IBD Patients With Clinical Remission Often Malnourished, Sarcopenic

By Lisa Rapaport

February 08, 2021

(Reuters Health) - Malnutrition and sarcopenia are common in patients with inflammatory bowel disease (IBD) in clinical remission, a recent study suggests.

In 344 IBD patients in clinical remission, researchers assessed malnutrition using the Mini Nutritional Assessment questionnaire and also examined hand grip, physical performance and fat-free mass to help identify sarcopenia.

Overall, 5.5% were underweight, 9.9% were malnourished and an additional 39.5% were at risk for becoming malnourished. The researchers identified sarcopenia or probable sarcopenia in 41.3%.

The total number of IBD flares requiring hospitalization was the biggest predictor of sarcopenia in the study population, followed by free-fat mass index, age, BMI, and the nutritional assessment, researchers report in the European Journal of Gastroenterology and Hepatology.

Malnutrition is common among IBD patients due to limited diet and food intake, malabsorption, and catabolism - and sarcopenia is a natural extension of malnutrition as protein stores in muscles are used to compensate for calorie energy deficits, said Dr. Berkeley Limketkai, director of clinical research at the Center for Inflammatory Bowel Diseases at the University of California Los Angeles David Geffen School of Medicine.

"These features would naturally be expected in times of active disease, as evidenced by the study showing that flares within the past year were associated with probable and confirmed sarcopenia," Dr. Limketkai, who wasn't involved in the study, said by email.

It's possible that some patients in remission may have malnutrition or sarcopenia because reversal of these conditions takes time, Dr. Limketkai said.

"While disease activity can rapidly fluctuate over the course of several days, reversal of a malnourished state and sarcopenia could take weeks to months," Dr. Limketkai said.

Beyond this, IBD patients are also at increased risk for developing avoidant/restrictive food intake disorder, which could lead to subconscious or intentional avoidance of food and a deficit of nutrients and calories, Dr. Limketkai added.

"This is one mechanism that not only leads to malnutrition and sarcopenia, but causes it to persist even after a flare has resolved," Dr. Limketkai said.

Dr. Ashwin Ananthakrishnan of Massachusetts General Hospital in Boston, who wasn't involved in the study, agreed. Patients may have altered their diet and physical activity during active disease and not fully resumed a normal eating and exercise habits once they were in remission, contributing to sarcopenia, he said.

Also, he noted, patients in clinical remission may have subclinical or endoscopic active inflammation that contribute to sarcopenia.

"The state of clinical remission only refers to symptom activity, but does not necessarily indicate underlying intestinal inflammation," Dr. Limketkai added. "As such, it is also possible for the catabolic effect of inflammation to persist."

"Clinicians caring for patients with IBD should assess nutritional status and sarcopenia periodically," Dr. Ananthakrishnan advised. "Those with sarcopenia or malnutrition should be referred for nutritional consultation and support services to build up muscle mass."

SOURCE: https://bit.ly/3pSBHoA European Journal of Gastroenterology and Hepatology, online January 18, 2021.

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