Nutrition Considerations in Inflammatory Bowel Disease

Abstract

The purpose of this article is to provide an updated review of the definition, prevalence, causes, and clinical management of malnutrition in inflammatory bowel disease (IBD). Prevalence of malnutrition in IBD is estimated to be between 6.1% and 69.7% depending on the definition used, the type of IBD, the clinical setting, and whether the IBD is active or in remission. Whereas older definitions of malnutrition have been found to be correlated with mortality and length of hospital stay, the more recent European Society for Clinical Nutrition and Metabolism (ESPEN) 2015 and the Global Leadership Initiative on Malnutrition (GLIM) definitions provide significantly different prevalence estimates of malnutrition when applied to the same patient population, and further work is needed to validate these two definitions against clinical outcomes. In patients with IBD with identified malnutrition, oral nutrition supplementation, enteral nutrition, or parenteral nutrition should be started. In malnourished patients with Crohn's disease undergoing surgery, preoperative enteral nutrition has been demonstrated to reduce the rate of postoperative complications. Overall, patients with IBD are at significant risk for malnutrition and should be screened for malnutrition by using a validated screening tool. The management of malnutrition in IBD is complex, and studies are often limited in their size or their ability to demonstrate an improvement in clinical outcomes based on specific nutrition-related interventions. Future studies particularly regarding the validation of new screening tools and perioperative management of malnutrition may provide insight into the standardization of diagnosis and management of malnutrition in IBD.

Parenteral Nutrition Overview

“…Malnutrition can occur in IBD, mainly in the active disease and to a greater degree in Crohn’s disease (CD) rather than in ulcerative colitis (UC). This is because of the capacity of CD to affect any part of the gastrointestinal tract, unlike UC, which is restricted to the colon [ 160 ]. Malnourished patients with IBD are more likely to be hospitalized and be admitted to hospital due to infection [ 161 ].…”

“…Malnourished patients with IBD are more likely to be hospitalized and be admitted to hospital due to infection [ 161 ]. Common indications for PN in IBD include an obstructed bowel where there is no possibility of a feeding tube being placed beyond the obstruction or where this has failed, as well as other complications such as an anastomotic leak or a high-output intestinal fistula [ 160 , 162 ]. The ESPEN guidelines for IBD particularly recommend that CD patients with a proximal fistula and/or a very high output fistula should receive nutritional support by partial or total PN.…”

“…The ESPEN guidelines for IBD particularly recommend that CD patients with a proximal fistula and/or a very high output fistula should receive nutritional support by partial or total PN. Since trials show no benefit of PN in the management of acute severe UC, both in terms of inflammatory disease and precolectomy optimization, it is only recommended in malnourished patients with UC and severe disease when EN cannot to be tolerated or oral nutrition or EN are not effective [ 160 , 163 , 164 , 165 ]. As previously mentioned, EN is recommended over PN for use in preoperative optimization [ 5 , 163 , 166 ].…”

“…As previously mentioned, EN is recommended over PN for use in preoperative optimization [ 5 , 163 , 166 ]. Thus, PN should be initiated preoperatively in CD patients at risk of malnutrition who have contraindications to EN or who are not able to maintain >60% of nutritional requirements orally [ 160 , 162 ]. Despite insufficient data supporting the routine use of PPN in IBD, it has been suggested that PPN could be advantageous in certain malnourished patients, especially when central VAD insertion may be delayed for logistical reasons.…”

Cyanidin-3-O-Glucoside Supplement Improves Sperm Quality and Spermatogenesis in a Mice Model of Ulcerative Colitis

“…For anti-sperm antigen–antibody reaction, the intestinal mucosal barrier will be destroyed, and intestinal permeability will be increased during the process of IBD, which might lead to increased immunological response against antigens of gut microbiota possessing common antigenicity with human spermatozoa [ 20 , 21 ]. For low leptin level under malnutrition, malnutrition is a common complication in IBD patients with a prevalence between 6.1% and 69.7%, which depends on different screening standards [ 22 , 23 ]. Under the condition of malnutrition, the fat reserves decline therewith leptin level secreted by adipocytes decreases [ 24 ].…”