Relation of geriatric nutritional risk index with clinical risks in elderly‐onset ulcerative colitis

Abstract

Background and AimWorldwide increasing aging societies have many elderlies with intractable diseases including ulcerative colitis (UC). Reportedly, each patients' frailty as well as chronological age is a clinical risk factor of elderly‐onset UC (EOUC). Because malnutrition is one of the major manifestations of frailty, we aimed to investigate the effect of malnutrition on the prognosis of EOUC with geriatric nutritional risk index (GNRI), a prognostic tool for several diseases in the elderly to estimate malnutrition, and to evaluate clinical risks among EOUC patients in Japan, the world‐leading aging society.MethodsThe EOUC patients (≥ 65 years at diagnosis, n = 2778) in the previous nationwide survey were classified by age and GNRI, and odds ratios (ORs) of hospitalization and UC‐related surgery were determined to evaluate the effects of malnutrition on the EOUC patients as well as aging.ResultsThe risks of hospitalization and surgery were elevated as age advanced. The value of GNRI, negatively correlated with disease activity (r = −0.53), could distinguish severe activity (cutoff ≤ 86.82, sensitivity = 0.79, and specificity = 0.77) and discriminate the EOUC patients suffering from surgery and hospitalization. In a multivariate analysis, GNRI ≤ 86.82 was a higher risk of hospitalization (OR: 4.0, 95% CI, 2.5–6.5) and surgery (OR: 2.7, 95% CI, 0.98–7.4) than cutoff age ≥ 75 years old (OR of hospitalization and surgery were 1.4 [95% CI, 0.99–2.0] and 2.3 [95% CI, 0.8–6.3], respectively).ConclusionMalnutrition estimated by GNRI was significantly related with poor clinical courses of the EOUC patients, suggesting that evaluation of nutritional status at the onset might be useful for predicting risks of clinical courses.

Nutritional Status Indicators as a Predictor of Achieving Remission at Week 14 during Vedolizumab Therapy in Patients with Ulcerative Colitis: A Pilot Study

“…Due to the progress of treatment, patients over 60 years of age constitute an increasing population of IBD patients. Higashiyama et al suggested that the risks of hospitalization and surgery were elevated as age advanced [ 28 ]. Moreover, UC is diagnosed more and more often in the elderly.…”

“…In their study, the value of geriatric nutritional risk index negatively correlated with disease activity, could distinguish severe activity and discriminate the elderly-onset UC patients suffering from surgery and hospitalization. Researchers proposed that malnutrition estimated by geriatric nutritional risk index was significantly related with poor clinical courses of the elderly-onset UC patients, suggesting that the evaluation of nutritional status at the onset might be useful for predicting risks of clinical courses [ 28 ].…”

Geriatric Nutritional Risk Index assessment in elderly patients during the COVID‐19 outbreak

“…GNRI is a general indicator that evaluates the nutritional status of patients, that is, it is an effective and simple risk indicator reflecting the nutritional risk of patients, and has been proven as a predictor of hospitalized elderly patient prognosis 12 . GNRI is based on serum albumin and weight loss measurements, which are strong independent risk factors for mortality in elderly persons 19 . GNRI can also classify elderly patients according to morbidity and mortality risks in relation to pathologies often associated with malnutrition 20 .…”

The dietary practices and beliefs of people living with older-onset inflammatory bowel disease

“…Nutritional deficiency and malnutrition are well documented in ageing populations and a diagnosis of IBD, with associated malabsorption, impaired appetite and unpleasant symptoms, may increase this risk [7,39,40]. Furthermore, studies suggest that malnutrition may contribute to worse outcomes in patients with older-onset IBD [6,8,41,42] (Fig. 1).…”

“…1). Thus, although IBD dietary guidance suggests limiting the intake of animal protein, complete avoidance of protein-rich dietary components, such as meat and dairy products, may increase the risk of sarcopenia and its associated complications in more frail, elderly people [8,13,40,43]. Similarly, adequate intake of dietary fibre is recommended in those with IBD and its avoidance has been linked with adverse medical outcomes in older adults such as colorectal cancer and cardiovascular disease [13,14,[44][45][46].…”