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P228 Prevalence of malnutrition and nutritional characteristics of patients with inflammatory bowel disease

M. Casanova*1, M. Chaparro1, B. Molina2, O. Merino3, O. Nuevo-Siguairo4, C. Dueñas-Sadornil5, A.M. García-Albert6, D. Hervías7, X. Calvet8, L. Bujanda9, G.E. Rodríguez10, M. Montoro11, L. Castro-Laria12, M. Barreiro-de Acosta13, M. Van Domselaar14, J. M. Huguet15, P. Ramírez de la Piscina16, J. Barrio17, A. Algaba18, A. D. Ávila19, S. Torra20, L. Pozzati21, F. J. Martínez-Cerezo22, M. Calvo23, M. Charro24, P. López-Serrano25, M. R. Arribas-López26, M. Muñoz Vicente27, M. L. Rincón28, A. C. Peláez29, E. Castro30, A. García-Herola31, R. Batanero32, A. Castaño-García33, P. Robledo-Andrés34, M. B. Gómez-Sánchez35, A. Figuerola36, J. M. Banales37, L. Díaz-Hernández10, I. Vázquez38, F. Arguelles-Arias12, E. Marti-Bonmati39, F. Bermejo18, P. Serrano40, I. Megias-Rangil41, M. Campderá42, A. Barragán43, A. Merchante44, J. P. Gisbert1

1Hospital Universitario de La Princesa, IIS-IP and CIBERehd, Gastroenterology Unit, Madrid, Spain, 2Hospital Universitario de La Princesa, IIS-IP and CIBERehd, Endocrinology Unit, Madrid, Spain, 3Hospital Universitario de Cruces, Gastroenterology Unit, Bilbao, Spain, 4Hospital Central de Asturias, Gastroenterology unit, Oviedo, Spain, 5Hospital San Pedro de Alcántara, Gastroenterology Unit, Cáceres, Spain, 6Hospital Universitario Reina Sofía, Gastroenterology Unit, Murcia, Spain, 7Hospital Virgen de la Altagracia, Gastroenterology Unit, Manzanares, Spain, 8Corporació Sanitària Parc Taulí and CIBERehd, Gastroenterology Unit, Sabadell, Spain, 9Hospital de Donostia, Instituto Biodonostia, UPV/EHU and CIBEREHD, Gastroenterology Unit, Guipuzcoa, Spain, 10Hospital Universitario Nuestra Señora de La Candelaria, Gastroenterology Unit, Tenerife, Spain, 11Hospital San Jorge, Gastroenterology Unit, Huesca, Spain, 12Hospital Universitario Virgen de La Macarena, Gastroenterology Unit, Sevilla, Spain, 13Hospital Clínico Universitario de Santiago, Gastroenterology Unit, Santiago de Compostela, Spain, 14Hospital de Torrejón, Gastroenterology Unit, Madrid, Spain, 15Consorcio Hospital General Universitario de Valencia, Gastroenterology Unit, Valencia, Spain, 16Hospital Universitario de Alava, Gastroenterology Unit, Vitoria, Spain, 17Hospital Universitario Rio Hortega, Gastroenterology Unit, Valladolid, Spain, 18Hospital Universitario de Fuenlabrada, Gastroenterology Unit, Madrid, Spain, 19Hospital Universitario Virgen del Rocío, Gastroenterology Unit, Sevilla, Spain, 20Parc Sanitari Sant Joan de Déu, Gastroenterology Unit, Barcelona, Spain, 21Hospital de Mérida, Gastroenterology Unit, Mérida, Spain, 22Hospital Universitario Sant Joan de Reus, Gastroenterology Unit, Tarragona, Spain, 23Hospital Universitario Puerta de Hierro, Gastroenterology Unit, Madrid, Spain, 24Hospital Royo Villanova, Gastroenterology Unit, Zaragoza, Spain, 25Hospital Universitario Fundación Alcorcón, Gastroenterology Unit, Madrid, Spain, 26Hospital Universitario Infanta Sofía, Gastroenterology Unit, Madrid, Spain, 27Hospital General Universitario de Castellón, Gastroenterology Unit, Castellón, Spain, 28Hospital Comarcal Bidasoa, Gastroenterology Unit, Guipúzkoa, Spain, 29Hospital General de Catalunya, Gastroenterology Unit, Barcelona, Spain, 30Hospital Lucus Augusti, Gastroenterology Unit, Lugo, Spain, 31Hospital Marina Baixa, Gastroenterology Unit, Alicante, Spain, 32Hospital Universitario de Cruces, Endocrinology Unit, Bilbao, Spain, 33Hospital Central de Asturias, Gastroenterology Unit, Oviedo, Spain, 34Hospital Universitario San Pedro Alcántara, Gastroenterology Unit, Cáceres, Spain, 35Hospital Universitario Reina Sofía, Endocrinology Unit, Murcia, Spain, 36Hospital de Sabadell. Institut Universitari ParcTaulí and CIBERehd, Gastroenterology Unit, Sabadell, Spain, 37Hospital de Donostia, Endocrinology Unit, Donostia, Spain, 38Hospital San Jorge, Endocrinology Unit, Huesca, Spain, 39Hospital General Universitario de Valencia, Pharmacy Unit, Valencia, Spain, 40Hospital Universitario Virgen del Rocío, Endocrinology Unit, Sevilla, Spain, 41Hospital Universitario Sant Joan de Reus, Endocrinology Unit, Tarragona, Spain, 42Hospital Universitario Puerta de Hierro, Endocrinology Unit, Madrid, Spain, 43Hospital Royo Villanova, Endocrinology Unit, Zaragoza, Spain, 44Hospital General Universitario de Castellón, Endocrinology Unit, Castellón, Spain

Background

The aims of the study were to determine the prevalence of malnutrition, analyse the dietary beliefs and behaviours, study the body composition, evaluate the muscular strength, and identify the factors associated with malnutrition in patients with IBD.

Methods

A prospective multicentre study was conducted at 30 Spanish centres. All consecutive Crohn’s disease and ulcerative colitis patients followed at IBD Units of the participant centres were included. The study had 2 parts. In the first one, a questionnaire of 11 items was applied to obtain data of the dietary behaviour and beliefs of IBD patients. In the second, the nutritional status of the patients was assessed using the Subjective Global Assessment (SGA). The body composition was evaluated through bioelectrical impedance, and handgrip strength was measured. Malnutrition was defined as the presence of a body mass index (BMI) < 18.5 Kg/m2, or a fat free mass index (FFMI) lower than 25th percentile, or a SGA grade B or C.

Results

In total, 1 272 patients were included (51%women, median age 45 years, 60% Crohn’s disease). From them, 304 patients participated in both parts of the study. Further, 18% were current smokers, 23% had a history of abdominal surgery; and 22% had clinical disease activity. The treatment for IBD was 46% 5-ASA, 46% immunomodulators, and 30% anti-TNFs. In addition, 8% of patients had been treated with systemic steroids. The prevalence of malnutrition was 28% (95% CI = 23%–34%). In the questionnaire, 48% of patients believed that certain foods increased the risk of developing IBD, and 69% considered that the diet played an important or a very important role in triggering a disease flare. Moreover,76% of the patients avoided some foods to prevent disease relapse (63% spicy foods, 48% alcohol, 40% fat, 37% carbonated beverages, 26% precooked food, 25% fibre, 23% dairy products, and 22% processed meat). Of patients, 86% avoided some foods when they had disease activity for fear of worsening the flare; 67% of patients had modified their dietary habits after IBD diagnosis. The BMI was below 18.5 Kg/m2 in 4%; the FFMI; the fat mass index and the muscular strength were under 25th percentile in 21%, 18%, and 16% of the patients, respectively. In the multivariate analysis, the only variable associated with the risk of malnutrition was the disease activity (OR = 2.9, 95% CI = 1.5–5.3), adjusted by type of IBD and history of abdominal surgery.

Conclusion

The prevalence of malnutrition in IBD patients was high. Clinical activity was associated with an increased risk of malnutrition. More than half of patients believed that certain foods might trigger IBD flare. The majority of patients avoided some foods with the intention of preventing a flare