D0353 - Micronutrient Deficiencies in Elderly Inflammatory Bowel Disease Are Not Associated With Worse Adverse Outcomes

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Brendan Andres, MD

University of Arizona
Tucson, AZ

Brendan Andres, MD¹, Garrett Pepich, DO¹, Ali Rasool, MD², Chiu-Hsieh Hsu, MS, PhD³, Sasha Taleban, MD¹
¹University of Arizona, Tucson, AZ; ²University of Arizona College of Medicine, Tucson, AZ; ³Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ

Introduction: Micronutrient deficiencies (MND) occur in 20-85% of inflammatory bowel disease (IBD) patients and have been associated with poor clinical outcomes. Advanced age is also a risk factor for MND. No study has examined the relationship between MND in elderly IBD patients and adverse clinical outcomes. We sought to evaluate MND rates in elderly IBD patients and determine their correlation with poor clinical outcomes.

Methods: We conducted a retrospective cohort study of a single, tertiary-care institution IBD database to collect demographic, micronutrient, and clinical outcome data. IBD adult patients with at least one year of follow-up were divided into two arms: 1) age 18-59, and 2) age ≥ 60 years old. Cutoffs for MND included: iron (ferritin < 30 ng/mL, transferrin saturation < 20%), 25-hydroxyvitamin D < 30 ng/mL, zinc < 0.66 mcg/dL, vitamin B12 < 200 pg/mL, and folate < 2.7 ng/mL. Primary outcomes included subsequent need for corticosteroids, combined intestinal complication (intra-abdominal abscess, intestinal stricture, internal fistula), IBD-related surgery or hospitalization, and a composite clinical outcome of any single outcome occurrence. Statistical analyses included Wilcoxon-Rank-Sum test, chi-squared, and Fisher’s Exact test.

Results: Of 185 total studied IBD patients, 57 were elderly, and there was no difference in corticosteroid or biologic use between the groups. Mean follow-up duration was 3.2 years. At least one MND was present in 80.5% of the total population and did not differ between the two age groups. Compared to younger IBD adults with MND, older patients had less corticosteroid use (19.3% vs 35.9%, p = 0.03) and a better composite clinical outcome (29.8% vs. 47.7%, p = 0.025). Vitamin D deficiency correlated with current biologic use (p = 0.044) and female sex was associated with zinc deficiency (p = 0.026). Iron deficiency coincided with increased rates of the composite outcome (63.5% vs 33.3%, p = 0.036) in the young cohort. Significant cohort-specific outcomes were not observed with other MNDs.

Discussion: Vitamin and mineral deficiencies were present in a vast majority of IBD patients regardless of age. Compared to younger adults with IBD, older IBD patients with MND were less likely to have adverse clinical outcomes. Larger and longer studies are needed to verify these results.

Outcome	Young (n = 128)	Elderly (n = 57)	p-value
Need for Corticosteroids	46 (35.94%)	11 (19.30%)	0.026
Internal Fistula	2 (1.56%)	1 (1.75%)	0.78
Intra-abdominal Abscess	3 (2.34%)	0 (0.00%)	0.61
Intestinal Stricture	9 (7.03%)	2 (3.51%)	0.51
Peri-Anal Disease	14 (10.94%)	4 (7.02%)	0.59
Combined Intestinal Complication	22 (17.19%)	6 (10.53%)	0.28
IBD-Related Surgery	9 (7.03%)	4 (7.02%)	>0.99
IBD-Related Hospitalization	21 (16.41%)	11 (19.30%)	0.68
MAGE	61 (47.66%)	17 (29.82%)	0.025

Table: Summary of Clinical Outcomes by Age Group for All IBD Patients. Fisher’s exact test was performed to compare each clinical outcome between age groups. Need for corticosteroids was defined by any oral corticosteroid prescription written for IBD symptoms during the follow-up period. Patients met the combined intestinal outcome by developing at least one internal fistula, intra-abdominal abscess or intestinal stricture during follow-up. Major adverse gastrointestinal event (MAGE) was defined as one or more of the following outcomes occurring during the follow-up period: need for corticosteroids, internal fistula, intra-abdominal abscess, intestinal stricture, peri-anal disease, IBD-related surgery, or IBD-related hospitalization.

Disclosures:

Brendan Andres indicated no relevant financial relationships.

Garrett Pepich indicated no relevant financial relationships.

Ali Rasool indicated no relevant financial relationships.

Chiu-Hsieh Hsu indicated no relevant financial relationships.

Sasha Taleban: AbbVie – Grant/Research Support. Bristol Myers Squib – Grant/Research Support. Janssen – Grant/Research Support. Pfizer – Grant/Research Support. Shire – Grant/Research Support. Takeda – Grant/Research Support.

Brendan Andres, MD¹, Garrett Pepich, DO¹, Ali Rasool, MD², Chiu-Hsieh Hsu, MS, PhD³, Sasha Taleban, MD¹. D0353 - Micronutrient Deficiencies in Elderly Inflammatory Bowel Disease Are Not Associated With Worse Adverse Outcomes, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.