Introduction

Inflammatory bowel disease patients are at risk of malnutrition due to the nature of the disease, the drugs used, and some dietary restrictions.Several screening tools are available, including the MUST score: the Malnutrition Universal Screening Tool, a simple and an easy-to-use tool.

Aims & Methods

The aim of our study was to assess the frequency of malnutrition risk using MUST score in IBD patients.
We conducted a prospective study that included 142 patients with IBD. All patients with IBD completed a self-administered nutrition screening assessment using the MUST score.Patients with a MUST score of ≥ 2 were concluded as high-risk for malnutrition.

Results

A total of 142 IBD patients were studied over 2 month period. We enrolled a total of 116 ( 82,1%) patients from outpatient and 26 (18,3%) from inpatient . Risk of malnutrition was identified in 21,1 % of patients according to MUST score. Number of hospitalized patients with malnutrition risk was significantly higher than the outpatient ones ( 84,6% vs 6.9 %, p<0.01).The frequency of high malnutrition risk was 36,8.% in ulcerative colitis (UC) patients and 15,4% in Crohn’s disease (CD) patients (p=0.006).
A high MUST score was strongly associated with an elevated Harvey Bradshaw Index score (p<0.01) for patients with Crohn’s disease, and with Partial Mayo Index scores (p<0.01) for patients with ulcerative colitis.

Conclusion

In our study, we found that the risk of malnutrition was high in both CD and UC patients, especially inpatients ,and it correlates to the disease activity.Considering the effect of malnutrition on the prognosis of the disease ,IBD patients should be evaluated in terms of malnutrition risk both during their routine follow-ups and during hospitalizations.

Introduction

Sarcopenia is associated with increased morbidity and mortality in IBD. The main objective of thisstudy was to prospectively evaluate sarcopenia by combining morphological and functional criteria inan outpatient IBD population.

Aims & Methods

In a prospective cohort study, we included all IBD patients admitted to the Day Hospital (DH) of ourdepartment between March 1st and 31st, 2023. Patients with short bowel syndrome were notincluded. Muscle mass was assessed using a Bodystat®1500MDD dual-frequency impedance meter,and muscle function was assessed by measuring handgrip strength, Carym® digital dynamometer. Pre-sarcopenia was defined by a handgrip measurement < 16 to 26, and myopenia was defined by anappendicular muscle mass index (AMMI) < 5.5 to 7 kg/m2 or a fat-free mass index (FFMI) < 15 to 17 inwomen or men. Sarcopenia was defined by the association of pre-sarcopenia and myopenia. Patientswere followed-up at 6 months to measure a composite criterion of disease activity combining one ofthe factors: FC > 250μg/g, endoscopic activity, therapeutic change, hospitalization, or IBD-relatedsurgery

Results

In total, 60 patients were included, median age 37 years (IQR 28-54), 55% women, with CD (52%) orUC (48%) diagnosed 9 years (4-17) ago, mostly in remission (67%, n=40). Patients with CD had ileocolic(48%), ileal (35%), or colonic (16%) involvement. Patients with UC had E1 (7%), E2 (41%), or E3 (52%)involvement. A history of digestive surgery linked to IBD was noted in 30% of cases. The biologicsadministered were infliximab (61%),vedolizumab (25%), or ustekinumab (14%). The BMI was 24 (21-27) and serum albumin was 41g/l (39-44). The prevalence of sarcopenia, pre-sarcopenia and myopeniawas 10%, 11% and 20%, respectively. Sarcopenic patients were significantly older (59 vs. 36 years,p=0.01), with older disease (20 vs. 8 years, p=0.003), and associated joint damage (40% vs. 2%,p=0.002) and tended to involve CD more frequently (80 vs. 49%, p=0.36). There was no significantdifference between biologics, BMI or albuminemia in sarcopenic patients, but vitamin D levels tendedto be lower (15 vs. 43, p=0.27). Myopenia was significantly associated with a history of surgery (67 vs.21%, p=0.004), a lower BMI (21 vs. 24, p=0.001) and a more active disease at M6 according to thecomposite criterion (50 vs. 21%, p=0.04 after adjustment for age, sex, and disease activity at baseline).Myopenia indices were strongly correlated with handgrip values(r=0.7, p<0.001)

Conclusion

In a prospective study of Day Hospital IBD patients, sarcopenia was identified by impedancemetry in11% and myopenia in 20% of cases, and associated with an increase in morbidity

Disclosure

No conflict of interest

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.

Introduction

Inflammatory bowel disease (IBD) significantly impacts patients’ nutritional status and quality of life. Nutritional deficiencies are common in IBD and can worsen disease progression.

Aims & Methods

The aim of this study is to assess the nutritional status of patients with IBD and explore its relationship with quality of life in this cohort. A cross-sectional study conducted at a specialized center assessed nutritional status using the MUST and MIRT tools. For pediatric patients, the "Strong Kids" screening tool was used. A multidisciplinary nutritional intervention was provided, followed by quality of life evaluation using the EQ-5D and IBDQ-32 instruments. Statistical analyses were performed to examine the association between nutritional status and quality of life.

Results

Among 90 IBD patients, 26.6% required hospitalization due to disease flare-ups, primarily adults and females. The median age was 36.7 years (range: 4–81, SD: 32.6), with 58.3% diagnosed with Crohn’s disease and 83.3% requiring biologic therapy (Table 1). The odds ratios (OR) for malnutrition in hospitalized patients were 8.33 (95% CI: 1.16–27) for ulcerative colitis and 25 (95% CI: 11.6–45.2) for Crohn’s disease. All hospitalized adults exhibited poor biochemical control and moderate-to-severe hypoalbuminemia; 25% had sarcopenia. Nutritional support was provided to 49% of patients within the past year. All severely ill hospitalized patients were malnourished.
Pediatric patients, all of whom received nutritional support, demonstrated a higher degree of nutritional compromise. Among these, 25% required parenteral nutrition, while 87.5% received enteral nutrition, primarily with high-calorie, high-protein formulas. During hospitalization, 87.5% gained weight and improved nutritionally, with 75% achieving normal nutritional status at three-month follow-up, although one patient died.
Following the nutritional intervention, over 80% of adults did not experience further nutritional deterioration. In the outpatient cohort, 20 patients were evaluated, of whom 30% were identified as high risk for malnutrition according to MUST, and 25% had nutritional risk (MIRT score ≥3). Patients with poorer initial nutritional status had significantly worse quality of life, with notable impairments in mobility (P = 0.2778; 95% CI: 2.03–64.1), self-care (P = 0.003; 95% CI: 9.45–90.5), daily activities (P = 0.1457; 95% CI: 1.14–58.2), pain/discomfort (P = 0.197; 95% CI: 0.53–53.3), and visual analog scale scores (P = 0.012; 95% CI: 22.9–88.4). Poor nutritional status was also associated with lower quality of life scores on the IBDQ-32 (P = 0.04; 95% CI: 10.3–60.7).

Conclusion

Nutritional status is a key component of IBD management, as malnutrition is linked to poorer quality of life. Screening tools such as MUST and MIRT in adults, and “Strong Kids” in children, are essential for early identification of at-risk patients. Pediatric patients tend to have more severe nutritional compromise than adults, and nutritional support during hospitalization contributes significantly to recovery.

References

1. Jabłońska B, Mrowiec S. Nutritional Status and Its Detection in Patients with Inflammatory Bowel Diseases. Nutrients. 2023 Apr 20;15(8):1991.
doi: 10.3390/nu15081991.
2. Pulley J, Todd A, Flatley C, Begun J. Malnutrition and quality of life among adult inflammatory bowel disease patients. JGH Open. 2019;4(3):454–60.
doi: 10.1002/jgh3.12278.
3. Valvano M, Capannolo A, Cesaro N, et al. Nutrition, Nutritional Status, Micronutrients Deficiency, and Disease Course of Inflammatory Bowel Disease. Nutrients. 2023 Aug 31;15(17):3824. doi: 10.3390/nu15173824.
4. Izquierdo LVP, Orduz-Diaz G, Frías-Ordoñez J, et al. P563 Nutritional screening in patients with inflammatory bowel disease: A challenge in the timely diagnosis of malnutrition and sarcopenia. J Crohns Colitis. 2024;18(Suppl_1). doi: 10.1093/ecco-jcc/jjad212.0693.

Disclosure

None declared