From the Guidelines
A micronutrient screen is recommended at least once per year for patients with conditions that impair nutrient absorption, such as inflammatory bowel disease, and should include tests for vitamin levels, minerals, and electrolytes. This recommendation is based on the most recent evidence from the ESPEN guideline on clinical nutrition in inflammatory bowel disease 1. The screen should be customized based on specific clinical concerns, such as checking thiamine levels in alcoholic patients or vitamin K in those with bleeding disorders.
Typical Micronutrient Screen Components
- Vitamin levels: B12, folate, vitamin D, vitamin A, vitamin E
- Minerals: iron studies including ferritin, zinc, copper, selenium
- Electrolytes: magnesium, calcium, phosphorus
Importance of Routine Monitoring
Routine monitoring is necessary to detect early signs of deficiency, as clinical manifestations of deficiency often represent a late presentation 1. Additionally, deficiencies in micronutrients can have significant consequences, such as anaemia, impaired linear growth, and poor bone health 1.
Considerations for Interpretation
When interpreting blood results of micronutrients and trace elements, it is essential to consider that many serum values are positive or negative acute phase reactants, which can affect the reliability of plasma micronutrient levels measurement in the presence of systemic inflammation 1.
High-Risk Groups
Patients with conditions that impair nutrient absorption, such as celiac disease, Crohn's disease, or gastric bypass, as well as those with chronic alcoholism, taking medications that interfere with nutrient absorption, or belonging to high-risk groups like pregnant women, the elderly, or those with eating disorders, should undergo routine micronutrient screening 1.
Supplementation and Investigation
Deficiencies identified through screening should prompt not only supplementation but also investigation into underlying causes, as micronutrient deficiencies often signal broader health issues or malabsorption problems that require addressing the root cause alongside replacement therapy 1.
From the Research
Micronutrient Screen Recommendation
A micronutrient screen is recommended for individuals who are at risk of micronutrient deficiencies, such as:
- Older adults
- Pregnant patients
- Patients with alcohol use disorder
- Patients with vegetarian or vegan diets
- Patients with increased requirements secondary to medical conditions or long-term drug use that alters nutrient absorption, metabolism, or excretion 2
- Children with inflammatory bowel disease (IBD) 3
Typical Components of a Micronutrient Screen
A micronutrient screen typically includes:
- Serum or plasma levels of nutrients such as:
- Folate
- Vitamin C
- B vitamins
- Vitamin D
- Selenium
- Copper
- Zinc 4
- Measurements of iron, ferritin, zinc, vitamin D, vitamin A, vitamin E, selenium, copper, vitamin B12, and red blood cell (RBC) folate 3
Importance of Micronutrient Screening
Micronutrient deficiencies can lead to various health problems, including:
- Intellectual impairment
- Poor growth
- Perinatal complications
- Degenerative diseases associated with aging
- Higher morbidity and mortality 4, 5
- Anemia and micronutrient deficiencies are common in children with IBD, and some may not recover after one year despite being in clinical remission 3
Prevention and Treatment of Micronutrient Deficiencies
Prevention and treatment of micronutrient deficiencies can be achieved through: