Impact of malnutrition and sarcopenia on quality of life in patients with inflammatory bowel disease: A multicentre study.

Abstract

Malnutrition and subsequent alterations in body composition (BC), particularly sarcopenia, are common but not yet elucidated in patients with inflammatory bowel disease (IBD); we aimed to detail the changes in BC and the characteristics of co-occurrence of malnutrition and sarcopenia in IBD patients and to investigate its effect on quality of life. This study was a multicentre, prospective, observational study involving four tertiary referral hospitals in China. The following data were collected from consecutive IBD inpatients: demographic information, medical history, recent weight change, handgrip strength (HGS) and BC parameters by bioelectrical impedance analysis (BIA). Nutritional assessments were performed through stepwise screening (Nutritional Risk Screening 2002) and diagnosis (World Health Organization-related body mass index [BMI], subjective global assessment, European Society for Clinical Nutrition and Metabolism 2015 and Global Leadership Initiative on Malnutrition [GLIM] criteria). The quality of life was assessed by the Inflammatory Bowel Disease Questionnaire. IBD patients were compared with 1:1 sex-, age- and BMI-matched healthy controls (MHC). A total of 238 IBD patients (177 Crohn's disease [CD] and 61 ulcerative colitis [UC]), 68.5% male, with a mean age of 38.5±14.0years and a mean BMI of 19.8±3.5kg/m2 , were recruited. Compared with MHC (n=122), IBD patients showed significant deterioration in BC and physical function, characterized by muscle depletion (appendicular skeletal muscle mass index [ASMI], 8.0±1.3 vs. 6.7±1.2kg/m2 , Δ% -15.0% [-22.0%, -10.0%], P<0.001) and fat accumulation (visceral fat area, 32.9±22.6 vs. 66.5±35.8, Δ% 110.0% [35.0%, 201.0%], P<0.001). The prevalence of GLIM-defined malnutrition and sarcopenia in IBD patients was 60.1% and 25.2%, respectively. The nutritional status of patients with CD was worse than that of patients with UC. The activity phase of IBD significantly and negatively affected BC, while the lesion location did not. The co-occurrence of sarcopenia and malnutrition was not optimistic; 16.4-21.8% of patients suffer from sarcopenia and malnutrition based on different criteria at the same time, which was accompanied by a reduction in quality of life. HGS was correlated with various BC parameters (body cell mass, r=0.76; ASMI, r=0.70; fat-free mass, r=0.73, all P<0.001). GLIM-defined malnutrition and sarcopenia were prevalent in IBD patients and kept a high rate of co-occurrence, which was accompanied with impaired quality of life. The alteration of BC in IBD patients was characterized by muscle depletion and fat accumulation. The strong correlation between HGS and BIA-derived BC suggested its hopeful evaluation in nutritional status and sarcopenia in IBD patients.