Published online Jul 28, 2019. doi: 10.3748/wjg.v25.i28.3823
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
Malnutrition is highly prevalent in patients with inflammatory bowel disease (IBD), however the optimal nutrition screening tools (NST) and nutrition assessment tools (NAT) to detect and diagnosis malnutrition respectively are unclear.
Given the negative clinical and economic impacts of malnutrition in IBD, identification of a simple, accurate and efficient process for identifying malnutrition may allow for increased recognition and earlier nutritional intervention.
To systematically review the prevalence of malnutrition in patients with IBD, whether available NSTs correlate with NATs, and whether NSTs and NATs are predictive of clinical outcomes.
PubMed and MEDLINE databases were systematically searched utilizing a comprehensive search strategy. Articles were reviewed and extracted by two independent reviewers against inclusion/exclusion criteria. Included articles underwent quality assessment review utilizing the modified Newcastle Ottawa Scale as well as data extraction, synthesis and review by the authors and a biostatistician.
A total of 1791 studies were identified from the initial search, 16 of which met all inclusion criteria and were included for qualitative synthesis. Prevalence of patients at high risk of malnutrition amongst inpatient and outpatient IBD patients as assessed by NSTs ranged from 28%-67%. Sarcopenia was identified in 39.5% of IBD patients. The malnutrition universal screening tool (MUST), Nutrition Risk Screening 2002 (NRS-2002), Malnutrition Inflammation Risk Tool (MIRT) and Saskatchewan Inflammatory Bowel Disease Nutrition Risk Tool (SaskIBD-NRT) all showed significant associations with various NAT measures. Of NSTs, the MIRT, NRS-2002 and NRI demonstrated significance in predicting clinical outcomes of relevant clinical outcomes. Presence of sarcopenia was significantly associated with various clinical and post-operative outcomes. The Subjective Global Assessment was not consistent in its association with clinical outcomes.
Malnutrition and sarcopenia remain highly prevalent in the IBD population as assessed by currently available NSTs and NATs. No single optimal NST or NAT can be recommended based on our review at this time. Based on current evidence, previously available NSTs including the NRS-2002 and MUST, as well as novel IBD-specific NSTs (MIRT, SaskIBD-NRT) are the most useful to screen for malnutrition in this population. Sarcopenia evaluation (via cross-sectional imaging) has promise as a robust nutrition assessment method given its significant associations with clinical outcomes. However, more accurate, practical and cost-effective methods of evaluating sarcopenia in the IBD population outside of conventional methods of body composition analysis should be explored.
The utility as well as strengths and weaknesses of available NSTs and NATs have been reviewed. Future research is needed to test and validate available tools in the IBD population. The development of novel tools will aid clinicians in identifying, diagnosing and intervening on malnourishment in the IBD patient population.