Risk Factors for Malnutrition among IBD Patients

Abstract

(1) Background: Malnutrition is a highly prevalent complication in patients with inflammatory bowel diseases (IBD). It is strongly associated with poor clinical outcomes and quality of life. Screening for malnutrition risk is recommended routinely; however, current malnutrition screening tools do not incorporate IBD specific characteristics and may be less adequate for screening these patients. Therefore, we aimed to identify IBD-related risk factors for development of malnutrition. (2) Methods: A retrospective case-control study among IBD patients attending the IBD clinic of the Tel-Aviv Medical Center for ≥2 consecutive physician consultations per year during 2017–2020. Cases who had normal nutritional status and developed malnutrition between visits were compared to matched controls who maintained normal nutritional status. Detailed information was gathered from medical files, including: demographics, disease phenotype, characteristics and activity, diet altering symptoms and comorbidities, medical and surgical history, annual healthcare utility, nutritional intake and the Malnutrition Universal Screening Tool (MUST) score. Univariate and multivariate analyses were used to identify malnutrition risk factors. The independent risk factors identified were summed up to calculate the IBD malnutrition risk score (IBD-MR). (3) Results: Data of 1596 IBD patients met the initial criteria for the study. Of these, 59 patients developed malnutrition and were defined as cases (n = 59) and matched to controls (n = 59). The interval between the physician consultations was 6.2 ± 3.0 months, during which cases lost 5.3 ± 2.3 kg of body weight and controls gained 0.2 ± 2.3 kg (p < 0.001). Cases and controls did not differ in demographics, disease duration, disease phenotype or medical history. Independent IBD-related malnutrition risk factors were: 18.5 ≤ BMI ≤ 22 kg/m2 (OR = 4.71, 95%CI 1.13–19.54), high annual healthcare utility (OR = 5.67, 95%CI 1.02–31.30) and endoscopic disease activity (OR = 5.49, 95%CI 1.28–23.56). The IBD-MR was positively associated with malnutrition development independently of the MUST score (OR = 7.39, 95%CI 2.60–20.94). Among patients with low MUST scores determined during the index visit, identification of ≥2 IBD-MR factors was strongly associated with malnutrition development (OR = 8.65, 95%CI 2.21–33.82, p = 0.002). (4) Conclusions: We identified IBD-related risk factors for malnutrition, highlighting the need for a disease-specific malnutrition screening tool, which may increase malnutrition risk detection.

Impact of malnutrition and nutrition support in hospitalised patients with inflammatory bowel disease

“…1,2 Both higher disease activity and avoidance of specific foods during disease flares have been shown to be strong predictors of PCM in IBD patients. 3,4 Disease-related malnutrition has a number of known sequelae that contribute to morbidity and mortality, including delayed wound healing, impaired immune function and functional impairment via decreased muscle function. 5 In IBD, poor nutritional status has been associated with suboptimal clinical response to therapy and reduced quality of life.…”

Frailty and Inflammatory Bowel Disease: A Scoping Review of Current Evidence

“…For example, inflammation can induce loss of skeletal muscle and may eventually lead to sarcopenia [ 27 ]. In addition, disease activity is described as a risk factor for malnutrition and polypharmacy [ 56 , 57 ]. Active disease can also impact the mental domain as both mood disorders and cognitive performance have been associated with disease activity over time in IBD [ 58 , 59 ].…”

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

“…The valuable work was published in 2021 by researchers from Israel aimed to identify IBD-related risk factors for development of malnutrition. Einav et al conducted retrospective matched case-control study to identify IBD-related risk factors for development of malnutrition [ 23 ]. They proved that independent IBD-related malnutrition risk factors were: 18.5 ≤ BMI ≤ 22 kg/m 2 , high annual healthcare utility and endoscopic disease activity.…”