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.
Highlights
Introduction distributed under the terms andThe prevalence of malnutrition in inflammatory bowel diseases (IBD) is estimated to be between 6.1% and 69.7% depending on the definition used, the type of IBD, the clinical setting and disease activity [1,2]
Clinical recommendations for nutritional therapy for IBD patients include assessment of nutritional status, and malnutrition risk screening upon diagnosis of IBD and annually [5]
IBD patients who were of normal nutritional status and developed malnutrition were compared to age, gender and disease-matched controls who maintained normal nutritional status
Summary
Introduction distributed under the terms andThe prevalence of malnutrition in inflammatory bowel diseases (IBD) is estimated to be between 6.1% and 69.7% depending on the definition used, the type of IBD, the clinical setting and disease activity [1,2]. Malnutrition and sarcopenia are associated with poor clinical outcomes, hospital admissions, response to therapy and quality of life [1,3,4]. Due to its high prevalence and associated risks, early detection of IBD patients at risk of malnutrition development is of high importance. The most common screening tool for malnutrition risk, and one of the most common tools used in practice, is the Malnutrition Universal Screening Tool (MUST), incorporating body mass index (BMI), recent weight loss and inadequate nutritional intake [6]. Other screening tools, such as the Malnutrition Screening Tool (MST)
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