Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Ege, Izmir, Turkey.
Eur J Gastroenterol Hepatol. 2021 Nov 1;33(11):1367-1375. doi: 10.1097/MEG.0000000000002044.
The aim of this study was to evaluate nutritional status and sarcopenia in patients with inflammatory bowel disease (IBD) in clinical remission.
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.
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%).
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.
本研究旨在评估处于临床缓解期的炎症性肠病（IBD）患者的营养状况和肌肉减少症。
本横断面研究纳入了 344 例处于临床缓解期的 IBD 患者。排除有临床活动（克罗恩病的 Harvey-Bradshaw 指数>5，溃疡性结肠炎的部分 Mayo 评分≥5）的患者。记录患者的社会人口学、临床和人体测量学数据。根据世界卫生组织（WHO）标准对 BMI 进行分类。使用 Mini Nutritional Assessment（MNA）问卷评估营养状况。通过 Tanita-330 ST 分析体脂量（FFM）来评估体成分。使用 Takei 数字握力计按照标准方案测量肌肉力量。使用 4 米步速测量身体活动能力。根据欧洲老年人肌肉减少症工作组 2 标准定义肌肉减少症。
总体而言，5.5%的患者体重不足，9.9%存在营养不良，39.5%有营养不良风险。41.3%的患者被诊断为肌肉减少症和可能的肌肉减少症。需要住院治疗的疾病发作总数（100%）是肌肉减少症最重要的预测因素，其次是疾病发作总数（80.1%）、FFMI（46.5%）、年龄（44.6%）、BMI（31.8%）、MNA 评分（27.7%）、血清肌酐（23.6%）、使用抗肿瘤坏死因子-α（23.3%）和性别（17.8%）。
总之，我们的研究结果显示，相当一部分处于临床缓解期的 IBD 患者存在营养不良或有营养不良风险，且肌肉减少症的发生率较高。这强调了即使在缓解期，也需要对 IBD 患者进行营养状况和身体成分分析的同时筛查，以便提供适当的营养支持，预防与肌肉减少症相关的手术和不良临床结局。
