Body Mass Index Is a Marker of Nutrition Preparation Sufficiency Before Surgery for Crohn's Disease From the Perspective of Intra-Abdominal Septic Complications

Abstract

Poor preoperative nutritional status for individuals with Crohn's disease (CD) is associated with intra-abdominal septic complications (IASCs). The present study aimed to investigate the association of the common nutrition indices serum albumin and body mass index (BMI) with IASCs. Sixty-four CD patients who had received elective intestinal operations were retrospectively investigated. Among these patients, 32 had received individualized fortified nutrition support. IASCs occurred in 7 patients (10.9%). Compared with non-IASC patients, IASC patients had a lower BMI (17.6 ± 2.7 vs 15.6 ± 1.3 kg/m2, P = 0.048). The area under the receiver operating characteristic curve according to the BMI-based IASC prediction was 0.772 (95% confidence interval [CI], 0.601–0.944; P = 0.020) with an optimum diagnostic cutoff value of 16.2 kg/m2. A BMI < 16.2 kg/m2 significantly increased the risk of developing an IASC (odds ratio [OR], 10.286; 95% CI, 1.158–91.386). Even after correction with the simplified CD activity index (CDAI), a low BMI level remained associated with IASCs (OR, 7.650; 95% CI, 0.808–72.427; P = 0.076). Serum albumin was not associated with IASCs. Although the fortified nutrition support group had an albumin level comparable to the control group, this group had a higher simplified CDAI score, a lower BMI level, and a comparable incidence rate of IASCs. Thus, BMI more accurately reflects the basic preoperative nutritional status of CD patients than serum albumin. BMI can aid in guiding preoperative nutrition support and judging the appropriate operation time for CD.

Effectiveness of postoperative elemental diet (Elental®) in elderly patients after gastrectomy

“…Further, the gastric emptying time for lipid soup has been reported to be significantly longer than that for non-lipid soup [ 16 ]; therefore, we considered that the low-lipid Elental® was less likely to lead to delayed gastric emptying. Because it only mildly irritates the gastrointestinal tract, this diet has been used for the treatment and perioperative nutritional management of patients with inflammatory bowel disease such as Crohn’s disease [ 17 – 19 ]. Therefore, a low burden is expected following the administration of this diet in the postoperative gastrointestinal tract with impaired function.…”

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

“…Nevertheless, in truth, none of the papers explains the methodology used for nutritional assessment. Standing alone, these anthropometric and laboratory parameters are not indicators of nutritional status in the presence of an active inflammatory syndrome, seeing they are highly influenced by variation in and retention of fluids [16, 49]. Preoperative serum albumin levels may reflect variations in a patient’s inflammatory status and/or nutritional state and, therefore, for one or both reasons, values below 3 g/dL are a risk factor for postoperative complications in abdominal surgery [4, 5, 7, 11, 16].…”

Skeletal Muscle Mass Index Predicts Postoperative Complications in Intestinal Surgery for Crohn's Disease

“…[12][13][14] For BMI, prognostic value has been demonstrated, especially with regard to postoperative septic complications. 15,16 Only a few studies have investigated the role of SMI in surgery for CD in small, retrospective cohorts. In this context, sarcopenia but not SMI has been described as a factor predicting intestinal resection in patients with CD admitted for disease exacerbation.…”