Background: Ulcerative colitis (UC) and Crohn's disease (CD) are types of inflammatory bowel disease (IBD). Significant abnormalities in body composition including muscle mass depletion have been found in IBD patients, despite a healthy Body mass index (BMI). It is proposed that more complete nutritional assessments of IBD patients needs to be incorporated into routine clinical practice.
The objectives of this study were to
1. Assess nutritional status of IBD inpatients
2. Compare two methods for body composition Tricep Skinfold thickness (TSF) and the Bioelectrical Impedence (BIA)
3. Audit inpatient experience of food and nutrition.
Methods: This pilot prospective study was conducted over 6 weeks (June-July 2016). Patients admitted to the gastroenterology ward for >24 hours with a confirmed diagnosis of IBD were approached. Anthropometric measurements including: weight, height, hand grip and pinch strength, TSF, Mid-upper arm circumference (MUAC), mid-upper arm muscle circumference (MAMC), clinical and demographic data was collected. Patients were also screened using the Malnutrition Universal Screening Tool. All measurements were taken at one time point at the patients' bed side. Additionally patients were asked to complete a diet and nutrition questionnaire.
Results: 23 IBD patients (13 males, 10 females) participated in the study. All four nutritional parameters (TSF, MAC, MAMC and grip strength) were lower than published population norms. UC patients had higher BMI, Fat mass percentage (FM%) and Lean body mass percentage (LBM%) than CD patients (BMI: 24.33±6.92 vs 21.84±4.13, FM%: 25.11±8.59 vs 24.04±15.09, LBM%: 76.73±16.26 vs 74.89±8.59) respectively.
The FM%, FM and LBM measured by BIA and TSF agreed well (correlation p>0.05).
Most patients were satisfied with hospital food (70%) and food portion size (86%). Patients' dissatisfaction was due to unappetising food (54%) and unmatched provision as per individual requirement (37.5%).
Conclusions: Both BIA and TSF correlated well and to some extent were interchangeable. BMI in CD patients was lower than population norms, but no obvious impairment was observed in UC. Both FM% and LBM% of CD patients were lower than UC patients.
It is recommended that grip strength is incorporated into routine nutritonal assessment of IBD patients in addition to BMI to help detect LBM deficit as it is a fast, convenient and non-invasive measurement.
Further research requires larger patient numbers and further validation of body composition assessment measures requires comparison to the DXA method. Improvements in food and nutritional support of IBD inpatients are required.