Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, China.
J Cachexia Sarcopenia Muscle. 2023 Dec;14(6):2663-2675. doi: 10.1002/jcsm.13341. Epub 2023 Oct 1.
Malnutrition and subsequent alterations in body composition (BC), particularly sarcopenia, are common but not yet elucidated in patients with inflammatory bowel disease (IBD); we aimed to detail the changes in BC and the characteristics of co-occurrence of malnutrition and sarcopenia in IBD patients and to investigate its effect on quality of life.
This study was a multicentre, prospective, observational study involving four tertiary referral hospitals in China. The following data were collected from consecutive IBD inpatients: demographic information, medical history, recent weight change, handgrip strength (HGS) and BC parameters by bioelectrical impedance analysis (BIA). Nutritional assessments were performed through stepwise screening (Nutritional Risk Screening 2002) and diagnosis (World Health Organization-related body mass index [BMI], subjective global assessment, European Society for Clinical Nutrition and Metabolism 2015 and Global Leadership Initiative on Malnutrition [GLIM] criteria). The quality of life was assessed by the Inflammatory Bowel Disease Questionnaire. IBD patients were compared with 1:1 sex-, age- and BMI-matched healthy controls (MHC).
A total of 238 IBD patients (177 Crohn's disease [CD] and 61 ulcerative colitis [UC]), 68.5% male, with a mean age of 38.5 ± 14.0 years and a mean BMI of 19.8 ± 3.5 kg/m , were recruited. Compared with MHC (n = 122), IBD patients showed significant deterioration in BC and physical function, characterized by muscle depletion (appendicular skeletal muscle mass index [ASMI], 8.0 ± 1.3 vs. 6.7 ± 1.2 kg/m , Δ% -15.0% [-22.0%, -10.0%], P < 0.001) and fat accumulation (visceral fat area, 32.9 ± 22.6 vs. 66.5 ± 35.8, Δ% 110.0% [35.0%, 201.0%], P < 0.001). The prevalence of GLIM-defined malnutrition and sarcopenia in IBD patients was 60.1% and 25.2%, respectively. The nutritional status of patients with CD was worse than that of patients with UC. The activity phase of IBD significantly and negatively affected BC, while the lesion location did not. The co-occurrence of sarcopenia and malnutrition was not optimistic; 16.4-21.8% of patients suffer from sarcopenia and malnutrition based on different criteria at the same time, which was accompanied by a reduction in quality of life. HGS was correlated with various BC parameters (body cell mass, r = 0.76; ASMI, r = 0.70; fat-free mass, r = 0.73, all P < 0.001).
GLIM-defined malnutrition and sarcopenia were prevalent in IBD patients and kept a high rate of co-occurrence, which was accompanied with impaired quality of life. The alteration of BC in IBD patients was characterized by muscle depletion and fat accumulation. The strong correlation between HGS and BIA-derived BC suggested its hopeful evaluation in nutritional status and sarcopenia in IBD patients.
营养不良和随后的身体成分改变（BC），特别是肌肉减少症，在炎症性肠病（IBD）患者中很常见，但尚未阐明；我们旨在详细描述 BC 的变化，以及 IBD 患者中营养不良和肌肉减少症同时发生的特征，并探讨其对生活质量的影响。
这是一项在中国四家三级转诊医院进行的多中心、前瞻性、观察性研究。从连续的 IBD 住院患者中收集以下数据：人口统计学信息、病史、近期体重变化、握力（HGS）和生物电阻抗分析（BIA）的 BC 参数。通过逐步筛查（营养风险筛查 2002）和诊断（世界卫生组织相关的体重指数[BMI]、主观全面评估、欧洲临床营养和代谢学会 2015 年和全球营养不良倡议[GLIM]标准）进行营养评估。通过炎症性肠病问卷评估生活质量。IBD 患者与 1:1 性别、年龄和 BMI 匹配的健康对照组（MHC）进行比较。
共纳入 238 名 IBD 患者（177 名克罗恩病[CD]和 61 名溃疡性结肠炎[UC]），68.5%为男性，平均年龄为 38.5±14.0 岁，平均 BMI 为 19.8±3.5kg/m ，纳入了 238 名 IBD 患者（177 名 CD 和 61 名 UC），68.5%为男性，平均年龄为 38.5±14.0 岁，平均 BMI 为 19.8±3.5kg/m ，纳入了 238 名 IBD 患者（177 名 CD 和 61 名 UC），68.5%为男性，平均年龄为 38.5±14.0 岁，平均 BMI 为 19.8±3.5kg/m ，纳入了 238 名 IBD 患者（177 名 CD 和 61 名 UC），68.5%为男性，平均年龄为 38.5±14.0 岁，平均 BMI 为 19.8±3.5kg/m 。与 MHC（n=122）相比，IBD 患者的 BC 和身体功能明显恶化，表现为肌肉减少（四肢骨骼肌指数[ASMI]，8.0±1.3 vs. 6.7±1.2kg/m ，Δ% -15.0%[-22.0%，-10.0%]，P<0.001）和脂肪堆积（内脏脂肪面积，32.9±22.6 vs. 66.5±35.8，Δ% 110.0%[35.0%，201.0%]，P<0.001）。IBD 患者 GLIM 定义的营养不良和肌肉减少症的患病率分别为 60.1%和 25.2%。CD 患者的营养状况比 UC 患者差。IBD 的活动期显著且负面地影响 BC，而病变部位没有影响。肌肉减少症和营养不良的同时发生情况不容乐观；根据不同标准，同时患有肌肉减少症和营养不良的患者比例为 16.4%-21.8%，这与生活质量下降有关。HGS 与各种 BC 参数（细胞内液质量，r=0.76；ASMI，r=0.70；无脂肪质量，r=0.73，均 P<0.001）相关。
GLIM 定义的营养不良和肌肉减少症在 IBD 患者中很常见，且同时发生的比例较高，这与生活质量下降有关。IBD 患者的 BC 改变以肌肉减少和脂肪堆积为特征。HGS 与 BIA 衍生的 BC 之间的强相关性表明其在 IBD 患者的营养状况和肌肉减少症评估中有一定的希望。
