title: Malnutrition and impaired muscle strength in patients with Crohn's disease and ulcerative colitis in remission.
abstract: 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.
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, CCM, Charité-Universitätsmedizin Berlin, Berlin, Germany. luzia.valentini@charite.de
authors.forename: Luzia
authors.initials: L
authors.lastname: Valentini
authors.forename: Lennart
authors.initials: L
authors.lastname: Schaper
authors.forename: Carsten
authors.initials: C
authors.lastname: Buning
authors.forename: Susanne
authors.initials: S
authors.lastname: Hengstermann
authors.forename: Thomas
authors.initials: T
authors.lastname: Koernicke
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Tillinger
authors.forename: Francesco William
authors.initials: FW
authors.lastname: Guglielmi
authors.forename: Kristina
authors.initials: K
authors.lastname: Norman
authors.forename: Sabine
authors.initials: S
authors.lastname: Buhner
authors.forename: Johann
authors.initials: J
authors.lastname: Ockenga
authors.forename: Matthias
authors.initials: M
authors.lastname: Pirlich
authors.forename: Herbert
authors.initials: H
authors.lastname: Lochs
mesh_terms: 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
chemical_list: D000893:Anti-Inflammatory Agents; D018977:Micronutrients; D012709:Serum Albumin; D002097:C-Reactive Protein; D011239:Prednisolone