Introduction
Nutritional deficiencies are common in IBD patients and have been widely reported in Crohn's disease (CD) patients in particular. Nonetheless micronutrient screening is not routine in all centres in the UK. Body Mass Index (BMI) is widely used for detecting malnutrition in clinical practice but it is not sensitive marker of muscle mass. Hand grip strength (HGS) is quick to perform and may be an effective parameter to predict muscle function and health in IBD patients in busy outpatient settings. Different cut points are used in clinical practice to determine muscle weakness and may yield different results.
Aims & Methods
The aims of this study were (1) To examine micronutrient status (2) To establish the incidence of over- and under-weight and (3) To measure hand grip strength to determine the frequency of dynapenia in stable patients with IBD referred to specialist dietitian clinic for advice.
A baseline micronutrient screen including 9 vitamin and minerals (Vitamins A,D, E, folate, B12, ferritin, selenium, copper and zinc as well as haemoglobin) was performed on all consenting patients at initial dietitian appointment. Inflammatory marker, C reactive protein, was also checked. Patients with raised CRP, were excluded from the micronutrient analysis. All patients were weighed, height measured and BMI calculated. Hand grip strength was measured using Marsden hand grip dynamometer. The maximum result of 6 trials was recorded and its corresponding percentile (1). Dynapenia was defined as HGS<16kg for females and <27kg for males (2) . Results of Ulcerative colitis (UC) and Crohn’s disease (CD) patients were compared.
Results
A total of 292 consecutive patients, (108m, 184 f) referred for dietitian input from April 2023 to March 2025 were included. Mean age was 45 years (SD18). 201 patients with CD and 91 with UC were included. Results are presented in Table 1. No difference in micronutrient status was found between CD and UC patients apart from vitamin D where a higher incidence of deficiency was found in UC compared with CD patients (p=0.045). Contrary to widespread belief incidence of underweight was low in both CD and UC with a higher incidence of obesity in both groups than underweight. Over a quarter of the IBD population had muscle weakness defined by both Dodds et al (2014) and Cruz-Jentofft et al (2019) which is concerning (1,2).
| NUTRITIONAL STATUS | CD | UC |
| BMI kg/m2 | Mean (SD)
24.8 (6.1)
<18.5 kg/m2 n=19 (9.5%)
>30kg/m2 n=33 (16.4%) | Mean (SD)
25.5 (6.5)
<18.5kg/m2 n=6 (6.7%)
>30 Kg/m2 n= 19 (21%) |
| HAND GRIP STRENGTH maximum (kg) | 38.5 (11.3) M
21.4 (7) F
<16kg n=20 (28%)
<27kg n=11( 20%)
<10TH Percentile n=48 (37.5%) | 40.2 (9.1)M
22.3 (6.6)F
<16kg n=3 (9%)
<27kg n=3 (11%)
<10th percentile n=18 (30%) |
| VITAMIN D | 77% | 68%* |
| FOLATE | 12.8% | 17.9% |
| B12 | 5.6% | 4.8% |
| SELENIUM | 10.7% | 3.4% |
| ZINC | 31.5% | 34.9% |
| FERRITIN | 23.2% | 15.4% |
| LOW HAEMOGLOBIN | 31.0% (M)
20.3% (F) | 35.4%(M)
22.6% (F) |
Conclusion
Vitamin D status in particular should be monitored in all stable patients with IBD. A high proportion of both UC and CD patients were found to have weak muscle strength. HGS is a readily obtainable measure quick to perform and could be easily incorporated into routine clinical practice. Further research is needed to establish its clinical significance for stable IBD patients.
References
1. Dodds RM, Syddall HE, Cooper R, Benzeval M, Deary IJ, Dennison EM, Der G, Gale CR, Inskip HM, Jagger C, Kirkwood TB, Lawlor DA, Robinson SM, Starr JM, Steptoe A, Tilling K, Kuh D, Cooper C, Sayer AA. Grip strength across the life course: normative data from twelve British studies. PLoS One. 2014 Dec 4;9(12):e113637. doi: 10.1371/journal.pone.0113637. PMID: 25474696; PMCID: PMC4256164.
2. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M; Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019 Jan 1;48(1):16-31. doi: 10.1093/ageing/afy169. Erratum in: Age Ageing. 2019 Jul 1;48(4):601. doi: 10.1093/ageing/afz046. PMID: 30312372; PMCID: PMC6322506.
Disclosure
No conflict of interest to disclose
