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Suggested laboratory tests for monitoring nutrition in patients with inflammatory bowel disease

	Ulcerative colitis	Crohn disease or indeterminate colitis	Conditional testing*
Complete blood count	X	X
CRP, ESR^¶	X	X
Albumin^¶	X	X
25-hydroxyvitamin D	X	X
Iron, ferritin, TIBC^Δ			X
Vitamin B12			X
Calcium			X
Phosphorus			X
Magnesium			X
Vitamin A			X
Vitamin E			X
PT or INR			X
Zinc			X
Folate			X
DXA scanning^◊			X

The above tests and frequencies reflect the author's practice and may vary among providers. We perform these tests approximately every 6 to 12 months in patients with quiescent disease and may test more frequently in patients with active disease or known deficiency or in growing children.

CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; TIBC: total iron-binding capacity; PT: prothrombin time; INR: international normalized ratio; DXA: dual-energy x-ray absorptiometry.
* These tests are performed in the case of malnutrition, malabsorption, symptoms of deficiency, or specific risk factors (eg, anemia, ileal resection, total parenteral or enteral nutrition, profuse diarrhea, or a high-output ostomy).
¶ CRP, ESR, and albumin primarily reflect the inflammatory state rather than nutritional status. This information is important for the interpretation of the other results, especially ferritin, which is increased in the setting of inflammation.
Δ Iron studies should be checked at diagnosis and then as needed for patients with unexplained anemia.
◊ DXA scanning is recommended in adults with risk factors for bone disease, including prolonged corticosteroid use or low-trauma fracture (refer to UpToDate content on metabolic bone disease in inflammatory bowel disease). There are no generally accepted standards for frequency of DXA scanning in children with inflammatory bowel disease.

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