Nationwide prevalence and prognostic significance of clinically diagnosable protein-calorie malnutrition in hospitalized inflammatory bowel disease patients

Authors

  • Geoffrey C. Nguyen MD, PhD,

    Corresponding author
    1. Mount Sinai Hospital IBD Centre, University of Toronto School of Medicine, Toronto, Ontario, Canada
    2. Harvey M. and Lyn P. Meyerhoff IBD Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • 600 University Ave., Suite 437, Toronto, Ontario M5G 1X5, Canada
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  • Melissa Munsell MD,

    1. Harvey M. and Lyn P. Meyerhoff IBD Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Mary L. Harris MD

    1. Harvey M. and Lyn P. Meyerhoff IBD Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract

Background Inflammatory bowel disease (IBD) patients are at increased risk of protein-calorie malnutrition. We sought to determine the prevalence of clinically diagnosable malnutrition among those hospitalized for IBD throughout the United States and whether this malnutrition influenced health outcomes.

Methods We queried the Nationwide Inpatient Sample between 1998 and 2004 to identify admissions for Crohn's disease (CD) or ulcerative colitis (UC) and a representative sample of non-IBD discharges. We assessed the prevalence and predictors of malnutrition and its association with in-hospital mortality and resource utilization.

Results The prevalence of malnutrition was greater in CD and UC patients than in non-IBD patients (6.1% and 7.2% versus 1.8%, P < 0.0001). The adjusted odds ratio for malnutrition among IBD admissions compared with non-IBD admissions was 5.57 [95% confidence interval (CI): 5.29–5.86]. More IBD discharges than non-IBD discharges with malnutrition received parenteral nutrition (26% versus 6%, P < 0.0001). There was increased likelihood of malnutrition among those with fistulizing CD (OR 1.65; 95% CI: 1.50–1.82) and among those who had undergone bowel resection (OR 1.37; 95% CI: 1.27–1.48). Malnutrition was associated with increased in-hospital mortality 3.49 (95% CI: 2.89–4.23), length of stay (11.9 days versus 5.8 days, P < 0.00001), and total charges ($45,188 versus $20,295, P < 0.0001).

Conclusions Clinically apparent malnutrition is more frequent among IBD admissions than among non-IBD admissions. Its association with greater mortality and resource utilization may reflect more severe underlying disease that can lead to both malnutrition and worse outcomes. Nonetheless, diagnosable malnutrition may serve as a clinical marker of poor IBD prognosis in hospitalized patients.

(Inflamm Bowel Dis 2008)

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