P364 Presence of malnutrition adversely affects short-term clinical outcomes in a sample of patients with Crohn's disease (CD)
Karachaliou, A.(1)*;Lekakis, V.(2);Bletsa, M.(3);Mantzaris, G.J.(4);Tzouvala, M.(5);Bamias, G.(6);Kontogianni, M.D.(1);
(1)Department of Nutrition & Dietetics- School of Health Sciences and Education, Harokopio University of Athens, Athens, Greece;(2)Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens- Laiko General Hospital, Athens, Greece;(3)Department of Nutrition and Dietetics, ‘’Sotiria’’ Thoracic Diseases Hospital, Athens, Greece;(4)Department of Gastroenterology, ‘’Evangelismos-Ophthalmiatreion Athinon-Polykliniki’’ General Hospital, Athens, Greece;(5)Department of Gastroenterology, General Hospital of Nikaia Piraeus “Agios Panteleimon”-General Hospital Dytikis Attikis “Agia Varvara”, Athens, Greece;(6)GI-Unit- 3rd Academic Department of Internal Medicine, “Sotiria’’ Thoracic Diseases Hospital- Medical School- National and Kapodistrian University of Athens, Athens, Greece;
Background
Malnutrition in patients with CD has been suggested to affect the disease course, leading to more frequent flare-ups, disease-related complications and longer hospitalizations. The aim of the present study was to assess the effect of malnutrition on several clinical outcomes of patients with CD.
Methods
Data regarding medical history, disease classification and basic anthropometric characteristics were collected at baseline. Disease activity was assessed endoscopically and using the Harvey-Bradshaw Index (HBI<5 indicates remission). Malnutrition was assessed with the GLIM (Global Leadership Initiative on Malnutrition) criteria and SGA (Subjective Global Assessment). Patients were followed-up at 6 and 12 months and clinical outcomes (need for hospitalization, corticosteroids and antibiotics’ use, change of biologic agents, surgery) were recorded.
Results
At baseline 237 patients (54.8% males, 41.2±14.1 years, 37.2% with active disease) were evaluated. Prevalence of malnutrition at baseline was 13.5% and 22.9% based on GLIM and SGA, respectively, and was higher in active disease compared to remission (GLIM: 25% vs. 6.7%, p<0.001, SGA: 41.9% vs. 11.5%, p<0.001). Outcomes of 237 patients were recorded at 6 months and of 233 at 12 months. Presence of malnutrition at baseline, according to GLIM criteria, was associated with an increased likelihood of need for intensification or change of biologic agent (OR: 2.66, 95% CI: 1.14-6.24, p=0.02], surgery (OR: 3.73, 95% CI: 1.02-13.70, p=0.04) and overall adverse outcome (OR: 2.33, 95% CI: 0.99-5.49, p=0.05) after adjustment for age, sex, disease location and disease activity at baseline. Similar results were observed when malnutrition was diagnosed with SGA only for need for intensification or change of biologic agent (OR: 5,78 (1,52, 21,92), p=0,01] after adjustment for age, sex, disease location and disease activity at baseline. No statistically significant associations were observed between presence of malnutrition (either diagnosed with GLIM criteria or SGA) and disease-related outcomes at 12 months.
Conclusion
Presence of malnutrition was associated with short-term (within 6 months) adverse clinical outcomes, such as need to intensify the therapeutic regimen, need for surgical interventions due to disease complications and a worse overall disease outcome in CD patients. No effect of malnutrition diagnosis on the examined clinical outcomes was observed at 12 months of follow-up.