More Malnutrition Screenings Recommended for IBD Patients

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Assessing fat free mass and reduced intake are particularly important in identifying malnutrition in patients with inflammatory bowel disease.

In new research presented during the 2022 European Crohn’s and Colitis Organisation annual meeting, investigators identified predictors for malnutrition in patients with inflammatory bowel disease (IBD).

A team, led by Evelien Hendrix, PhD, Maastricht University, School for Nutrition and Translational Research in Metabolism NUTRIM, assessed the prevalence of malnutrition and evaluated the accuracy of screening recommendations given in current IBD guidelines and identified which patients have an increased risk of malnutrition.

IBD and Malnutrition

IBD is often linked to malnutrition, which can progress the course of the disease and impact the patient’s quality of life. There remains a need for guidelines that advocate for screening patients in clinical practice.

In past research, the prevalence of malnutrition in IBD-cohorts varies, mainly because of the differences in parameters used in the study.

In the study, the investigators used single and combined sets of parameters from the Global Leadership Initiative-on Malnutrition (GLIM) criteria.

Overall, 200 patients were included in the final analysis, 139 of which had Crohn’s disease and 61 had ulcerative colitis.

Defining Malnutrition

The team defined malnutrition using the GLIM criteria, based on the combination of phenotypic and an etiologic criterium. Malnutrition was also determined using single parameters for impaired body composition, muscle strength, or caloric intake, as well as the combination of low body mass index (BMI) and unintentional weight loss as advised in current IBD guidelines.

The investigators also used the Short Nutritional Assessment Questionnaire (SNAQ) and Malnutrition Universal Screening Tool (MUST) to screen for malnutrition and analyzed independent risk factors using multivariable logistic regression.

Finding the Right Parameters

Of the 200 patients, 20.5% (n = 41) fulfilled the GLIM criteria and 47.5% (n = 95) had at least one parameter for malnutrition impaired, the majority of which was for the fat free mass index measure.

When the investigators used unintentional weight loss and/or low BMI as a screening marker for nutritional status in line with current IBD guidelines, only 14.5% (n = 29) of patients would have been identified.

However, using the SNAQ technique for screening, the investigators identified 22% (n = 44) with a positive score, compared to 12.9% (n = 23) using the MUST technique.

For gender, only female sex was linked to malnutrition when at least 1 parameter was impaired (OR, 2.47; 95% CI, 1.35-4.51).

“Almost half of the IBD outpatients had malnutrition as defined by various single parameters and irrespective of disease characteristics,” the authors wrote. “Screening instruments and/or markers according to current IBD guidelines, did not identify a substantial part of the patients.”

The investigators said the study results confirm that screening for malnutrition should be recommended for all outpatients by multiple parameters, but special attention should be paid for assessing fat free mass and reduced intake.

The study, “P116 Screening for low BMI and unintentional weight loss alone is insufficient to identify patients at risk for malnutrition in an outpatient IBD population,” was published online by the European Crohn’s and Colitis Organisation.