Malnutrition and sarcopenia are prevalent among inflammatory bowel disease patients with clinical remission

Abstract

Aim The aim of this study was to evaluate nutritional status and sarcopenia in patients with inflammatory bowel disease (IBD) in clinical remission. Methods A total of 344 patients with IBD in clinical remission were included in this cross-sectional study. Patients with clinical activity (Harvey-Bradshaw index >5 for Crohn’s disease and partial Mayo scores ≥5 for ulcerative colitis) were excluded. Sociodemographic, clinical, and anthropometric data were recorded. BMI was categorized according to WHO criteria. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) questionnaire. Body composition included fat-free mass (FFM) analyzed with Tanita-330 ST. Muscle strength was measured with a Takei digital hand grip dynamometer using a standard protocol. Physical performance was measured as 4-m gait speed. Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People 2 criteria. Results Overall, 5.5% of patients were underweight, 9.9% were malnourished, and 39.5% were at risk of malnutrition. Sarcopenia and probable sarcopenia were diagnosed in 41.3% of patients. Total number of flares requiring hospitalization (100%) was the most important predictor of sarcopenia, followed by total number of flares (80.1%), FFMI (46.5%), age (44.6%), BMI (31.8%), MNA score (27.7%), serum creatinine (23.6%), anti-tumor necrosis factor alpha use (23.3%), and gender (17.8%). Conclusion In conclusion, our findings revealed a considerable proportion of IBD patients in clinical remission to be malnourished or at risk of malnutrition along with a high rate of sarcopenia. This emphasizes the need for concomitant screening for nutritional status and body composition analysis in patients with IBD for provision of appropriate nutritional support, even during the remission period, and prevention of sarcopenia-related surgical and poor clinical outcomes.

Inflammatory Bowel Disease and Sarcopenia: Its Mechanism and Clinical Importance

“…Table 1 shows the evaluation methods and frequency of sarcopenia reported in recent years in patients with IBD [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. In more than half of the reports, computed tomography (CT, L3 level) is used to assess sarcopenia, but many reports only use muscle mass assessment to determine sarcopenia, while a few include grip strength and walking speed in the assessment of sarcopenia [ 17 ]. Furthermore, unlike primary sarcopenia [ 4 , 5 ], no reference values have been established for muscle mass, grip strength, or walking speed in patients with IBD.…”

“…Table 1 shows the evaluation methods and frequency of sarcopenia reported in recent years in patients with IBD [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. In more than half of the reports, computed tomography (CT, L3 level) is used to assess sarcopenia, but many reports only use muscle mass assessment to determine sarcopenia, while a few include grip strength and walking speed in the assessment of sarcopenia [17].…”

Inflammatory Bowel Diseases and Sarcopenia: The Role of Inflammation and Gut Microbiota in the Development of Muscle Failure

“…The association of malnutrition and sarcopenia in IBD patients is controversial. Indeed, it is noteworthy that while malnutrition in IBD is characterized by weight loss during the acute phase of disease followed by a gradual recovery during disease remission, sarcopenia may be present even in IBD patients in remission and not only with low but also normal or elevated values of BMI (85)(86)(87).…”

“…Notably, sarcopenic IBD patients had lower preoperative serum levels of albumin and higher preoperative serum levels of C-reactive protein, deemed markers of malnutrition/inflammation and predictive factor of surgical negative outcome ( 86 ). Furthermore, a recent cross-sectional study involving 344 IBD patients in clinical remission revealed an increased risk of sarcopenia in malnourished patients ( 87 ).…”

Influence of nutritional status in the postoperative period of patients with inflammatory bowel disease

“…In IBD patients, malnutrition and excess weight can coexist with sarcopenia, which is a skeletal muscle syndrome characterized by progressive and generalized reduction in the quantity and quality ( i.e. strength or physical performance) of muscle mass[ 76 ]. The etiology of sarcopenia is multifactorial, involving aging, physical inactivity, presence of other diseases ( e.g.…”