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P546. Diagnostic value of laboratory tests in the assessment of malnutrition in patients with ulcerative colitis

M. Sanges1, M. Miniero1, M.G. Ceriello1, A. Piacente1, L. Florio1, D. Trio1, O. Donatore1, D. Mattera1, R. Sollazzo1, A. D'Arienzo1, 1Federico II University of Naples, Gastroenterology Unit, Department of Clinical and Experimental Medicine, Naples, Italy

Background

Nutritional care is important in the management of patients with ulcerative colitis (UC) and early recognition of malnutrition is central in these patients. There are several laboratory tests for the nutritional assessment of UC patients, but the gold standard has not yet been established. Our aim was to evaluate the diagnostic performance of laboratory tests in identifying malnutrition in UC.

Methods

137 UC patients were enrolled. For the anthropometric assessment, the following variables were evaluated: weight, height, body mass index (BMI), triceps skinfold thickness (TSF) and mid-arm muscle circumference (MAMC). Patients with malnutrition were defined as those with BMI < 18.5 kg/m2 or unintentional weight loss >10% in the last six months and TSF or MAMC <15th percentile. Using the anthropometric criteria as the gold standard, we evaluated the diagnostic performance in identifying malnutrition of the following laboratory tests: lymphocyte count, total proteins, albumin, prealbumin, transferrin, total cholesterol, creatinine and creatinine height index (CHI).

Results

81 (59.1%) patients were in active phase and 56 (40.9%) were in remission. According to anthropometric criteria, 32 (23.4%) patients were malnourished. The prevalence of malnutrition was significantly higher in patients with active UC (37%) than in patients in remission (3.6%) (p < 0.001). The diagnostic performance of laboratory tests is given in the table.

Creatinine, total cholesterol and CHI showed the best diagnostic performance. Cut-off values were ≤0.6 mg/dL for creatinine, ≤129 mg/dL for total cholesterol and ≤89% for CHI.

Table: Diagnostic performance of various laboratory tests in identifying malnutrition in patients with ulcerative colitis
 AlbuminPrealbuminSerum total proteinsTotal cholesterolCreatinineTransferrinTotal lymphocyte countCHI
Sensitivity (%)7779768380687989
Specificity (%)5660518688655293
Accuracy (%)6264598484646290
CHI: creatinine height index.

Conclusion

Our data have shown that creatinine, total cholesterol and CHI are useful markers for the diagnosis of malnutrition in UC. On the other hand, widely used nutritional parameters, such as albumin, prealbumin and transferrin, failed to be accurate markers of malnutrition in our patients. That is probably because serum levels of these proteins decease in response to inflammation and in UC decreased values may reflect acute disease rather than malnutrition.