B-vitamins, related vitamers, and metabolites in patients with quiescent inflammatory bowel disease and chronic fatigue treated with high dose oral thiamine.

None

• This was a small secondary analysis of samples and data from a previous RCT and further investigations would be of benefit to confirm findings.
• However, low plasma B2 vitamin and FMN levels may be associated with chronic fatigue in individuals with IBD.
• Thiamine supplementation may result in higher use of riboflavin and ways to support these should be considered and may improve outcomes in this patient group.

Introduction

Fatigue is considered a symptom of inflammatory bowel disease (IBD), and may be related to nutrient deficiencies and inflammation. Thiamine is an essential vitamin in the biosynthesis of adenosine triphosphate and energy, however deficiency amongst individuals with IBD is not common and so not monitored. This study aimed to compare plasma B vitamin levels, and their related metabolites and vitamers of individuals with quiescent IBD either with fatigue or without fatigue and determine the effect of high dose thiamine on fatigue.

Methods

• This was a secondary analysis of blood plasma samples collected from a previous randomised control trial (RCT), which looked at the supplementation of high dose thiamine on levels of fatigue in individuals with IBD.
• Samples were available from 60 individuals with IBD; 40 individuals with quiescent IBD and chronic fatigue. 20 individuals with quiescent IBD and no fatigue.
• 21 B vitamins and their associated metabolites and vitamers were analysed.

Results

• Of the 21 measures, only flavin mononucleotide (FMN), a B2 vitamer, was different between those with IBD and fatigue and those with IBD without fatigue. Those with fatigue had lower median FMN levels than those without (11.1 nmol/L; IQR 8.4 to 13.7 vs 14.2 nmol/l; IQR 10.9 to 17.0; P= 0.02).
• Thiamine treatment amongst those with fatigue increased thiamine levels, but had no effect on other metabolites or vitamers (statistics not given).
• Individuals with fatigue who improved with thiamine treatment showed a drop in riboflavin levels after therapy was given (P=0.01), whilst all other B vitamins, vitamers, and metabolites stayed the same.

Conclusion

• It was concluded that amongst the vitamers, metabolites, and B vitamins analysed, only FMN and riboflavin are associated with chronic fatigue in individuals with IBD.

• Low FMN may be involved in the development of fatigue in individuals with IBD.
• This trial did not show if vitamin B2 supplementation would be of benefit to individuals with IBD and chronic fatigue.
• Lower riboflavin levels following thiamine supplementation may be associated with an increase in its use for thiamine mediated ATP production.
• This study may be able to inform future research or support the supplementation of B2 if further research is found.
• Blood plasma levels of other B vitamins and their metabolites and vitamers is unlikely to be related to chronic fatigue in individuals with IBD.
• Use of the IBD fatigue questionnaire may be of utility in clinical practice.

• Larger RCTs, which have been designed to analyse this specific research question are warranted, as this study was conducted in a small number of individuals as a secondary analysis of samples from another RCT.
• Supplementation RCTs of vitamin B2 alone and in combination with thiamine on individuals with IBD and chronic fatigue would be of benefit.