Risk of malnutrition in patients with inflammatory bowel diseases: Results from an Italian multi-centre observational cross-sectional study

Prevalence of malnutrition in patients with inflammatory bowel diseases (IBD) has not yet been well defined, ranging from 6 up to 75% in various studies based on different criteria used. Malnutrition universal screening tool (MUST) is the recommended tool to define the risk of malnutrition, but it has never been applied to IBD patients. Aim of the study were to define the prevalence and risk of malnutrition in IBD patients, and to evaluate nutritional interventions in malnourished or at risk patients. All consecutive IBD adult patients afferent evaluated in 14 centres in a 2-week period were enrolled. Patients with short-bowel syndrome and those who had received artificial nutrition in the previous 6 months were excluded. For all the patients demographic, IBD history, physical and laboratory data were recorded, together with body mass index (BMI) and MUST score. A BMI less than 18.5 kg/m2 identified malnourished patients and a MUST score ≥1 patients at risk of malnutrition. Patients with BMI ≥ 18.5 kg/m2 and MUST score <1 were considered as controls. Clinical disease activity was measured by CDAI and DAI scores. Statistical analysis was performed by using chi-square, Fisher exact, and Kruskal–Wallis tests. A total of 295 patients with IBD were enrolled, 148 Crohn’s disease (CD) (66 males, 44 ± 14 years) and 147 ulcerative colitis (UC) (81 males, 49.6 ± 15.7 years). Most patients were evaluated in an outpatient setting (95% of CD and 99% of UC patients). The overall prevalence of malnutrition was 6.4%, with no significant difference between CD and UC patients (8.1% vs. 4.8%, p > 0.05). Patients at risk of malnutrition were 16.6% (18.2% in CD and 14.9% in UC, p > 0.05). Significant differences were found among the three groups regarding disease activity and CRP levels (see Table). A comprehensive nutritional assessment was offered only to one-third of patients with malnourished or at risk CD and to one fourth of patients with UC at risk of malnutrition. Artificial nutrition was started in 8% of malnourished CD patients, 15% of CD patients at risk of malnutrition and in 10% of UC patients at risk of malnutrition. The prevalence of malnutrition in IBD patients is lower than previously reported, but there is 17% of patients at risk of malnutrition mostly related to clinical disease activity. Nutritional interventions are currently offered to a small proportion of malnourished or at risk patients. Physicians should be taken into greater account the nutritional aspects of IBD patients.