IBD and Malnutrition
Inflammatory bowel disease (IBD) is an umbrella term that refers to diseases that involve chronic inflammation of the digestive tract. Crohn’s disease and ulcerative colitis are the two major types of IBD. In Crohn’s disease, inflammation affects any part of the digestive system, often involving the lowest portion of the small intestine where the gut absorbs most of the nutrients from the food we eat. In ulcerative colitis, inflammation occurs in the large intestine. Diarrhea, intense abdominal pain, fever, nausea, and loss of appetite are some of the symptoms of IBD, but there are several treatments and management strategies available.
Since IBD affects the digestive system, which is where we process food and absorb nutrients, there are many factors that can lead to malnutrition. While it is difficult to pinpoint how common it is, research shows that somewhere between 20-85% of individuals with IBD experience malnutrition.1 Medication side effects, diminished ability to absorb nutrients (malabsorption), surgical resections, flares, and restrictive diets necessary for imaging and diagnostic tests are some of the ways malnutrition can develop in individuals with IBD. Also, those in hospital are at a higher risk for malnutrition due to lack of subsequent home care support, potential anorexia from illness, or procedure requirements preventing oral intake of food and drinks such as a nothing by mouth (NPO) order. In turn, this complication is a risk factor for repeated or longer hospital stays, increased risk of infections, mortality, and more. Malnutrition can also increase the risk of infection for those on immunosuppressive agents (e.g., azathioprine, methotrexate).
Researchers from the University of Calgary1 observed that there were significant gaps in knowledge and clinical practice guidelines on malnutrition in IBD. The study authors conducted a narrative review of the prevalence of malnutrition and its current care guidelines. They searched for English publications on IBD and nutrition interventions in Ovid Medline and PubMed. Based on their findings and analysis, they produced an expert opinion summary to inform clinicians on timely intervention and diagnosis of malnutrition in IBD that is not based on the requirement of weight loss or body mass index (BMI). This is because malnutrition occurs regardless of changes in body weight. It develops from a lack of adequate consumption or absorption of necessary nutrients that leads to changes in body composition, altered physical and mental function, and other impairments.
Concerningly, the study authors found that there is no gold standard definition of malnutrition in IBD for hospitalized individuals and community populations as well as validated tools for nutritional screening and assessment. There is also a lack of data on the use of parenteral nutrition in IBD populations and evidence gaps on the effectiveness of nutrition intervention on hospitalized IBD patients. Parenteral nutrition is intravenous delivery of nutrients, and it is an option when the gastrointestinal tract is not working. The nutrients given include protein, carbohydrate, fat, vitamins and minerals, electrolytes, and water. As a model of care, they highlight the University of Calgary’s High Risk Malnutrition Clinic as an example of a multidisciplinary facility that includes physician nutrition specialists and registered dietitians who have an expertise in nutrition for liver diseases.
The researchers recommend that there needs to be more awareness and recognition on the impact and prevalence of malnutrition among individuals living with IBD, especially for those in hospital. As a preventative step, healthcare professionals should screen all hospitalized patients with IBD for malnutrition. Those living with IBD should also receive appropriate nutrition interventions and the study authors proposed algorithms for consideration, which include screening, diagnosis, and treatment for IBD patients in hospital. They suggest that future research should focus on finding the best treatment options for malnutrition in IBD.
Learn more about nutrition and IBD by watching our video, featuring Anne-Marie Stelluti, registered dietitian.