Original article
Nutritional status in patients with active inflammatory bowel disease: Prevalence of malnutrition and methods for routine nutritional assessment

https://doi.org/10.1016/j.ejim.2010.04.012Get rights and content

Abstract

Background and aim

Malnutrition is a common feature of inflammatory bowel disease (IBD). There are numerous methods for the assessment of nutritional status, but the gold standard has not yet been established. The aims of the study were to estimate the prevalence of undernutrition and to evaluate methods for routine nutritional assessment of active IBD patients.

Material and methods

Twenty-three patients with active Crohn disease, 53 patients with active ulcerative colitis and 30 controls were included in the study. The nutritional status was assessed by extensive anthropometric measurements, percentage of weight loss in the past 1–6 months and biochemical markers of nutrition.

Results

All investigated nutritional parameters were significantly different in IBD patients compared to control subjects, except MCV, tryglicerides and serum total protein level. Serum albumin level and bodymass index (BMI) were the most predictive parameters of malnutrition. According to different assessment methods the prevalence of undernutrition and severe undernutrition in patients with active IBD were 25.0%–69.7% and 1.3%–31.6%, respectively, while in the control subjects no abnormalities have been detected. There was no statistically significant difference of nutritional parameters between UC and CD patients except lower mid-arm muscle circumference in UC group.

Conclusions

Malnutrition is common in IBD patients. BMI and serum albumin are simple and convenient methods for the assessment of the nutritional status in IBD patients. Further studies with larger group of patients are necessary to elucidate the prevalence of malnutrition and the most accurate assessment methods in IBD patients.

Section snippets

Background

Undernutrition has been often reported in patients with inflammatory bowel disease (IBD), particularly in patients with active Crohn's disease (CD) [1], [2], [3], [4], [5]. Furthermore, the presence of malnutrition has been linked to adverse outcomes [2], [4]. The aetiology of malnutrition in patients with IBD is multifactorial, and the nutritional status is the result of complex pathophysiological processes [6], [7], [8], [9], [10]; these include poor nutritional intake due to postprandial

Materials and methods

Seventy-six consecutive patients with active IBD from the Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, were included in the study. Written informed consent was obtained from each subject. Fifty-three patients with UC, aged 42.31 ± 15.42 years, (range, 17.0–74.0 years) and 23 CD patients, aged 39.21 ± 15.47 years (range 19.0–74.0 years) entered the study protocol. Thirty healthy volunteers (14 men and 16 women) participated in this study as a control group. Subject

Results

Fifty-two (68.4%) IBD patients with active disease, meet the criteria for malnutrition according to data of unintentional weight loss [24 (31.6%) were severely malnourished], while in controls unintentional weight loss was not detected (χ² test, p < 0.01). In malnourished IBD patients with active disease, 36 (67.9%) had UC and 16 (69.6%) had CD (χ² test, p > 0.05). The anthropometric parameters of nutrition: BW, BMI, TSF, BSF, SsSF, SiSF, percentage of body fat, MAC and MAMC were significantly

Discussion

The data regarding nutritional status in patients with IBD are inconsistent and inadequate to characterize it precisely. However, it is clear that malnutrition is a significant problem in IBD patients. In this study, the nutritional status was assessed by comprehensive anthropometric, as well as biochemical parameters and percentage of weight loss in the past 1 to 6 months. These methods were selected as they are widely available and suitable for routine use. We confirmed that undernutrition is

Learning points

  • Malnutrition is common in patients with active CD and UC. In addition, substantial proportion of IBD patients with active disease is severely malnourished. Serum albumin and BMI are simple and convenient methods for routine assessment of nutritional status in patients with active IBD. Further studies with large subgroups of patients with IBD are necessary to define influencing factors, and the most accurate nutritional assessment methods.

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