Unveiling hidden malnutrition in IBD: A cross-sectional multi-tool analysis reveals high prevalence beyond weight-based assessment

Abstract

Objective

Malnutrition is a serious complication of inflammatory bowel disease (IBD), associated with increased morbidity, postoperative complications, and reduced quality of life. While well-documented in Western populations, data on nutritional status in understudied IBD populations remain scarce. This study aims to comprehensively evaluate the nutritional status of an IBD cohort at a tertiary referral center in Algeria using multiple assessment tools, to identify factors associated with malnutrition, and to explore the relationship between inflammatory activity and nutritional parameters.

Patients and methods

A prospective cross-sectional study was conducted at a tertiary referral center. Nutritional assessment included anthropometric measurements, biochemical parameters, and four validated scores: CONUT, McClave, HALP, and GLIM criteria. Disease activity was assessed using the Harvey-Bradshaw Index for Crohn's disease and the Partial Mayo Score for ulcerative colitis.

Results

Ninety patients were included forming a Crohn's-dominant cohort (94.4% Crohn's disease). Mean age was 39.5 ± 13.7 years, 53.3% female. Overall, 24.4% had active disease. Nutritional assessment revealed: 18.9% had low BMI (<18.5 kg/m²). Malnutrition prevalence varied by tool: CONUT 46.7%, McClave 20.6%, HALP 26.8%, and GLIM 14.6%. Active disease significantly correlated with nutritional deterioration and worse nutritional scores (p < 0.01). Multivariate logistic regression analysis was performed indicates that although clinical flare and hospitalization were associated with malnutrition in univariate analysis, none of the variables reached statistical significance in the multivariate analysis.

Conclusions

Malnutrition is highly prevalent in IBD patients, particularly during active disease. The inflammatory process plays a crucial role in nutritional deterioration. Systematic nutritional screening using composite scores should be integrated into routine management, especially during disease flares.

Resumen

Objetivo

La desnutrición es una complicación grave en la enfermedad inflamatoria intestinal (EII), relacionada con mayor morbilidad y complicaciones posoperatorias. Este estudio evaluó el estado nutricional de pacientes con EII en un centro terciario en Argelia mediante múltiples herramientas.

Pacientes y métodos

Estudio transversal prospectivo que incluyó mediciones antropométricas, parámetros bioquímicos y cuatro puntuaciones validadas: CONUT, McClave, HALP y GLIM. La actividad de la enfermedad se evaluó con el Índice de Harvey-Bradshaw para Crohn y la Puntuación Parcial de Mayo para colitis ulcerosa.

Resultados

Noventa pacientes (94.4% enfermedad de Crohn), edad media 39.5 ± 13.7 años, 53.3% mujeres. El 24.4% presentaba enfermedad activa. Un 18.9% tenía IMC bajo (<18.5 kg/m²). La prevalencia de desnutrición varió según herramienta: CONUT 46.7%, McClave 20.6%, HALP 26.8%, GLIM 14.6%. La enfermedad activa se correlacionó con deterioro nutricional (p< 0.01). El análisis de regresión logística multivariante realizado indica que, aunque el brote clínico y la hospitalización se asociaron con la desnutrición en el análisis univariante, ninguna de las variables alcanzó significación estadística en el análisis multivariante.

Conclusiónes

La desnutrición es muy prevalente en pacientes con EII, especialmente durante la actividad de la enfermedad. El cribado nutricional sistemático debe integrarse en el manejo rutinario, particularmente durante los brotes.