reffitt, DM & Doig, LA (1998) Ferric trimaltol corrects iron deficiency anaemia in patients intolerant of iron. Aliment Pharmacol Ther 12, 845848.CrossRefGoogle Scholar
Hodges, P, Gee, M, Grace, M & Thomson, AB (1984) Vitamin and iron intake in patients with Crohn's disease. J Am Diet Assoc 84, 5258.Google ScholarPubMed
Holland, B, Welch, AA, Unwin, ID, Buss, DH, Paul, AA & Southgate, DAT (1991) McCance and Widdowson's The Composition of Foods. London: The Royal Society of Chemistry.Google Scholar
Hunt, JR (1996) Bioavailability algorithms in setting recommended dietary allowances: lessons from iron, applications to zinc. J Nutr 126, 2345S2353S.CrossRefGoogle Scholar
Hunt, JR & Roughead, ZK (2000) Adaptation of iron absorption in men consuming diets with high or low iron bioavailability. Am J Clin Nutr 71, 94102.CrossRefGoogle ScholarPubMed
Imes, S, Pinchbeck, BR & Thomson, AB (1987) Diet counseling modifies nutrient intake of patients with Crohn's disease. J Am Diet Assoc 87, 457462.Google ScholarPubMed
Lashner, BA (1995) Epidemiology of inflammatory bowel disease. Gastroenterol Clin North Am 24, 467474.Google ScholarPubMed
Lomer, MCE (2002) Dietary microparticles and Crohn's disease, PhD thesis: University of London.Google Scholar
Lynch, S (2002) Food iron absorption and its importance for the design of food fortification strategies. Nutr Rev 60, S3S6.CrossRefGoogle ScholarPubMed
Mamula, P, Piccoli, DA, Peck, SN, Markowitz, JE & Baldassano, RN (2002) Total dose intravenous infusion of iron dextran for iron-deficiency anaemia in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 34, 286290.CrossRefGoogle ScholarPubMed
Martini, GA & Brandes, JW (1976) Increased consumption of refined carbohydrates in patients with Crohn's disease. Klin Wochenschr 54, 367371.CrossRefGoogle ScholarPubMed
Millar, AD, Rampton, DS & Blake, DR (2000) Effects of iron and iron chelation in vitro on mucosal oxidant activity in ulcerative colitis. Aliment Pharmacol Ther 14, 11631168.CrossRefGoogle ScholarPubMed
Mishkin, S (1997) Dairy sensitivity, lactose malabsorption, and elimination diets in inflammatory bowel disease. Am J Clin Nutr 65, 564567.CrossRefGoogle ScholarPubMed
Monsen, ER (1988) Iron nutrition and absorption: dietary factors which impact iron bioavailability. J Am Diet Assoc 88, 786790.Google ScholarPubMed
Monsen, ER & Balintfy, JL (1982) Calculating dietary iron bioavailability: refinement and computerization. J Am Diet Assoc 80, 307311.Google ScholarPubMed
Monsen, ER, Hallberg, L & Layrisse, M (1978) Estimation of available dietary iron. Am J Clin Nutr 31, 134141.CrossRefGoogle ScholarPubMed
Morris, ER (1987) Iron. In Trace Elements in Human and Animal Nutrition, pp. 79142[Mertz, W, editor]. New York: Academic Press.CrossRefGoogle Scholar
National Association for Colitis and Crohn's Disease (2002) Statement on age distribution of Crohn's disease. http:/www.nacc.org.uk.Google Scholar
National Research Council (1989) Recommended Dietary Allowances. Washington, DC: National Academy Press.Google Scholar
Nelson, M, Atkinson, M & Darbyshire, S (1996) Food photography II: use of food photographs for estimating portion size and the nutrient content of meals. Br J Nutr 76, 3149.CrossRefGoogle ScholarPubMed
Oldenburg, B, Koningsberger, JC, Berge Henegouwen, GP, Van Asbeck, BS & Marx, JJ (2001) Iron and inflammatory bowel disease. Aliment Pharmacol Ther 15, 429438.CrossRefGoogle ScholarPubMed
Reddy, MB, Hurrell, RF & Cook, JD (2000) Estimation of nonheme-iron bioavailability from meal composition. Am J Clin Nutr 71, 937943.CrossRefGoogle ScholarPubMed
Reid, I (1980) Social class, ethnicity, sex, and age in empirical research. In Social Class Differences in Britain; Life-chances & Lifestyles. London: Fontana Press.Google Scholar
Rigaud, D, Angel, LA & Cerf, M (1994) Mechanisms of decreased food intake during weight loss in adult Crohn's disease patients without obvious malabsorption. Am J Clin Nutr 60, 775781.CrossRefGoogle ScholarPubMed
Riordan, AM, Ruxton, CH & Hunter, JO (1998) A review of associations between Crohn's disease and consumption of sugars. Eur J Clin Nutr 52, 229238.CrossRefGoogle ScholarPubMed
Russel, MG, Engels, LG & Muris, JW (1998) ‘Modern life’ in the epidemiology of inflammatory bowel disease: a case-control study with special emphasis on nutritional factors. Eur J Gastroenterol Hepatol 10, 243249.CrossRefGoogle ScholarPubMed
Thomas, AG, Taylor, F & Miller, V (1993) Dietary intake and nutritional treatment in childhood Crohn's disease. J Parenteral Enteral Nutr 17, 7581.Google ScholarPubMed
Thomson, AB, Brust, R, Ali, MA, Mant, MJ & Valberg, LS (1978) Iron deficiency in inflammatory bowel disease. Diagnostic efficacy of serum ferritin. Am J Dig D is 23, 705709.CrossRefGoogle ScholarPubMed
Tseng, M, Chakraborty, H, Robinson, DT, Mendez, M & Kohlmeier, L (1997) Adjustment of iron intake for dietary enhancers and inhibitors in population studies: bioavailable iron in rural and urban residing Russian women and children. J Nutr 127, 14561468.CrossRefGoogle Scholar
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