title: Inflammation-driven malnutrition: a new screening tool predicts outcome in Crohn's disease.
abstract: Malnutrition is a frequent feature in Crohn's disease (CD), affects patient outcome and must be recognised. For chronic inflammatory diseases, recent guidelines recommend the development of combined malnutrition and inflammation risk scores. We aimed to design and evaluate a new screening tool that combines both malnutrition and inflammation parameters that might help predict clinical outcome. In a prospective cohort study, we examined fifty-five patients with CD in remission (Crohn's disease activity index (CDAI) <200) at 0 and 6 months. We assessed disease activity (CDAI, Harvey-Bradshaw index), inflammation (C-reactive protein (CRP), faecal calprotectin (FC)), malnutrition (BMI, subjective global assessment (SGA), serum albumin, handgrip strength), body composition (bioelectrical impedance analysis) and administered the newly developed 'Malnutrition Inflammation Risk Tool' (MIRT; containing BMI, unintentional weight loss over 3 months and CRP). All parameters were evaluated regarding their ability to predict disease outcome prospectively at 6 months. At baseline, more than one-third of patients showed elevated inflammatory markers despite clinical remission (36·4 % CRP ≥5 mg/l, 41·5 % FC ≥100 µg/g). Prevalence of malnutrition at baseline according to BMI, SGA and serum albumin was 2-16 %. At 6 months, MIRT significantly predicted outcome in numerous nutritional and clinical parameters (SGA, CD-related flares, hospitalisations and surgeries). In contrast, SGA, handgrip strength, BMI, albumin and body composition had no influence on the clinical course. The newly developed MIRT was found to reliably predict clinical outcome in CD patients. This screening tool might be used to facilitate clinical decision making, including treatment of both inflammation and malnutrition in order to prevent complications.
authors.affiliation: 1Department of Hepatology and Gastroenterology,Charité - Universitätsmedizin,Charitéplatz 1,10117 Berlin,Germany.
authors.forename: Irene
authors.initials: I
authors.lastname: Jansen
authors.affiliation: 1Department of Hepatology and Gastroenterology,Charité - Universitätsmedizin,Charitéplatz 1,10117 Berlin,Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Prager
authors.affiliation: 2Unit of Dietetics,University of Applied Sciences,Brodaer Str. 2,17033 Neubrandenburg,Germany.
authors.forename: Luzia
authors.initials: L
authors.lastname: Valentini
authors.affiliation: 1Department of Hepatology and Gastroenterology,Charité - Universitätsmedizin,Charitéplatz 1,10117 Berlin,Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Büning
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000150:complications*; D005260:Female; D018737:Hand Strength; D006801:Humans; D007249:Inflammation / Q000150:complications*; D008297:Male; D044342:Malnutrition / Q000209:etiology*; D008875:Middle Aged; D015596:Nutrition Assessment; D012307:Risk Factors
keywords: CD Crohn’s disease; CDAI Crohn’s disease activity index; CRP C-reactive protein; Crohn’s disease; FC faecal calprotectin; HBI Harvey–Bradshaw index; Inflammation; MIRT Malnutrition Inflammation Risk Tool; MUST Malnutrition Universal Screening Tool; Malnutrition; Malnutrition Inflammation Risk Tool; NRS Nutritional Risk Screening; SGA subjective global assessment