Malnutrition Linked to Severe Outcomes for IBD Patients

Malnutrition and nutrition deficiencies can lead to more adverse outcomes in patients with inflammatory bowel disease (IBD).

A team, led by Jing Liu, MD, Inflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, assessed the prevalence of and risk factors for malnutrition, use of nutritional support, and sociopsychological status linked to malnutrition for patients with IBD in China.

Malnutrition can be common for patients with IBD. However, there is not much data regarding the nutritional profiles of patients with IBD in Asia.

The Study

In the cross-sectional study, the investigators recruited 1013 patients with IBD from 43 tertiary referral hospitals. Each participant was screened for malnutrition and nutrient deficiencies, while the use nutrition support was recorded. The investigators assessed the sociopsychological status using subjective questionnaires and analyzed the factors associated with malnutrition.

Finally, the team used multivariate regression to determine independent predictors of malnutrition.

The median age of the patient population was 35 years, while 58.5% of the patients had Crohn’s disease and 61.4% of the study population was male.

The investigators identified 501 (49.5%) patients diagnosed with malnutrition, which includes 57% of the patients with Crohn’s disease, 38.8% of patients with ulcerative colitis, and 44.1% of patients with quiescent or mildly active disease.

Factors

One thing that stood out is nutrient deficiencies were prevalent even without malnutrition as a factor.

However, malnutrition was linked to adverse sociopsychological status, including decreased social support, higher perceived stress, and impaired quality of life.

The investigators identified a pair of independent risk factors for malnutrition in moderate to severe disease activity and extensive disease.

Overall, 41.6% of patients who received nutrition support and patients with risk factors were more likely to receive nutrition support.

“Malnutrition was highly prevalent and associated with adverse consequences in Chinese patients with IBD,” the authors wrote. “Malnutrition screening and early initiation of nutrition support are essential components in IBD care.”

Malnutrition

Malnutrition has long been linked to severe outcomes for a number of other diseases, including alcoholic hepatitis.

Last year, a team, led by David U. Lee, MD, Liver Center, Division of Gastroenterology, Tufts Medical Center, evaluated the effect of malnutrition on the infection risks of patients admitted to the hospital with alcoholic hepatitis.

In the study, the researchers used a 2011-2017 National Inpatient Sample to isolate patients with alcoholic hepatitis and stratified the sample using malnutrition—protein-calorie malnutrition, sarcopenia, and weight loss/cachexia.

The researchers found higher mortality rates in the malnutrition cohort (5.02 vs. 2.29%; P <0.001, OR, 2.25; 95% CI, 1.93-2.63). This was also true for sepsis (14.2 vs. 5.46%; P <0.001; OR, 2.87; 95% CI, 2.60-3.18), pneumonia (10.9 vs. 4.63%; P <0.001; OR, 2.51; 95% CI, 2.25-2.81), and urinary tract infection (14.8 vs. 9.01%; P <0.001; OR, 1.76; 95% CI, 1.61-1.91).

These trends for the malnutrition group were also found for cellulitis (3.17 vs. 2.18%; P <0.001; OR, 1.47; 95% CI, 1.24-1.74), cholangitis (0.52 vs. 0.20%; P <0.001; OR, 2.63; 95% CI, 1.59-4.35), and Clostridium difficile infection (CDI) (1.67 vs. 0.91%; P <0.001; OR, 1.85; 95% CI, 1.44-2.37).

The study, “Prevalence of Malnutrition, Its Risk Factors, and the Use of Nutrition Support in Patients with Inflammatory Bowel Disease,” was published online in Inflammatory Bowel Diseases.