Malnutrition in inflammatory bowel disease patients in northern India: frequency and factors influencing its development.

ABSTRACT

BACKGROUND: Patients with inflammatory bowel disease (IBD) are often under nourished. Though there are several studies evaluating nutrition in patients with IBD from the developed world, the data from developing countries are scanty, where under nutrition is predominant. METHOD: 62 patients with IBD (55 ulcerative colitis [UC] and 7 Crohn's disease [CD] patients) and 42 healthy subjects (HS) were evaluated for nutrition using dietary survey, anthropometric and biochemical parameters. RESULTS: Of the patients with IBD, 23 (37%) had active disease and 39 (63%) were in remission. Daily intake of calories (1725 Kcal/d [500-2458] vs. 2239 Kcal/d [1835-3000], p<0.0001), protein (40 g/d [19-96] vs. 50 g/d [29-73], p=0.001) and iron (9 mg/d [1-16] vs. 12 mg/d [9-16], p<0.0001) and anthropometric parameters of nutrition such as body mass index (BMI) (19.8 [13.7-27.5] vs. 23 [17.9-27.2], <0.0001), biceps (0.3 mm [0.1-1.9] vs. 0.5 mm [0.2-1.0], p<0.0001) and triceps (0.7 mm [0.2-2.9] vs. 1.2 mm [0.5-2.3], p<0.0001) skin fold thickness (BSF, TSF) and mid-arm muscle circumference (MAMC, 25.9 mm [15-35] vs. 26.8 mm [23-32] <0.04) were lower among the IBD patients than among the HS. Though patients with CD had a lower level of haemoglobin (median 9.2 g vs. 10.8 g, respectively; p<0.05) and serum total protein (median 6 g, range 3-7 vs. 7 g, range 3-9, respectively; p<0.05), serum albumin, BMI, BSF and TSF thicknesses, MAMC and daily intake of protein, calories, calcium and iron were comparable between UC and CD patients. Though daily dietary intake was comparable between patients with active disease and those in remission yet patients with active disease had lower BMI, MAMC and serum protein level. CONCLUSION: Under nutrition is common in patients with IBD, particularly in those with acute exacerbation.