Endocrine Abstracts

Background: Malnutrition and weight loss are well-recognized complications of Crohn disease (CD), however nutritional routine assessment is not commonly performed, resulting in under-detection and under-treatment of both malnutrition and nutrient deficiencies. In fact, a number of nutrition screening tools are available including the Nutritional Risk Index (NRI).

Aim: The aim of this study was to investigate the prevalence and the associated factors of malnutrition during CD.

Methods: We conducted a retrospective single-center study, including patients followed for CD over a 7-year period [2014 - 2021]. Clinico-biological data, anthropometric data, disease severity, and long-term outcomes were collected. Malnutrition risk was estimated based on Nutritional Risk Index (NRI) calculated at first presentation with the following formula: NRI=(1.519 × serum albumin (g/L) +41.7× (present weight/usual weight). Nutrition status of patients was categorized into four groups: NRI score of >100 was considered in no risk group, 97.5–100 mild risk, 83.5–97.5 moderate risk, and < 83.5 severe risk group.

Results: In total, 50 patients were enrolled with a mean age of 44.3 years [20-82], a median disease duration of 106 months and a sex ratio M/F of 3.16. Based on NRI, 11/50 (22%) patients had normal nutritional status, 27/50 (54%) mild-moderate risk of malnutriton and 12/50 (24%) had severe malnutrition. In the univariate study, severe malnutrition was associated with the presence of anemia (P=0.002), thrombocytosis (P=0.05), hypocholesterolemia (P=0.024), as well as the existence of radiologic sarcopenia (P=0.05). This risk was increased by extensive ileal involvement of more than 50 cm (P=0.014), the occurrence of complications such as intraabdominal collection (P=0.001) and thromboembolic complications (P=0.05). Uncontrolled disease in severe relapse was also a factor associated with malnutrition (P=0.05). Regarding, patients who underwent surgical treatment, the occurrence of postoperative complications and extensive small bowl resection were factors associated with severe malnutrition with a P-value of 0.02 and 0.025 respectively. On multivariate regression analysis, patients developing intra-abdominal abscess were more likely to have malnutrition (OR 10.5 95% CI 2.22-49.51), P=0.003).

Conclusion: Patients with malnutrition had more severe course of CD. Nutritional Risk Index is a simple, validated and reproducible tool to identify patients at increased risk of malnutrition allowing adapted nutritional support.