Introduction
Inadequate nutritional status is a major complication of chronic gastrointestinal diseases such as Inflammatory Bowel Diseases (IBD), including two main types: Crohn's Disease (CD) and Ulcerative Colitis (UC) [1]. Previously, sarcopenia and myopenia were associated only with ageing, but they also affect patients with chronic diseases, including IBD, regardless of age [2]. Both malnutrition and sarcopenia lead to poorer health outcomes in IBD patients, increasing the risk of hospitalization, disease exacerbation, need for surgery and post-operative complications [3, 4].
Aims & Methods
The aim of this study was to assess the prevalence of sarcopenia, myopenia and malnutrition in Polish patients with IBD using clinical tools available in daily practice. A total of 91 IBD patients (48 CD, 43 UC), aged 18-65 years, with both inactive and active disease (30 and 61, respectively), were included in the study. Sarcopenia was assessed using the Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire and the 5-times sit-to-stand test, while myopenia was evaluated through the Fat-Free Mass Index (FFMI). Nutritional status was determined using BMI, the Nutritional Risk Screening (NRS-2002), biochemical parameters (albumin and ferritin levels), and body composition analysis.
Results
Malnutrition was identified in 22% of patients based on BMI (3 inactive, 17 active IBD) and in 31.9% based on NRS-2002 (1 inactive, 28 active IBD). Based on BMI, 25 patients (27.5%) were classified as excessive body weight, and 44% of these were in the active phase of the disease. Hypoalbuminemia and low ferritin levels were observed in 64% and 38.3% of participants, respectively. Sarcopenia was present in 24.3% of patients (SARC-F) and 17.6% (sit-to-stand test), while myopenia was detected in 36.7%. Sarcopenia and myopenia were more common during active disease phases. A significant association was found between regular physical activity of patients and a reduced incidence of myopenia (OR = 0.24; 95% CI: 0.09 - 0.64) – compared to patients who did not declare such activity. It was observed that patients receiving biological therapy had a significantly lower prevalence of malnutrition according to the NRS - 2002 scale (OR = 0.33; 95% CI: 0.11 - 0.98). Additionally, in this patient group, a trend toward a lower prevalence of sarcopenia, as assessed by the SARC - F questionnaire, was observed. No significant associations were found between the increased prevalence of either sarcopenia or myopenia and disease type, patient gender, or disease duration.
Conclusion
Our study shows that malnutrition and sarcopenia are prevalent in Polish IBD patients, necessitating comprehensive assessment tools. We demonstrated that reliance on BMI alone is insufficient. While BMI identified malnutrition in a lower percentage of patients, the use of additional parameters, such as the NRS - 2002 scale and biochemical markers, provided a more comprehensive assessment. Higher BMI values can obscure malnutrition by masking muscle loss and nutritional deficiencies, making standard BMI assessments insufficient. In addition, we observed that biological therapy can have a beneficial effect on the nutritional status of IBD patients. We have shown that all of the methods we have presented for detecting malnutrition and sarcopenia can be successfully used in patients with IBD. However, further research is needed to identify the preferred method.
References
[1] Massironi S, Viganò C, Palermo A, Pirola L, Mulinacci G, Allocca M, Peyrin-Biroulet L, Danese S. Inflammation and malnutrition in inflammatory bowel disease. Lancet Gastroenterol Hepatol. 2023 Jun;8(6):579-590. doi: 10.1016/S2468-1253(23)00011-0.
[2] Neelam PB, Sharma A, Sharma V. Sarcopenia and frailty in inflammatory bowel disease: Emerging concepts and evidence. JGH Open. 2024 Jan 27;8(1):e13033. doi: 10.1002/jgh3.13033.
[3] Liu S, Ding X, Maggiore G, Pietrobattista A, Satapathy SK, Tian Z, Jing X. Sarcopenia is associated with poor clinical outcomes in patients with inflammatory bowel disease: a prospective cohort study. Ann Transl Med. 2022 Mar;10(6):367. doi: 10.21037/atm-22-1126.
[4] Dhaliwal A, Quinlan JI, Overthrow K, Greig C, Lord JM, Armstrong MJ, Cooper SC. Sarcopenia in Inflammatory Bowel Disease: A Narrative Overview. Nutrients. 2021 Feb 17;13(2):656. doi: 10.3390/nu13020656.
