The Nottingham Digestive Diseases Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, UK; MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research & National Institute of Health Research, Nottingham Biomedical Research Centre, University of Nottingham, UK.
Nottingham University Hospitals NHS Trust, Nottingham, UK.
Clin Nutr. 2023 Aug;42(8):1276-1291. doi: 10.1016/j.clnu.2023.05.002. Epub 2023 Jun 2.
There is growing evidence of increased muscle atrophy in IBD patients, likely resulting in a higher sarcopenia prevalence in IBD. The aims of this systematic review are A1; to estimate sarcopenia prevalence in IBD patients, A2; to investigate its impact on IBD patients, and A3; the effectiveness of nutritional interventions on muscle mass and/or strength in IBD patients.
On 28 July 2021, three electronic databases were used to identify eligible studies, including peer-reviewed studies (randomised controlled trials [RCTs], non-RCTs, observation studies) in adult (⩾ 18 years) IBD patients. For A1 and A2 only, studies defined low muscle mass and/or strength cut-off points. For A2, studies assessed association between sarcopenia and IBD complication. For A3, studies assessed the nutrition effect among IBD patients.
35 studies were included, 34 for A1, 20 for A2, and three for A3. 42% of adult IBD patients have myopenia, 34% have pre-sarcopenia, and 17% sarcopenia. Myopenic IBD was significantly associated with therapy failure including IBD-related surgery risk in six studies, risk of medical therapy failure in four studies, risk of hospitalisation in one study. A significant association existed with postoperative complications risk in IBD patients in four studies, reduction in BMD in two studies, and increased incidence of non-alcoholic fatty liver disease (NAFLD) in one study. Sarcopenia in IBD was significantly associated with a reduction in BMD in one study. Two studies found a personalised nutrition plan (high protein) in IBD patients significantly improved muscle mass. One study found a significant positive association between muscle mass and dietary intake including high protein intake.
Over one third of adult IBD patients have myopenia and pre-sarcopenia, and nearly a fifth have sarcopenia. Myopeninc IBD is significantly associated with increased risk of IBD therapy failure, postoperative complications, and low BMD, with possible association with increased NAFLD risk. Nutritional therapy may play a role in reversing low muscle mass though yet unclear if this is through disease activity reversal. Further studies on adult IBD patients focusing on sarcopenia/myopenia are needed with recommended study designs of 1) standardised population-based definitions with recommended standard methods used to measure skeletal muscle mass, 2) prospective studies with IBD patients stratified by Montreal classification, disease activity, disease duration and concomitant medication to observe muscle changes, 3) mechanistic studies on sarcopenia aetiology, specifically focusing on protein handling atrophy and absorption, 4) properly designed RCT to assess nutrition intervention in sarcopenic IBD patients.
越来越多的证据表明炎症性肠病（IBD）患者存在肌肉萎缩，这可能导致 IBD 患者中肌少症的患病率更高。本系统综述的目的是：A1. 估计 IBD 患者中肌少症的患病率；A2. 研究其对 IBD 患者的影响；A3. 营养干预对 IBD 患者肌肉质量和/或力量的有效性。
于 2021 年 7 月 28 日，使用三个电子数据库来确定符合条件的研究，包括针对成人（⩾ 18 岁）IBD 患者的同行评审研究（随机对照试验[RCT]、非 RCT、观察性研究）。对于 A1 和 A2，仅研究定义了低肌肉质量和/或力量的切点。对于 A2，研究评估了肌少症与 IBD 并发症之间的关联。对于 A3，研究评估了营养干预对 IBD 患者的影响。
共纳入 35 项研究，其中 34 项用于 A1，20 项用于 A2，3 项用于 A3。42%的成年 IBD 患者存在肌少症，34%存在前肌少症，17%存在肌少症。肌少症与六种研究中的 IBD 相关手术风险、四种研究中的药物治疗失败风险、一种研究中的住院风险显著相关。四项研究发现肌少症与 IBD 患者术后并发症风险相关，两项研究发现骨密度降低，一项研究发现非酒精性脂肪性肝病（NAFLD）发病率增加。一项研究发现 IBD 患者的肌少症与骨密度降低显著相关。两项研究发现，对 IBD 患者进行个性化营养计划（高蛋白）可显著改善肌肉质量。一项研究发现肌肉质量与饮食摄入（包括高蛋白摄入）之间存在显著正相关。
超过三分之一的成年 IBD 患者存在肌少症和前肌少症，近五分之一的患者存在肌少症。肌少症与 IBD 治疗失败、术后并发症和低骨密度的风险增加显著相关，可能与增加的非酒精性脂肪性肝病风险相关。营养治疗可能在逆转低肌肉质量方面发挥作用，但尚不清楚这是否是通过疾病活动的逆转。需要对成年 IBD 患者进行更多的肌少症/肌少症研究，建议的研究设计包括：1）采用标准化的基于人群的定义和推荐的标准方法测量骨骼肌质量；2）对按蒙特利尔分类、疾病活动、疾病持续时间和伴随药物分层的 IBD 患者进行前瞻性研究，以观察肌肉变化；3）对肌少症病因进行机制研究，特别是重点关注蛋白质处理萎缩和吸收；4）进行适当设计的 RCT 以评估肌少症 IBD 患者的营养干预。
