P019 OPTIMIZING NUTRITION RISK SCREENING AND FOLLOW-UP NUTRITION COUNSELING IN AN OUTPATIENT INFLAMMATORY BOWEL DISEASE POPULATION
Authors: AlChoufete Therezia , Proksell Siobhan , Schwartz Marc , Myers Cassie , Weaver Emily , Frantz Anna , Mittura Julie , Saucier Kate , Strassburger Meredith , Szigethy Eva 
Published: January 2020

Abstract

Background
As management of Inflammatory Bowel Disease (IBD) advances, the outpatient (OP) population is shifting its fears from risks of malnutrition to those associated with over-nutrition and under-nutrition, lack of diet education, access to resources, mental health implications, and socioeconomic status. Failure to identify a patient at nutrition risk could lead to increased costs of care which can be avoided by proper nutrition screening and counseling with a Registered Dietitian (RD). The integration of nutrition counseling into the interdisciplinary care model for patients with IBD needs to be optimized to identify a broader range of risks to nutrition status in an efficient and objective format that can be applied universally in the OP IBD setting.

Aims
This study 1) explores a novel approach to nutrition risk screening within the OP IBD setting using an interdisciplinary team approach; and 2) evaluates correlations between an objective scoring method for biological and psychosocial risk with nutrition risk scores reported by an RD.

Methods
Two objective nutrition risk scoring methods were developed to capture biological (NUTR-OBJ) and lifestyle (NUTR-WELL) nutrition factors on a 0–6 scale (low-severe risk). Scores were determined using review of the electronic health record and a screening tool provided to patients. These scores were compared to the previously established IBD Biopsychosocial Complexity Grid, a tool which organizes this health information into biological and psychological domains and serves as the basis for algorithm-driven treatment plans within an IBD Medical Home.

Results
Data from 44 patients (mean age:35.2 years;47.7% female;56.8% Crohn’s Disease) were included in this study. BMI ranged from 18.08 to 37.92 kg/m2. BIO-C-PRO (mean=1.95,SD 1.86) and BIO-C-OBJ (mean 1.59, SD 1.76) indicate mild overall disease risk within our sample. NUTR-OBJ scores (mean=2.39, SD 1.28) showed no significant correlations with biological (BIO-C-PRO/OBJ) or psychosocial (PSY-C/H;SOC-SES;MI-C) scores. NUTR-WELL (mean=1.98,SD 1.36) showed strong positive correlations with PSY-C (r=.326, p&lt;.05), PSY-H (r=.386,p&lt;.01), SOC-SES (r=.306,p&lt;.05), and MI-C (r=.473,p&lt;.01).

Discussion
This study indicates a significant correlation between NUTR-WELL scores and psychosocial scores, suggesting validity for this nutrition screening tool to determine behaviors that may increase nutrition risk. Poor correlations between NUTR-OBJ and biological scores suggests that the need for nutrition intervention may not always be indicated by disease severity. This scoring system can potentially serve as a guide to maximize efficiency of follow-up appointments with an RD and avoid complications of care related to poor nutrition status that may be unidentified by disease risk alone. Further research is needed to confirm findings and extend to a larger sample.