A multicentre Study of Nutrition Risk Assessment in Adult Patients with Inflammatory Bowel Disease Attending Outpatient Clinics

Abstract

Background: Overnutrition and undernutrition can affect patients with inflammatory bowel disease (IBD). Although all IBD outpatients should be screened for nutrition risk, screening is not routinely performed, potentially leading to reduced identification and treatment. This study aimed to estimate the prevalence of nutrition risk in adult IBD outpatients and the proportion of cases who discussed diet and/or nutrition during their routine clinical appointment. Methods: Adults with IBD attending outpatient clinics at 4 hospitals in Greece and in UK were recruited. Demographic and anthropometric data were collected using face-to-face patient interviews and clinical records. Patients were classified as high (i.e., body mass index [BMI] < 18.5 or 18.5–20 kg/m² and weight loss > 5%), moderate (i.e., BMI 20–25 kg/m² and weight loss > 5%) or low risk of undernutrition and high risk of obesity (i.e., BMI 25–30% and weight gain > 5%). The proportion of patients who discussed diet and/or nutrition during their clinical appointment was calculated. Results: In total, 390 IBD patients participated. Sixteen (4%) patients were underweight, 113 (29%) were overweight and 71 (18%) were obese. Twenty-one (5%) patients were at high risk of undernutrition; of these 4 (19%) were under dietetic care. Of those at high risk of undernutrition, 11 (52%) had discussed diet and/or nutrition during their routine clinical appointment. Fifty-six (14%) patients had gained more than 5% weight since their last recorded/reported weight and 19 (5%) were at high risk of obesity. Conclusions: Few patients were identified to be at high risk of undernutrition and less than a fifth of these were under dietetic care. Overnutrition is a growing problem in IBD with almost half of adult patients being overweight or obese. Diet and/or nutrition were not routinely discussed in this group of IBD outpatients.

Impact of dietary manganese on experimental colitis in mice

“…25 Fe deficiency is associated with the bleeding, malabsorption, or anemia that occurs in one-third of IBD patients, 26 while zinc deficiency is also common in patients with IBD (15 to 40% of the patient population). 27 Similarly, an inverse association has been reported for nutritional Se status and the occurrence of IBD. 28 These previous studies are reminiscent of the findings described here for Mn, as deficiencies in these other trace minerals also show effects on the intestinal barrier and immune functions.…”

“…Micronutrient deficiencies have been, for decades, a major concern in the management of IBD as numerous studies have documented associations between IBD and deficiencies in trace minerals, such as Fe, Zn, and Se . Fe deficiency is associated with the bleeding, malabsorption, or anemia that occurs in one‐third of IBD patients, while zinc deficiency is also common in patients with IBD (15 to 40% of the patient population) . Similarly, an inverse association has been reported for nutritional Se status and the occurrence of IBD .…”

Hair EDX Analysis—A Promising Tool for Micronutrient Status Evaluation of Patients with IBD?

“…The common encounter of zinc deficiency reported in patients with IBD (15 to 40% of the patient population) [ 35 ] is not surprising, considering the chronic diarrhea and malabsorption during disease flares and the key role zinc plays in the maintenance of intestinal barrier integrity [ 36 ]. On the other hand, zinc deficiency has also been reported for patients in remission, reaching up to one-third of patients [ 37 , 38 ].…”

Weight Gain and Liver Steatosis in Patients with Inflammatory Bowel Diseases

“…It is now well accepted that weight loss and malnutrition are features of IBD patients during acute flare-ups and hospital admissions [ 28 ], while a normal or high BMI is associated with stable disease [ 29 ]. Over half of Crohn’s disease patients are overweight/obese [ 30 ]. Thus, there is now increasing focus on the potential negative effects of weight gain or obesity on the long-term general health of patients with IBD.…”