Systematic Reviews
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2019; 25(28): 3823-3837
Published online Jul 28, 2019. doi: 10.3748/wjg.v25.i28.3823
Systematic review of nutrition screening and assessment in inflammatory bowel disease
Suqing Li, Michael Ney, Tannaz Eslamparast, Ben Vandermeer, Kathleen P Ismond, Karen Kroeker, Brendan Halloran, Maitreyi Raman, Puneeta Tandon
Suqing Li, Division of Internal Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta T6G 2G3, Canada
Michael Ney, Maitreyi Raman, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta T2N 2T9, Canada
Tannaz Eslamparast, Kathleen P Ismond, Karen Kroeker, Brendan Halloran, Puneeta Tandon, Cirrhosis Care Clinic, Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta T6G 2X8, Canada
Ben Vandermeer, Alberta Research Centre for Health Evidence, Biostatistician, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta T6G 1C9, Canada
Author contributions: Li S, Tandon P, Ney M and Raman M designed the research; Li S, Ney M and Vandermeer B collected data; Li S, Ney M, Vandermeer B and Tandon P analyzed the data; Li S, Ney M, Eslamparast T, Vandermeer B, Ismond KP, Kroeker K, Halloran B, Raman M and Tandon P interpreted the data; Li S, Ney M, Eslamparast T, Vandermeer B, Ismond KP, Kroeker K, Halloran B, Raman M and Tandon P wrote and edited the manuscript.
Conflict-of-interest statement: All authors have no conflict of interest related to the manuscript.
PRISMA 2009 Checklist statement: Authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Maitreyi Raman, FRCP (C), MD, MSc, Associate Professor, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, 6D33 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta T2N 2T9, Canada. mkothand@ucalgary.ca
Telephone: +1-403-592-5020
Received: March 18, 2019
Peer-review started: March 18, 2019
First decision: May 16, 2019
Revised: June 17, 2019
Accepted: July 1, 2019
Article in press: July 3, 2019
Published online: July 28, 2019
Abstract
BACKGROUND

Malnutrition is prevalent in inflammatory bowel disease (IBD). Multiple nutrition screening (NST) and assessment tools (NAT) have been developed for general populations, but the evidence in patients with IBD remains unclear.

AIM

To systematically review the prevalence of abnormalities on NSTs and NATs, whether NSTs are associated with NATs, and whether they predict clinical outcomes in patients with IBD.

METHODS

Comprehensive searches performed in Medline, CINAHL Plus and PubMed. Included: English language studies correlating NSTs with NATs or NSTs/NATs with clinical outcomes in IBD. Excluded: Review articles/case studies; use of body mass index/laboratory values as sole NST/NAT; age < 16.

RESULTS

Of 16 studies and 1618 patients were included, 72% Crohn’s disease and 28% ulcerative colitis. Four NSTs (the Malnutrition Universal Screening Tool, Malnutrition Inflammation Risk Tool (MIRT), Saskatchewan Inflammatory Bowel Disease Nutrition Risk Tool (SaskIBD-NRT) and Nutrition Risk Screening 2002 (NRS-2002) were significantly associated with nutritional assessment measures of sarcopenia and the Subjective Global Assessment (SGA). Three NSTs (MIRT, NRS-2002 and Nutritional Risk Index) were associated with clinical outcomes including hospitalizations, need for surgery, disease flares, and length of stay (LOS). Sarcopenia was the most commonly evaluated NAT associated with outcomes including the need for surgery and post-operative complications. The SGA was not associated with clinical outcomes aside from LOS.

CONCLUSION

There is limited evidence correlating NSTs, NATs and clinical outcomes in IBD. Although studies support the association of NSTs/NATs with relevant outcomes, the heterogeneity calls for further studies before an optimal tool can be recommended. The NRS-2002, measures of sarcopenia and developments of novel NSTs/NATs, such as the MIRT, represent key, clinically-relevant areas for future exploration.

Keywords: Nutrition, Inflammatory bowel disease, Ulcerative colitis, Crohn’s disease, Screening, Outcomes research

Core tip: Malnutrition is highly prevalent amongst patients with inflammatory bowel disease (IBD) and negatively impacts various clinical outcomes. This review highlights the Malnutrition Universal Screening Tool, Malnutrition Inflammation Risk Tool, Saskatchewan Inflammatory Bowel Disease Nutrition Risk Tool, Nutrition Risk Screening 2002 and cross-sectional imaging assessments of sarcopenia as promising nutrition screening and assessment tools in IBD. By becoming familiar with and consistently applying these tools we can move towards early recognition, diagnosis and management of malnutrition in clinical practice. Further research will elucidate the optimal tools and the impact of their integration into routine practice on clinical outcomes in IBD.