Abstract
Background
Malnutrition is highly prevalent in inflammatory bowel disease (IBD) but is not routinely screened or assessed. Multiple nutrition screening (NST) and assessment tools (NAT) have been developed for general populations, but the ideal tools and their predictive validity for clinical outcomes in IBD remain unclear. We hypothesize this knowledge gap may be a reason why NST and NAT are not routinely utilized in this at risk population.
Aims
To provide a review of the evidence in IBD populations:
1. Correlating NST or NAT to clinical outcomes
2. Correlating NST to NAT for diagnosis of malnutrition
Methods
We performed a comprehensive search strategy including Medline, CINAHL Plus and PubMed with study selection and quality assessment carried out by two independent reviewers. A third reviewer resolved disagreements.
Inclusion criteria: Diagnosis of IBD; Age ≧18 years; studies correlating NST to NAT or correlating NST/NAT to clinical outcomes; RCT/case-control/cohort/cross-sectional study
Exclusion criteria: Use of BMI or lab values as sole NST/NAT
Results
1052 articles were identified from the initial search. 41 full-texts were reviewed against inclusion/exclusion criteria; 5 studies with a total of 494 patients were analyzed (CD n=447, UC n=47). Reasons for exclusion were: no predictive clinical outcomes (n=22) and no formal screening/assessment method (n=14).
NST included the Nutritional Risk Screening 2002 (NRS-2002, n=1), Malnutrition Universal Screening Tool (MUST, n=1), Nutritional Risk Index (NRI, n=1), and Malnutrition Inflammation Risk Tool (MIRT, n=1). NAT included Body Impedance Analysis (BIA, n=2), Skeletal Muscle Index (SMI, n=1) and Subjective Global Assessment (SGA, n=1).
Four studies assessed correlation of NST or NAT to outcomes and three studies assessed NST to NAT. Two studies demonstrated correlation between NST of MIRT with outcomes (hospitalizations [R=0.398, p=0.003], flares [R=0.299, p=0.03], surgeries [R=0.371, p=0.006], complications [R=0.333, p=0.015]) and low NRI (< 97.5) with poor response to biologics (p=0.037). Two studies found associations between NAT (low SMI, BIA [Increased skeletal muscle percentage]) and surgical complications (OR 9.24 and 0.487 respectively). Three studies demonstrated NST (MUST, NRS-2002, MIRT) correlated with BIA (FFMI), SMI and SGA.
Conclusions
There is limited evidence correlating NST, NAT and clinical outcomes in IBD populations. Our review found statistically significant associations between NST/NAT with outcomes, and between NST with NAT, was present in all studies. Despite this, the small number of studies and differences in NST/NAT methods did not allow for further meta-analysis. Further prospective studies are necessary to evaluate the performance of these tools to determine the most effective nutrition screening/assessment algorithm for IBD patients.
Funding Agencies
None