Malnutrition and impaired muscle strength in patients with Crohn's disease and ulcerative colitis in remission.
OBJECTIVE
This prospective, controlled, and multicentric study evaluated nutritional status, body composition, muscle strength, and quality of life in patients with inflammatory bowel disease in clinical remission. In addition, possible effects of gender, malnutrition, inflammation, and previous prednisolone therapy were investigated.


METHODS
Nutritional status (subjective global assessment [SGA], body mass index, albumin, trace elements), body composition (bioelectrical impedance analysis, anthropometry), handgrip strength, and quality of life were assessed in 94 patients with Crohn's disease (CD; 61 female and 33 male, Crohn's Disease Activity Index 71 +/- 47), 50 patients with ulcerative colitis (UC; 33 female and 17 male, Ulcerative Colitis Activity Index 3.1 +/- 1.5), and 61 healthy control subjects (41 female and 20 male) from centers in Berlin, Vienna, and Bari. For further analysis of body composition, 47 well-nourished patients with inflammatory bowel disease were pair-matched by body mass index, sex, and age to healthy controls. Data are presented as median (25th-75th percentile).


RESULTS
Most patients with inflammatory bowel disease (74%) were well nourished according to the SGA, body mass index, and serum albumin. However, body composition analysis demonstrated a decrease in body cell mass (BCM) in patients with CD (23.1 kg, 20.8-28.7, P = 0.021) and UC (22.6 kg, 21.0-28.0, P = 0.041) compared with controls (25.0 kg, 22.0-32.5). Handgrip strength correlated with BCM (r = 0.703, P = 0.001) and was decreased in patients with CD (32.8 kg, 26.0-41.1, P = 0.005) and UC (31.0 kg, 27.3-37.8, P = 0.001) compared with controls (36.0 kg, 31.0-52.0). The alterations were seen even in patients classified as well nourished. BCM was lower in patients with moderately increased serum C-reactive protein levels compared with patients with normal levels.


CONCLUSIONS
In CD and UC, selected micronutrient deficits and loss of BCM and muscle strength are frequent in remission and cannot be detected by standard malnutrition screening.
Valentini
Luzia
L
Department of Gastroenterology, Hepatology and Endocrinology, CCM, Charité-Universitätsmedizin Berlin, Berlin, Germany. luzia.valentini@charite.de
Schaper
Lennart
L
Buning
Carsten
C
Hengstermann
Susanne
S
Koernicke
Thomas
T
Tillinger
Wolfgang
W
Guglielmi
Francesco William
FW
Norman
Kristina
K
Buhner
Sabine
S
Ockenga
Johann
J
Pirlich
Matthias
M
Lochs
Herbert
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001823:Body Composition / Q000502:physiology; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000097:blood / Q000150:complications*; D003424:Crohn Disease / Q000097:blood / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D018977:Micronutrients / Q000172:deficiency; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D015596:Nutrition Assessment; D009748:Nutrition Disorders / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D009752:Nutritional Status; D011239:Prednisolone / Q000627:therapeutic use; D011446:Prospective Studies; D011788:Quality of Life; D012075:Remission, Spontaneous; D012709:Serum Albumin / Q000032:analysis
D000893:Anti-Inflammatory Agents; D018977:Micronutrients; D012709:Serum Albumin; D002097:C-Reactive Protein; D011239:Prednisolone