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P507 Nutrition status in pre-surgical Crohn's disease, active Crohn's disease, Crohn's disease in remission and ulcerative colitis in remission: a cross-sectional study

Sandall A.M.*1, Patel K.V.2, O'Hanlon D.V.3, Smith S.J.1, Darakhshan A.A.4, Sanderson J.D.2, Lomer M.C.1,3

1King's College London, Diabetes and Nutritional Sciences Division, London, United Kingdom 2Guy's and St Thomas' NHS Foundation Trust, Gastroenterology, London, United Kingdom 3Guy's and St Thomas' NHS Foundation Trust, Nutrition & Dietetics, London, United Kingdom 4Guy's and St Thomas' NHS Foundation Trust, Colorectal Surgery, London, United Kingdom

Background

Malnutrition (undernutrition) in inflammatory bowel disease (IBD) is associated with increased morbidity, post-operative complications and reduced quality of life. Alterations in nutrition status in active versus remission IBD remain poorly characterised. Additionally, nutrition status has not been quantified in pre-surgical Crohn's disease (CD) patients requiring gastrointestinal resection. This study aimed to quantify body composition, muscle strength, micronutrients and lipid profile and to compare between the following IBD groups: pre-surgical CD; active CD; CD in remission; and ulcerative colitis (UC) in remission.

Methods

A cross-sectional study recruited IBD patients from a London teaching hospital. Body mass index (BMI) was measured. Direct anthropometry was undertaken to determine mid-upper arm circumference (MUAC), tricep skinfold (TSF), mid-arm muscle circumference (MAMC) and waist circumference (WC). Bioelectrical impedance analysis (BIA) determined fat mass (FM) and fat-free mass (FFM). To establish muscle strength, dynamometers measured hand-grip strength (HGS). Blood tests determined plasma micronutrients and lipids. Comparisons between groups were made using one-way ANOVA for continuous data with significance at p<0.05.

Results

Eighty-four IBD patients were recruited: 23 pre-surgical CD; 21 active CD; 27 CD in remission; and 13 UC in remission. Pre-surgical CD had significantly depleted body composition compared to CD in remission based on: BMI (22.11±3.69 vs. 26.00±5.90kg/m2, p=0.035); MUAC (26.8±3.9 vs. 30.8±3.9cm, p=0.010); and MAMC (20.8±3.3 vs. 24.1±3.0cm, p=0.015). In males only, pre-surgical CD had significantly depleted FFM compared to CD in remission (56.77±13.41 vs. 68.69±7.46kg, p=0.014). Muscle strength did not differ across female IBD groups, but male HGS was lower in pre-surgical CD compared to CD in remission (29.55±9.15 vs. 40.13±7.29kg, p=0.002) and UC in remission (44.41±9.70kg, p=0.006). No significant differences in body composition or muscle strength existed between active and IBD groups in remission but CD in remission had significantly lower vitamin D compared to active CD (46.58±20.15 vs. 70.53±28.17nmol/L, p=0.035). Pre-surgical CD had significantly lower mean zinc levels (10.05±2.86μmol/L) compared to CD in remission (12.34±2.45μmol/L, p=0.037) and UC in remission (12.84±2.05μmol/L, p=0.039).

Conclusion

Across IBD phenotypes and disease activity groups, nutrition status is most depleted in pre-surgical CD patients. This study may help healthcare services prioritise dietetic provision to IBD patients, specifically for pre-surgical CD patients.