Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2016; 8(7): 563-572
Published online Jul 15, 2016. doi: 10.4251/wjgo.v8.i7.563
Undernutrition, risk of malnutrition and obesity in gastroenterological patients: A multicenter study
Massimiliano Rizzi, Silvia Mazzuoli, Nunzia Regano, Rosa Inguaggiato, Margherita Bianco, Gioacchino Leandro, Elisabetta Bugianesi, Donatella Noè, Nicoletta Orzes, Paolo Pallini, Maria Letizia Petroni, Gianni Testino, Francesco William Guglielmi
Massimiliano Rizzi, Silvia Mazzuoli, Nunzia Regano, Francesco William Guglielmi, Gastroenterology Unit, San Nicola Pellegrino Hospital, 76125 Trani, Italy
Donatella Noè, Nicoletta Orzes, Paolo Pallini, Maria Letizia Petroni, Gianni Testino, Francesco William Guglielmi, AIGO-Committee on Nutrition and Alcoholism, 20153 Milano, Italy
Rosa Inguaggiato, Margherita Bianco, Gioacchino Leandro, Gastroenterology Unit I, Saverio De Bellis IRCCS, 70013 Castellana Grotte, Italy
Gioacchino Leandro, UCL, Department of Liver and Digestive Health, London NW3 2PF, England
Elisabetta Bugianesi, Division of Gastro-Hepatogy, Department of Medical Sciences, University of Torino, 10126 Torino, Italy
Donatella Noè, Dietetics and Clinical Nutrition Unit, S. Carlo Borromeo Hospital, 20153 Milano, Italy
Nicoletta Orzes, Gastroenterology Unit, S. Giovanni di Dio Hospital, 34170 Gorizia, Italy
Paolo Pallini, Gastroenterology Unit, Umberto I Hospital, 30174 Mestre, Italy
Maria Letizia Petroni, Nutritional and Gastroenterological Unit, IRCCS, 28824 Piancavallo, Italy
Gianni Testino, Alcoholism and Related Conditions Unit, IRCCS-AOU S. Martino-IST, 16132 Genova, Italy
Author contributions: Rizzi M, Leandro G, Bugianesi E, Noè D, Orzes N, Pallini P, Petroni ML, Testino G and Guglielmi FW contributed to the study conception and design; Rizzi M, Mazzuoli S, Regano N, Inguaggiato R, Noè D and Collaborators contributed to the data acquisition; Rizzi M, Leandro G, Bianco M and Guglielmi FW contributed to the data analysis and interpretation and writing of the article; Bugianesi E, Noè D, Orzes N, Pallini P, Petroni ML and Testino G contributed to editing, reviewing and the final approval of the article.
Institutional review board statement: The study was reviewed and approved by the AIGO (Italian Hospital Gastroenterology Association) - Committee on Nutrition and Alcoholism.
Informed consent statement: All study participants or their legal guardian provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare that there are no conflicts of interest and that no financial support has been received.
Data sharing statement: No additional data are available.
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/
Correspondence to: Francesco William Guglielmi, Professor, Gastroenterology Unit, Regional Centre of Home Artificial Nutrition, “San Nicola Pellegrino” Hospital, 76125 Trani, Italy. guglielmifw@libero.it
Telephone: +39-883-483209 Fax: +39-883-483342
Received: December 22, 2015
Peer-review started: December 24, 2015
First decision: January 20, 2016
Revised: March 23, 2016
Accepted: April 20, 2016
Article in press: April 22, 2016
Published online: July 15, 2016

AIM: To investigate the prevalence of undernutrition, risk of malnutrition and obesity in the Italian gastroenterological population.

METHODS: The Italian Hospital Gastroenterology Association conducted an observational, cross-sectional multicenter study. Weight, weight loss, and body mass index were evaluated. Undernutrition was defined as unintentional weight loss > 10% in the last three-six months. Values of Malnutrition Universal Screening Tool (MUST) > 2, NRS-2002 > 3, and Mini Nutritional Assessment (MNA) from 17 to 25 identified risk of malnutrition in outpatients, inpatients and elderly patients, respectively. A body mass index ≥ 30 indicated obesity. Gastrointestinal pathologies were categorized into acute, chronic and neoplastic diseases.

RESULTS: A total of 513 patients participated in the study. The prevalence of undernutrition was 4.6% in outpatients and 19.6% in inpatients. Moreover, undernutrition was present in 4.3% of the gastrointestinal patients with chronic disease, 11.0% of those with acute disease, and 17.6% of those with cancer. The risk of malnutrition increased progressively and significantly in chronic, acute and neoplastic gastrointestinal diseases in inpatients and the elderly population. Logistical regression analysis confirmed that cancer was a risk factor for undernutrition (OR = 2.7; 95%CI: 1.2-6.44, P = 0.02). Obesity and overweight were more frequent in outpatients.

CONCLUSION: More than 63% of outpatients and 80% of inpatients in gastroenterological centers suffered from significant changes in body composition and required specific nutritional competence and treatment.

Keywords: Obesity, Malnutrition, Risk of Malnutrition, NRS2002, Gastrointestinal disease

Core tip: The relevance of this study concerns the finding that in patients with gastroenterological disease, both prevalence of undernutrition and risk of malnutrition were higher in patients admitted to the hospital and in patients with cancer disease, while obesity and overweight were more frequently detected in outpatients. In conclusion, we can attest that two-thirds of gastroenterological patients suffered from abnormalities in body composition and required targeted nutritional treatments.