Patients with Crohn's Disease Report Low Calcium, Magnesium Intake

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Adequate magnesium and calcium intake, that which is associated with improved nutritional status, may reduce inflammation in patients with Crohn’s disease and therefore benefit their disease and symptoms.

According to new data from a team of China investigators, serum levels of magnesium and calcium were generally lower in patients with Crohn’s disease versus a control cohort—enough so to warrant their description as a deficiency in many patients. Along with uncovering a positive correlation between increased disease activity and malnutrition status in patients with Crohn’s disease, the investigators were also able to ascertain that increased intake of calcium and magnesium may be a safe, cost-effective, pre-pharmaceutical treatment for such patients.

Investigators led by Ying Zhen, Yijun Liao and Ye Ouyang, of the Southern Medical University in Guangzhou, sought to analyze the link between dietary intake and serum concentration of magnesium and calcium in patients with Crohn’s disease, as well as indicators of nutrition and inflammation in patients based on these levels. A majority of patients with the gastric disease will develop malnutrition, the investigators noted, which leads them susceptible to more active and severe disease.

“It is thus important to identify indicators that can link the nutritional and inflammatory status of the patient as a reflection of disease activity, while also having therapeutic significance,” investigators wrote. “Although there are a number of biomarkers that can evaluate the inflammatory activity of patients, there are few reports on indicators that are able to combine the nutritional status of patients and disease activity.”

The team conducted their prospective, observational analysis through inpatient data collected at the Guangdong Provincial People’s Hospital. Eligible patients were adults aged ≥18 years old with a confirmed Crohn’s disease diagnosis who had not yet begun treatment for their condition. Investigators recruited patients and a general population control cohort from October 2018 – October 2020.

Investigators evaluated disease activity per Crohn’s Disease Activity Index (CDAI) scores, with CDAI <150 indicating remission and ≥150 indicating active disease. Their laboratory data include serum levels of tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), C-reactive protein (CRP), calcium and magnesium. They additionally assessed dietary intake for each patient.

Overall, investigators enrolled 159 individuals for the Crohn’s disease patient (n = 76) and control cohorts (n = 83). There were no significant differences in cohort mean age and sex, with male participants approximating three-fourths of the population and a mean age of approximately 32 years old.

Patients with Crohn’s disease were found to have lower nutritional status per serum magnesium (0.86 mmol/L) and calcium levels (2.183 mmol/L) versus control (0.898 and 2.397 mmol/L, respectively), as well as the Nutritional Risk Screening 2002 (NRS-2002; 3.29 vs 0.211, respectively).

Additionally, patients with Crohn’s disease reported significantly greater levels of IL-6 (17.7 vs 3.13 pg/ml), CRP (26.25 vs 2.18 mg/L), TNF-α (37.14 vs 4.77 fmol/ml) than the control cohort, respectively—indicating significantly increased inflammation.

Among patients with a Crohn’s disease in remission, investigators observed improved NRS-2002 scores (2.72 vs 3.86), greater dietary calcium and magnesium, and significantly improved inflammation per IL-6, CRP, and TNF-α versus patients with active disease.

Among the novel findings procured by the analysis included that patients with Crohns’ disease experienced sustained calcium and magnesium deficiencies in both remission and active phases; dietary intake of both calcium and magnesium among Chinese patients with Crohn’s disease is “seriously inadequate;” there is a possibility to use serum magnesium and calcium levels as biomarkers for Crohn’s disease and its activity status.

As such, the team concluded serum magnesium and calcium levels can bridge nutritional and inflammatory conditions in patients with Crohn’s disease.

“Sufficient intake of magnesium and calcium may be a safe and cost-effective strategy to reduce inflammation and malnutrition, and to further improve clinical prognosis,” they wrote.

References

^{Zheng Y, Liao Y, Ouyang Y, et al. The effects and predictive value of calcium and magnesium concentrations on nutritional improvement, inflammatory response and diagnosis in patients with Crohn's disease [published online ahead of print, 2023 Jul 23]. J Hum Nutr Diet. 2023;10.1111/jhn.13201. doi:10.1111/jhn.13201}