Inflammation-driven malnutrition: a new screening tool predicts outcome in Crohn’s disease

Abstract

Malnutrition is a frequent feature in Crohn's disease (CD), affects patient outcome and must be recognised. For chronic inflammatory diseases, recent guidelines recommend the development of combined malnutrition and inflammation risk scores. We aimed to design and evaluate a new screening tool that combines both malnutrition and inflammation parameters that might help predict clinical outcome. In a prospective cohort study, we examined fifty-five patients with CD in remission (Crohn's disease activity index (CDAI) <200) at 0 and 6 months. We assessed disease activity (CDAI, Harvey-Bradshaw index), inflammation (C-reactive protein (CRP), faecal calprotectin (FC)), malnutrition (BMI, subjective global assessment (SGA), serum albumin, handgrip strength), body composition (bioelectrical impedance analysis) and administered the newly developed 'Malnutrition Inflammation Risk Tool' (MIRT; containing BMI, unintentional weight loss over 3 months and CRP). All parameters were evaluated regarding their ability to predict disease outcome prospectively at 6 months. At baseline, more than one-third of patients showed elevated inflammatory markers despite clinical remission (36·4 % CRP ≥5 mg/l, 41·5 % FC ≥100 µg/g). Prevalence of malnutrition at baseline according to BMI, SGA and serum albumin was 2-16 %. At 6 months, MIRT significantly predicted outcome in numerous nutritional and clinical parameters (SGA, CD-related flares, hospitalisations and surgeries). In contrast, SGA, handgrip strength, BMI, albumin and body composition had no influence on the clinical course. The newly developed MIRT was found to reliably predict clinical outcome in CD patients. This screening tool might be used to facilitate clinical decision making, including treatment of both inflammation and malnutrition in order to prevent complications.

GLIM Criteria for Malnutrition in Surgical IBD Patients: A Pilot Study

“…The results were compared with ESPEN 2015 criteria for diagnosis of malnutrition [ 17 ] to evaluate their concordance. All patients were screened for malnutrition with different existing nutritional tools such as the Nutritional Risk Screening (NRS-2002) [ 18 ], the Malnutrition Universal Screening Tool (MUST) [ 19 ], the Malnutrition Screening Tool (MST) [ 20 ] and with two other tests specifically designed for the IBD population, i.e., the Malnutrition Inflammation Risk Tool (MIRT) [ 21 ] and the Saskatchewan IBD–Nutrition Risk (SaskIBD-NR) [ 22 ]. Stool type was reported according to the Bristol stool chart [ 23 ].…”

Nutritional Aspects in Inflammatory Bowel Diseases

“…Malnutrition is one of the most important factors associated with a poor clinical outcome in patients with IBD [24,25]. The severity of malnutrition in IBD patients is dependent on the activity, duration, and extent of the disease and, in particular, on the magnitude of the inflammatory systemic…”

“…Malnutrition is one of the most important factors associated with a poor clinical outcome in patients with IBD [24,25]. The severity of malnutrition in IBD patients is dependent on the activity, duration, and extent of the disease and, in particular, on the magnitude of the inflammatory systemic response mediated by pro-inflammatory cytokines such as tumor necrosis factor (TNF)-α and interleukins-1 and -6, which can increase catabolism and lead to anorexia [26].…”

Ileo-ileal fistula with severe malnutrition caused by strangulated ileus surgery while preserving ischemic ileum: A case report

“…It is widely accepted that chronic inflammation causes malnutrition [ [16] , [17] , [18] ]. Malnutrition causes various systemic dysfunctions such as decreased immunity [ 16 , 17 ].…”