MedStar Georgetown University Hospital Washington, DC
Introduction: Malnutrition is highly prevalent in patients with inflammatory bowel disease (IBD). Nutritional assessment tools have been created to identify malnourished individuals and facilitate prompt nutritional intervention. The Malnutrition Universal Screening Tool (MUST) is a validated tool recommended for patients across all healthcare settings. In the present study, we implemented the MUST among patients with IBD at outpatient clinics in an academic health system. The aim of this study was to examine the relationship between patient and clinical characteristics, and laboratory markers of nutrition with the MUST nutritional risk score in patients with IBD.
Methods: This was a multi-center retrospective study conducted in outpatient clinics throughout the MedStar Healthcare System. 199 patients with IBD were screened using the MUST between February 10, 2022, and May 31, 2022. Low, medium, and high nutritional risk scores were defined as a score of 0, 1, or ≥ 2, respectively. We examined the association between the MUST scores and patient demographic data, markers of nutrition, and markers of disease activity. Univariate and multivariate logistic regression was used to examine associations between independent risk factors with nutritional risk score.
Results: Among the 199 patients screened, 87% were classified as low risk for malnutrition, 9% as moderate risk, and 4% as high risk. There was no statistically significant association between nutritional risk score and sex, IBD diagnosis, or age. In univariate analysis, IBD-related hospitalizations within one year of screening (p = 0.022), recent steroid use (p < .001), and elevated C-reactive protein (CRP) (p = 0.027) were associated with moderate-to-high risk of malnutrition as compared to low risk (Table 1). Decreased albumin (OR: 0.10; 95% CI: 0.02-0.57) and decreased hemoglobin (OR: 0.58; 95% CI: 0.40-0.84) were also significant predictors of malnutrition. In multivariate analysis, recent steroid use remained an independent risk factor for malnutrition.
Discussion: In this study, we demonstrate that MUST screening correlates to markers of disease activity, inflammation, and nutrition in patients with IBD. Univariate analysis identified IBD-related hospitalizations, recent steroid use, elevated CRP, decreased albumin, and decreased hemoglobin as risk factors. Only recent steroid use was identified as an independent risk factor. Further study on nutritional risk screening and disease markers in larger populations is warranted.
