Malnutrition risk in new Dx IBD

June 20, 2023

Issue 12

Clinical Question

How prevalent is malnutrition in newly-diagnosed IBD and who is most at risk?

Editor’s Bottom Line

Nutrition status should be assessed routinely in patients with IBD, particularly in those with active Crohn’s disease and prior resection.

Reference

Gold SL, Rabinowitz LG, Manning L, et al. High Prevalence of Malnutrition and Micronutrient Deficiencies in Patients With Inflammatory Bowel Disease Early in Disease Course. Inflamm Bowel Dis. 2023 Mar 1;29(3):423–29; https://www.ncbi.nlm.nih.gov/pmc.pdf

Synopsis

This single-center retrospective study included 182 adults with IBD diagnosed a median of 2.5 months prior to enrolment. Patients were a median 27 years of age at baseline and 55% had normal body mass index, while 10% were underweight, 24% were overweight and 11% were obese. Forty-five percent of patients reported unintentional weight loss at the time of study enrolment.

The authors employed five malnutrition screening tools, and compared their accuracy in identifying patients at moderate-to-high risk of malnutrition, as defined by the European Society for Clinical Nutrition and Metabolism (ESPEN).

Findings revealed that 36% of patients met ESPEN criteria for malnutrition. In univariate analyses, those who had prior surgery for IBD were most at risk, with a 4.5-fold increased likelihood of malnutrition (Odds Ratio [OR]: 4.5; 95% Confidence Interval [CI], 1.1–18.2; p=0.004). Active Crohn’s disease (OR: 2.8; 95% CI, 1.1–7.4; p=0.03) and diarrhea (OR:  2.1; 95% CI, 1.1–4.0; p=0.02) were also predictors of malnutrition risk in a univariate model. The authors did not perform a multivariate analysis.

Of the 74% of patients who had serum micronutrients measured, 78% had one or more micronutrient deficiencies. The most common micronutrient deficiencies were vitamin D 25-OH (74%), ferritin (42%), vitamin B12 (22%), vitamin C (22%), zinc (15%), and phosphorus (15%).

The Malnutrition Universal Screening Tool and the Saskatchewan IBD Nutrition Risk Tool were most sensitive, detecting 100% of patients at moderate-to-high risk of malnutrition. The least sensitive screening tool was the Nutritional Risk Index, which detected 76.7% of patients at elevated risk of malnutrition.

Details

Study Design: Retrospective cohort

Funding: National Institutes of Health

Allocation: Not applicable

Setting: Single-center

Level of Evidence: 2b