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P382 Prevalence of impaired muscle strength in an IBD outpatient cohort.

C. Spooren*, M. Pierik, T. van den Heuvel, E. de Koning, Z. van Mechelen, A. Masclee, D. Jonkers

Maastricht University Medical Center+, Internal Medicine - Division Gastroenterology-Hepatology, Maastricht, Netherlands

Background

Patients with inflammatory bowel disease (IBD), with active or quiescent disease, often have an impaired nutritional status, due to decreased food intake, nutrient malabsorption, and/or hyper metabolic state. This can cause depletion of fat stores, loss of muscle mass and thereby decreased physical performance. We aimed to evaluate physical performance by muscle strength in an IBD outpatient cohort from daily clinical practice.

Methods

We included consecutive IBD outpatients as part of a large prospective study on nutritional status. Muscle strength, as indicator for physical performance, was assessed by handgrip strength (HGS). A hydraulic hand dynamometer was used in sitting position with elbow flexed 90 degrees in free position and neutral position of the forearm and wrist, recording the highest value of a triplicate assessment of the non-dominant hand. A cut off below the 10th percentile of the HGS was defined as impaired [1] . Fat and fat free mass were assessed by air displacement plethysmography. The fat free mass index (FFMI) includes a correction for height and was used as indicator for muscle mass. Spearman's rank correlation was used for assessing the correlation between FFMI and HGS. Moreover multivariate logistic regression analysis was performed to identify independent risk factors for impaired HGS.

Results

In total 115 consecutive IBD outpatients were included, comprising 84 CD and 31 UC. Of these patients, 57% was female, mean age was 46,8 (SD 15) years, mean disease duration of 150 (SD 121) months, and mean body mass index was 25,4 (SD 4,0) kg/m2 . Of all patients, 31% had a HGS below the 10th percentile, being 29.8% of CD and 35.5% of UC patients.

The Spearman's rank correlation coefficient showed a significant correlation between HGS and the FFMI (R = 0,586; p<0,01).

 

ECCOJC jju027 P382 F0001

“Correlation between fat free mass index meauserd by air displacement plethysmography and hand grip strength”

Using multivariate logistic regression analysis, disease phenotype (UC or CD), active disease, and history of surgery did not affect the presence of reduced HGS in the total group of IBD or in CD patients only. In the latter group, also no effect of disease location was found.

 

Conclusion

About one third of IBD patients from daily clinical practise were found to have an impaired HGS, which correlated with a diminished FFMI. This was not affected by disease phenotype, disease activity, and surgical history in the total group, nor by disease location in CD patients. It would be of relevance to check dietary intake, and to study whether dietary advice and/or physical exercise may improve muscle strength.

References:

[1] Department of Dietetics MUMC, (2012), Dutch Reference Values on Hand Grip Strength. Maastricht: Maastricht University Medical Center; (updated on 2011; cited on December 2012), http://www.nutritionalassessment.azm.nl/algoritme+na/onderzoek/ functionele+parameters/nederlandse+normaalwaarden+hkk.htm.