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P207 Disease activity is associated with indicators of impaired nutritional status in inflammatory bowel disease outpatients

C. Spooren*1, 2, M. Wierikx1, 2, T. van den Heuvel1, 2, A. Masclee1, 2, M. Pierik1, 2, D. Jonkers1, 2

1Maastricht University Medical Centre+, Internal Medicine - Division Gastroenterology-Hepatology, Maastricht, Netherlands, 2School of Nutrition & Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, Netherlands

Background

Reduced food intake, nutrient malabsorption, and/or hypermetabolic state can result in impaired nutritional status, including loss of muscle mass, in patients with inflammatory bowel disease (IBD). This may contribute to decreased physical activity, fatigue, and negatively affect quality of life (QoL). Data on prevalence of impaired nutritional status and risk factors thereof in daily clinical practice are however limited. This study aimed to assess the effect of disease phenotype on indicators of an impaired nutritional status (INS) in IBD.

Methods

We included consecutive IBD outpatients as part of a large prospective study on nutritional status. Data on disease phenotype (Montreal classification), disease activity, smoking status and body mass index (BMI) were collected. Handgrip strength (HGS) was assessed by a hydraulic hand dynamometer with patient in sitting position with elbow flexed 90 degrees in free position of the non-dominant hand. Further, the Short Nutritional Assessment Questionnaire (SNAQ) and Malnutrition Screening Tool (MST) were completed. An INS was indicated by either HGS < 15th percentile, or SNAQ and/or MST score ≥ 1. Active disease was defined by 2 or more of the following: serum CRP > 5 mg/ml, faecal calprotectin > 200 μg/g or doubled, and/or increased activity index score (Harvey–Bradshaw Index [HBI] ≥ 5 or Simple Clinical Colitis Activity Index [SCCAI] ≥ 3 points). A multivariable logistic regression analysis was performed to assess the association between host and disease characteristics and risk of INS for IBD, Crohn’s disease (CD), and ulcerative colitis (UC) separately.

Results

In total, 143 IBD patients were included (97 CD and 46 UC). In IBD, INS was present in 47.6% (42.3% CD and 58.7% UC), with active disease in 32.9% (30.9% CD and 37% UC). Mean age at diagnosis was 47.8 years (SD 15.3) (CD 46.5 and SD 15.6), (UC 50.6) (SD 14.6), and mean BMI was 25.5 kg/m2 (SD 4.1, CD 25.6) (SD 4.2) (UC 25.1) (SD 3.9). Multivariable analysis showed active disease (OR 3.0 95% CI 1.4–6.2, p = 0.003), but not in gender, age, localisation, BMI, smoking status, or IBD subtype to be associated with INS in IBD. For UC, active disease (OR 12.3 95% CI 1.8–86.3, p = 0.012) and female gender (OR 26.6 95% CI 4.1–173.4 p = 0.001) were associated with INS. No associations were found for CD.

Conclusion

The high prevalence of indicators for INS and its association with disease activity in the total and UC subpopulation, point to the importance of nutritional assessment in IBD patients. Dietary guidance may improve their nutritional status and thereby QoL.