Taylor Lorian M, Eslamparast Tannaz, Farhat Kamal, Kroeker Karen, Halloran Brendan, Shommu Nusrat, Kumar Ankush, Fitzgerald Quinn, Gramlich Leah, Abraldes Juan G, Tandon Puneeta, Raman Maitreyi
Department of Medicine, University of Calgary, Calgary, Alberta T2N 4N1, Canada.
Department of Medicine, University of Alberta, Zeidler Ledcor Centre, 130 University Campus, Edmonton, Alberta T6G 2X8, Canada.
Crohns Colitis 360. 2021 Jul 7;3(3):otab043. doi: 10.1093/crocol/otab043. eCollection 2021 Jul.
Malnutrition is associated with adverse clinical outcomes in patients with inflammatory bowel disease (IBD), however, malnutrition screening is not routinely performed. This study aimed to identify the prevalence of malnutrition in patients with IBD and compare the accuracy of patient completed screens to a gold-standard malnutrition assessment tool: the dietitian-completed subjective global assessment (SGA).
This cross-sectional study was conducted at 2 hospitals and 2 ambulatory care clinics in Alberta, Canada. Patients with IBD completed 4 malnutrition screening tools: abridged patient-generated SGA (abPG-SGA), Malnutrition Universal Screening Tool (MUST), Canadian Nutrition Screening Tool (CNST), and Saskatchewan IBD-nutrition risk (SaskIBD-NR). Risk of malnutrition was calculated for each tool and differences were compared between IBD subtype and body mass index (BMI) categories. Sensitivity and specificity, negative and positive predictive values (NPV and PPV), and area under the receiver operating characteristic curve (AUC) were calculated compared to SGA.
Patients with Crohn's disease ( = 149) and ulcerative colitis ( = 96) participated in this study. Overall prevalence of malnutrition using SGA was 23% and malnutrition risk for CNST, abPG-SGA, SaskIBD-NR, and MUST was 37%, 36%, 36%, and 27%, respectively. Overall, the abPG-SGA had the highest sensitivity (83%), PPV (53%), and NPV (94%), and largest AUC (0.837) compared to SGA. For patients with a BMI ≥25 kg/m, sensitivity and PPV of the abPG-SGA decreased to 73% and 41%, respectively, with a AUC of 0.841.
Malnutrition is prevalent in patients with IBD and using malnutrition risk screening tools such as the abPG-SGA may be useful to identify patients who would benefit from further assessment.
营养不良与炎症性肠病（IBD）患者的不良临床结局相关，但营养不良筛查并非常规进行。本研究旨在确定IBD患者中营养不良的患病率，并将患者自行完成的筛查与金标准营养不良评估工具——营养师完成的主观全面评定法（SGA）的准确性进行比较。
本横断面研究在加拿大艾伯塔省的2家医院和2家门诊护理诊所进行。IBD患者完成了4种营养不良筛查工具：简化的患者自评SGA（abPG-SGA）、营养不良通用筛查工具（MUST）、加拿大营养筛查工具（CNST）和萨斯喀彻温IBD营养风险评估（SaskIBD-NR）。计算每种工具的营养不良风险，并比较IBD亚型和体重指数（BMI）类别之间的差异。与SGA相比，计算敏感性和特异性、阴性和阳性预测值（NPV和PPV）以及受试者工作特征曲线下面积（AUC）。
克罗恩病患者（n = 149）和溃疡性结肠炎患者（n = 96）参与了本研究。使用SGA评估的总体营养不良患病率为23%，CNST、abPG-SGA、SaskIBD-NR和MUST的营养不良风险分别为37%、36%、36%和27%。总体而言，与SGA相比，abPG-SGA具有最高的敏感性（83%）、PPV（53%）和NPV（94%），以及最大的AUC（0.837）。对于BMI≥25 kg/m²的患者，abPG-SGA的敏感性和PPV分别降至73%和41%，AUC为0.841。
营养不良在IBD患者中普遍存在，使用abPG-SGA等营养不良风险筛查工具可能有助于识别那些将从进一步评估中获益的患者。
