Researchers link IBD patients to higher malnutrition risk, suggest treatment support

11 Dec 2023 --- Doctors at the University of North Carolina (UNC) School of Medicine, US, highlight the need for dietitian support in their Inflammatory Bowel Disease (IBD) clinic as 14% of patients were found to be at high risk of malnutrition.

IBD, including Crohn’s disease and ulcerative colitis, can result in chronic inflammation of the digestive tract, which can lead to malnutrition. The research team underscores that a malnourished state is linked to an increased risk of morbidity and mortality. 

Researchers screened patients at the clinic with a validated and reliable malnutrition screening tool, revealing that 28% of clinic patients with active IBD met the requirements for malnutrition, compared to 8% of patients in remission. Moreover, 15% of patients with Crohn’s disease and 12% of those with ulcerative colitis had a high malnutrition risk. 

“It was important to do this study because we have limited time with our patients and often many problems to address,” says Dr. Anne F. Peery, corresponding author and associate professor of medicine at the UNC School of Medicine. “It’s easy to miss malnutrition in the clinic setting.”

The researchers caution that malnutrition risk can develop at any BMI.Malnutrition screening 
The researchers screened 237 patients with the Malnutrition Screen Tool — a three-minute survey. The survey includes three questions — have you recently lost weight without trying? If yes, how much weight have you lost? Have you been eating poorly because of a decreased appetite? 

In addition, the researchers collected information on the patients’ age, sex, visit type, height, weight, body mass index (BMI), IBD type, disease activity status, surgical history, medications, smoking rates and enteral or parenteral nutrition use. 

The researchers note that most patients who screened positive for malnutrition had a normal or overweight BMI, indicating that “malnutrition risk can develop at any BMI.” A history of smoking also increases malnutrition risk. 

Prior studies have identified a similar rate of malnutrition risk for IBD patients as the study published in Gastro Hep Advances. 

According to the researchers, active disease was significantly associated with malnutrition risk, like in previous studies. Signs of active disease include diarrhea, abdominal pain, fever, nausea, low energy and loss of appetite. 

Meanwhile, they caution that the study did not collect data on IBD disease duration, instead assuming that most patients had a long-standing disease. Moreover, the researchers could not screen every IBD patient during the study period as multiple clinic visits co-occurred. 

Treatment support 
The researchers conclude that the validated three-question survey “could be easily implemented in routine clinical care in an IBD clinic to provide same-day dietitian support for patients at risk for malnutrition.” 

They add that an evaluation from a registered dietitian is critical in caring for IBD patients in the clinic. A dietitian can help the team identify deficiencies, estimate a patient’s energy and protein needs and help to develop a plan to meet these needs. 

“A positive screen for malnutrition should be immediately followed up with a formal nutrition assessment,” underscores Peery. “A registered dietitian in a clinic can fill this care gap and help the team develop a plan to meet the patient’s nutrition needs. We are fortunate to have a full-time registered dietitian in the gastrointestinal clinic. She has significantly improved the care we provide.”

“Moving forward, it would be useful to have our care partners in the clinic who room the patient and screen them for malnutrition.” 

By Jolanda van Hal