Associations between Folate and Vitamin B12 Levels and Inflammatory Bowel Disease: A Meta-Analysis

Yun Pan, Ya Liu, Haizhuo Guo, Majid Sakhi Jabir, Xuanchen Liu, Weiwei Cui, Dong Li, Yun Pan, Ya Liu, Haizhuo Guo, Majid Sakhi Jabir, Xuanchen Liu, Weiwei Cui, Dong Li

Abstract

Background: Inflammatory bowel disease (IBD) patients may be at risk of vitamin B12 and folate insufficiencies, as these micronutrients are absorbed in the small intestine, which is affected by IBD. However, a consensus has not been reached on the association between IBD and serum folate and vitamin B12 concentrations.

Methods: In this study, a comprehensive search of multiple databases was performed to identify studies focused on the association between IBD and serum folate and vitamin B12 concentrations. Studies that compared serum folate and vitamin B12 concentrations between IBD and control patients were selected for inclusion in the meta-analysis.

Results: The main outcome was the mean difference in serum folate and vitamin B12 concentrations between IBD and control patients. Our findings indicated that the average serum folate concentration in IBD patients was significantly lower than that in control patients, whereas the mean serum vitamin B12 concentration did not differ between IBD patients and controls. In addition, the average serum folate concentration in patients with ulcerative colitis (UC) but not Crohn's disease (CD) was significantly lower than that in controls. This meta-analysis identified a significant relationship between low serum folate concentration and IBD.

Conclusions: Our findings suggest IBD may be linked with folate deficiency, although the results do not indicate causation. Thus, providing supplements of folate and vitamin B12 to IBD patients may improve their nutritional status and prevent other diseases.

Keywords: folate; inflammatory bowel disease; meta-analysis; nutrition; vitamin B12.

Conflict of interest statement

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Figures

Figure 1
Figure 1
Flow diagram of the literature search.
Figure 2
Figure 2
Forest plot of the serum folate concentrations in the inflammatory bowel disease (IBD) patients vs. controls; standardized mean differences with the 95% confidence interval and weight percentage are shown. * Reported in ulcerative colitis; # reported in Crohn’s disease.
Figure 3
Figure 3
Forest plot of the serum concentrations of vitamin B12 in the IBD patients vs. controls; standardized mean differences with the 95% confidence interval and weight percentage are shown. * Reported in ulcerative colitis; # reported in Crohn’s disease.
Figure 4
Figure 4
Forest plot of the serum concentrations of folate in the ulcerative colitis (UC), Crohn’s disease (CD) and IBD patients vs. controls; standardized mean differences with the 95% confidence interval and weight percentage are shown. Subtotals are for the UC, CD and IBD patients.
Figure 5
Figure 5
Forest plot of the serum concentrations of vitamin B12 in the UC, CD and IBD patients vs. controls; standardized mean differences with the 95% confidence interval and weight percentage are shown. Subtotals are for the UC, CD and IBD patients.
Figure 6
Figure 6
Forest plot of the serum concentrations of folate in the IBD patients vs. controls; standardized mean differences with the 95% confidence interval and weight percentage are shown. Subtotals are for the studies from Asia, Europe, and others. * Reported in ulcerative colitis; # reported in Crohn’s disease.
Figure 7
Figure 7
Forest plot of the serum concentrations of vitamin B12 in the IBD patients vs. controls; standardized mean differences with the 95% confidence interval and weight percentage are shown. Subtotals are for the studies from Asia, Europe, and others. * Reported in ulcerative colitis; # reported in Crohn’s disease.
Figure 8
Figure 8
Forest plot of the serum concentrations of folate in the IBD patients vs. controls; standardized mean differences with a 95% confidence interval and weight percentage are shown. Subtotals are for the three detection methods. * Reported in ulcerative colitis; # reported in Crohn’s disease.
Figure 9
Figure 9
Forest plot of the serum concentrations of vitamin B12 in IBD patients vs. controls; standardized mean differences with a 95% confidence interval and weight percentage are shown. Subtotals are for the three detection methods. * Reported in ulcerative colitis; # reported in Crohn’s disease.

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