P0683 Is it time to move away from malnutrition screening as a gateway to a dietitian referral in patients with Inflammatory Bowel Disease? An investigation into nutritional Issues in Crohn’s Disease Remission
Authors: Westoby C , Katarachia V , McDonnell M , Sartain S , Cummings J R F , Wootton S ,   INTICO2
Published: January 2025

Background

Conventional methods of triaging patients with Crohn’s Disease (CD) to see a dietitian mainly focus on generic risk scores for identifying overt malnutrition and do not consider dietary-impact factors more specific to CD, such as food-related gastrointestinal (GI) symptoms, bowel strictures or food avoidance. The INTICO-2 study characterised the nutritional state of adults in CD remission and included a novel patient-completed questionnaire of nutritional risk factors and symptoms, which would warrant a referral to a dietitian.

Methods

The INTICO2 study recruited adults with CD in confirmed clinical (HBI &lt;5) and biochemical remission (faecal calprotectin &lt;250 mg/g) from a single UK outpatient IBD Centre for nutritional assessment. Participants completed a dietetic-developed questionnaire that addressed signs and symptoms likely to limit dietary intake or indicate nutritional risk, including weight, weight loss, appetite (SNAQ)1, food restriction, CD phenotype (strictures, previous surgery), GI symptoms and physical symptoms associated with nutritional deficiencies.

Results

The median BMI in the cohort was 26.1 kg/m2 (18.0-48.9), and only one reported recent weight loss. Only one patient was assessed as at risk of malnutrition by MUST criteria.

Nevertheless, most patients (92%; 180/196) reported at least one sign or symptom with a mean of 4 (SD 3) signs or symptoms for the cohort. About a third (34%, 67/196) reported food restriction; dairy, wheat, red meat, pulses, garlic, and onion were the most avoided. On average, patients avoided two foods, with 47 different foods reported across the cohort.

About a third of patients (30%, 57/192) reported impaired appetite (SNAQ≤14); the mean SNAQ score was 15.5 (SD 2.3). Gastrointestinal symptoms after eating and signs and symptoms that suggest micronutrient deficiencies were evident (Table 1).

Participants who answered ‘yes’ to the presence of strictures or previous CD surgery had significantly more signs and symptoms than those who did not: Mean(SD) strictures 6.32 (2.9) versus no strictures 3.66 (2.7) P&lt;0.001 and surgery 5.4(2.8) versus no surgery 3.8 (2.9) P&lt;0.05).

Conclusion

Patients with CD in remission may experience significant symptoms impacting their nutritional intake. Patients in remission do not routinely see a dietitian. Triage based on low BMI or weight loss may be insufficient to identify those who might benefit from further dietetic assessment and advice. A move towards dietetic triage that also considers GI signs, symptoms, and prior surgery might improve the identification of those who would benefit from dietetic advice by improving nutritional intake and tailoring advice to relieve symptoms (e.g. texture modification advice for those with strictures).

References

1.Wilson M.-M.G., Thomas D.R., Rubenstein L.Z., Chibnall J.T., Anderson S., Baxi A., Diebold M.R., Morley J.E. Appetite Assessment: Simple Appetite Questionnaire Predicts Weight Loss in Community-Dwelling Adults and Nursing Home Residents. Am. J. Clin. Nutr. 2005;82:1074–1081. doi: 10.1093/ajcn/82.5.1074.