title: Factors affecting poor nutritional status after small bowel resection in patients with Crohn disease.
abstract: In Crohn disease, bowel-preserving surgery is necessary to prevent short bowel syndrome due to repeated operations. This study aimed to determine the remnant small bowel length cut-off and to evaluate the clinical factors related to nutritional status after small bowel resection in Crohn disease.We included 394 patients (69.3% male) who underwent small bowel resection for Crohn disease between 1991 and 2012. Patients who were classified as underweight (body mass index < 17.5) or at high risk of nutrition-related problems (modified nutritional risk index < 83.5) were regarded as having a poor nutritional status. Preliminary remnant small bowel length cut-offs were determined using receiver operating characteristic curves. Variables associated with poor nutritional status were assessed retrospectively using Student t tests, chi-squared tests, Fisher exact tests, and logistic regression analyses.The mean follow-up period was 52.9 months and the mean patient ages at the time of the last bowel surgery and last follow-up were 31.2 and 35.7 years, respectively. The mean remnant small bowel length was 331.8 cm. Forty-three patients (10.9%) underwent ileostomy, 309 (78.4%) underwent combined small bowel and colon resection, 111 (28.2%) had currently active disease, and 105 (26.6%) underwent at least 2 operations for recurrent disease. The mean body mass index and modified nutritional risk index were 20.6 and 100.8, respectively. The independent factors affecting underweight status were remnant small bowel length ≤240 cm (odds ratio: 4.84, P < 0.001), ileostomy (odds ratio: 4.70, P < 0.001), and currently active disease (odds ratio: 4.16, P < 0.001). The independent factors affecting high nutritional risk were remnant small bowel length ≤230 cm (odds ratio: 2.84, P = 0.012), presence of ileostomy (odds ratio: 3.36, P = 0.025), and currently active disease (odds ratio: 4.90, P < 0.001).Currently active disease, ileostomy, and remnant small bowel length ≤230 cm are risk factors affecting the poor nutritional status of patients with Crohn disease after small bowel resection.
authors.affiliation: Department of Colorectal Surgery, University of Ulsan College of Medicine, Asan Medical Center Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Ki Ung
authors.initials: KU
authors.lastname: Jang
authors.forename: Chang Sik
authors.initials: CS
authors.lastname: Yu
authors.forename: Seok-Byung
authors.initials: SB
authors.lastname: Lim
authors.forename: In Ja
authors.initials: IJ
authors.lastname: Park
authors.forename: Yong Sik
authors.initials: YS
authors.lastname: Yoon
authors.forename: Chan Wook
authors.initials: CW
authors.lastname: Kim
authors.forename: Jong Lyul
authors.initials: JL
authors.lastname: Lee
authors.forename: Suk-Kyun
authors.initials: SK
authors.lastname: Yang
authors.forename: Byong Duk
authors.initials: BD
authors.lastname: Ye
authors.forename: Jin Cheon
authors.initials: JC
authors.lastname: Kim
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D009752:Nutritional Status; D012307:Risk Factors; D012778:Short Bowel Syndrome / Q000517:prevention & control