Nutritional evaluation of inflammatory bowel disease

OBJECTIVES: Nutritional status is quite variable in Inflammatory Bowel Disease (IBD). In the nutritional status assessment, physical examination, blood tests, questionnaires and some devices can be used. Our aim is to evaluate the fast, reliable and cost-effective alternatives that we can use in the nutritional status assessment of IBD. In addition, it is another aim to investigate the relationship between fatigue, disability, nutritional status and disease activation. MATERIAL AND METHOD: This study included 286 patients with IBD between the ages of 19-82 (mean age: 45,51  14,80). Of the patients, 117 female, 169 male, 109 patients with ulcerative colitis (UC), 175 patients with Crohn's disease (CD) and 2 were indeterminate colitis. Modified Mayo Score (remission ≤ 2) was used in patients with UC to evaluate disease activation, and Harvey Bradshaw Index (remission≤4) in patients with CD. Nutritional status assessment was performed with Subjective Global Assessment in all patients. Bioelectrical Impedance Analysis (with Biospace InBody 720 Body Composition Analyzer) was performed to determine body composition for 82 volunteer patients. In addition, patients were evaluated with Brief Fatigue Inventory for fatigue and IBD-DI-SR for disability. The modified Glasgow Prognostic Score was also used as the measure of inflammation. RESULTS: In this study, while 83/109 (76.15%) of the patients with UC diagnosed were in remission, 26/109 (23.85%) were active; 124/175 (70.86%) of the patients diagnosed with CD were in remission and 51/175 (29.14%) were active. While all patients in remission in the UC group were in the SGD A group, 65.38% of the active ones were in the A group, 30.77% in the B group and 3.85% in the C group. In the CD group, 98.39% of patients in remission were in the A group, 1.61% in the B group, 78.43% of the active ones were in the A group, 21.57% were in the B group, and there were no patients in the C group. 34 of the 82 patients who performed BIA were diagnosed with UC and 48 with CH. About fat status, 82.35% of the UC patiens were high, 11.77% were normal, 5.88% were low; 64.51% of the CD patients were high, 31.25% were normal, 4.17% were low. About muscle status, 67.65% of patients diagnosed with UC were normal, 17.65% were high, 14.7% were low; 64.58% of patients with CD were normal, 25% were low, and 10.42% were high. While average body mass indexes of UC patients were 25.67  4.83 kg/m2, CD patients' were 24.73  4.32 kg/m2. About fatigue status, 72/81 (88.9%) of the patients diagnosed with UC were not tired, while 113/134 (84.3%) of the patients with CH were not tired. In the IBD-DI-SR test for disability, the mean score of the UCs was -2.43  6.94, while the CHs were -0.56  5.5. Hemoglobin and albumin were low in clinically active UC patients and they were normal in remission. Ferritin, B12, folic acid, magnesium and zinc were normal both in remission and active. 25-OH vitamin D was low in both groups. Those associated with clinical activation were hemoglobin (p <0.001), albumin (p = 0.014), B12 (p = 0.013) and CRP (p = 0.004). Albumin was low in clinically active CD patients and it was normal in remission. Hemoglobin, ferritin, B12, folic acid, magnesium, zinc were normal in both groups. 25-OH vitamin D was low in both groups. Those associated with clinical activation were albumin (p = 0.008) and CRP (p = 0.002). In the SGD - laboratory relationship, statistical significance was determined with magnesium (p = 0.015). mGPS has no difference between UC and CD but it was associated with clinical activity both UC and CD (respectively, p <0.001 and p = 0.001). When compared with SGD, it was seen that malnutrition group had a worse prognosis (p <0.001). CONCLUSION: Our study shows that when evaluating nutritional status in IBD, body mass index is insufficient and bioelectrical impedance analysis has limited benefit. At the same time, it was observed that fatigue and disability states were associated with nutritional status and disease activation. In clinically active UC, hemoglobin and albümin were low. In clinicaly active CDs, albumin was low. Low magnesium was associated with malnutrition. mGPS is associated with both clinical activation and malnutrition. KEYWORDS: Inflammatory Bowel Disease, Subjective Gobal Assessment, Nutrition, Fatigue, Disability, Body composition