Abstract
Malnutrition is highly prevalent in inflammatory bowel disease (IBD) patients and disproportionately affects those admitted to hospital. Malnutrition is a risk factor for many complications in IBD, including prolonged hospitalization, infection, greater need for surgery, development of venous thromboembolism, post-operative complications, and mortality. Early screening for malnutrition and prompt nutrition intervention if indicated has been shown to prevent or mitigate many of these outlined risk factors. There are many causes of malnutrition in IBD including reduced oral food intake, medications, active inflammation, and prior surgical resections. Hospitalization can further compound pre-existing malnutrition through inappropriate diet restrictions, nil per os (NPO) for endoscopy and imaging, or partial bowel obstruction, resulting in “post-hospital syndrome” after discharge and readmission. The aim of this article is to inform clinicians of the prevalence and consequences of malnutrition in IBD, as well as available screening and assessment tools for diagnosis, and to offer an organized approach to the nutritional care of hospitalized adult IBD patients.
Highlights
Inflammatory bowel disease (IBD) is a chronic debilitating inflammatory disorder of the gastrointestinal tract characterized by a relapsing and remitting course
There are multiple contributors to sarcopenia in IBD, including chronic inflamMalnutrition in hospitalized patients is associated with prolonged length of stay, higher readmission rates after discharge, greater rates of complications, infections, and increased mortality [18,20,21]
Given the success of hospitalized in-patient malnutrition screening in other populations that led to nutritional interventions and reduced patient mortality and readmissions, we suggest using either the Malnutrition Universal Screening Tool (MUST) or NRS-2002 to screen hospitalized IBD patients [46,48]
Summary
Inflammatory bowel disease (IBD) is a chronic debilitating inflammatory disorder of the gastrointestinal tract characterized by a relapsing and remitting course. The risk of disease progression or developing complications requiring surgery remains high, with a ten-year surgical risk of 46.6% and 15.6% in CD and UC, respectively [4]. In the case of IBD, malnutrition can result from a number of different mechanisms (see Figure 1) including decreased oral intake, medication-related nutrient interactions, malabsorption, gastrointestinal nutrient loss, bile salt wasting, surgical resections, active inflammation, small intestinal bacterial overgrowth, chronic dehydration with resultant renal insufficiency, micronutrient deficiency, and metabolic bone disease. Small bowel involvement in CD may lead to greater protein-energy malnutrition and micronutrient deficiencies over time, whereas UC patients tend to present with rapid nutritional decline during an acute flare or hospitalization [8,9].
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