Micronutrient abnormalities in adults with type 2 intestinal failure: A retrospective cross-sectional study

Micronutrient concentrations in patient cohorts with acute severe (Type 2) intestinal failure have not yet been described. The literature mostly consists of studies of metabolically stable patients with chronic, Type 3, Intestinal Failure. We aimed to characterise micronutrient abnormalities at the point of admission in adults with new Type 2 Intestinal Failure and assess the effects of inflammation on micronutrient concentrations.

A retrospective cross-sectional study was undertaken at a national intestinal failure reference centre. Adults admitted with new Type 2 Intestinal Failure (April 2022-July 2023) were included if micronutrient tests and C-reactive protein (CRP) were obtained within 24 h of admission. Serum levels of vitamins A, D, E, B12, and folate, along with trace elements zinc, copper, and selenium, were recorded using established evidence-based cut-offs. Micronutrient concentrations were assessed across the entire patient cohort before comparisons were made between patients with high and low CRP levels.

Seventy-five patients were included (mean age 53 years; 67% female). Across the entire patient cohort, vitamin D deficiency/insufficiency (66%) was most common, followed by zinc deficiency (34%). Abnormalities remained frequent in patients with CRP ≤10, including vitamin D deficiency/insufficiency (68%) and zinc deficiency (33%). No statistically significant micronutrient differences were observed between high- and low-CRP groups after correction.

Micronutrient abnormalities are highly prevalent at Type 2 Intestinal Failure presentation. However, despite the well-published effects of inflammation distorting micronutrient levels, we did not observe any significant differences between micronutrient concentrations in patients with high and low CRP levels. This finding requires further study and may indicate that inflammation has a more limited effect on micronutrient levels in patients presenting with acute Type 2 Intestinal Failure than is often feared.