Table 4.
Key studies highlighting nutritional deficiencies associated with AST
| Study | Study characteristic | Key findings |
|---|---|---|
| Hypomagnesemia | ||
| Kieboom et al.23 | Population-based prospective cohort study N = 9,818 individuals from the general population | Prolonged PPI use was associated with lower levels of serum magnesium level and significantly increased risk of PPIH (OR, 2.00) Concomitant loop diuretic use further increases the risk The risk was less in H2RA users |
| Cheungpasitporn et al.24 | Meta-analysis of nine observational studies N = 1,09,798 patients | PPI use was associated with a 43% increased risk of hypomagnesemia |
| Srinutta et al.25 | Meta-analysis of 16 observational studies N = 1,31,507 patients | PPI use was significantly associated with hypomagnesemia (OR, of 1.83; p = 0.002) High-dose PPI use was associated with higher odds relative to low-dose PPI use (OR 2.13; p = 0.005) |
| Seah et al. 202326 | Retrospective study N = 53,149 patients | Higher recurrence of hypomagnesemia in patients continuing PPI therapy (p = 0.009) |
| Iron deficiency | ||
| Sarzynski et al.27 | Retrospective cohort study N = 98 patients on chronic PPI therapy | Chronic PPI therapy resulted in a reduction in hematologic indices compared with baseline, including a decrease in hemoglobin (–0.19 gm/dL, p = 0.03), hematocrit (–0.63%, p = 0.02), and mean corpuscular volume (–0.49 fL, p = 0.05). |
| Tran-Duy et al.28 | Case-control study N = 26,806 patients with iron deficiency | Chronic PPI use increases the risk of iron deficiency (OR, 3.60) A clear association was seen between iron deficiency and PPI use in terms of both duration of treatment and PPI dosage. Continuous use of PPIs for one year or more is linked to elevated iron deficiency risk. Average daily dosage of PPIs equal to or exceeding 1 DDD have a higher risk of iron deficiency. |
| Douwes et al.29 | Cross-sectional cohort study N = 646 stable outpatient RTR | PPI use was inversely associated with serum iron (p = 0.001), natural log-transformed serum ferritin (p < 0.001), TSAT (p = 0.001), and hemoglobin levels (p = 0.007)
A higher risk of iron deficiency was observed in patients taking high dosages of PPIs |
| Vitamin B12 deficiency | ||
| Dharmarajan et al.30 | Cross-sectional study N = 659 adults >60 years age | Vitamin B12 levels decline during prolonged PPI use in older adults; however, prolonged H2RA use did not affect vitamin B12 status |
| Mumtaz et al.31 | Cohort study N = 1,225 patients on long-term use of PPIs | Patients taking PPIs were more likely to develop vitamin B12 deficiency. More than half of the men exhibited low levels of vitamin B12 |
DDD, defined daily dose; H2RA, histamine-2 receptor antagonist; ICU, intensive care unit; OR, odds ratio; PPI, proton pump inhibitor; PPIH, proton pump inhibitor-induced hypomagnesemia; RTR, renal transplant recipients; TSAT, transferrin saturation