Relationship between Nutritional Screening Tools and GLIM in Complicated IBD Requiring Surgery
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population and Design
- (1)
- Anthropometric parameters (consistent with GLIM phenotypic criteria)
- -
- BMI: values under <18.5 kg/m2 are associated with poor outcome and higher mortality rates [13,14]. GLIM BMI cut-off for malnutrition risk is <20 kg/m2. In older adults, the cut-off for the definition of underweight is higher (<22 kg/m2) as carrying some extra weight seems to be protective in this population [6,15];
- -
- (2)
- Disease-related parameters (consistent with GLIM etiologic criteria)
- -
- -
2.2. Statistical Analysis
3. Results
3.1. Demographics and Clinical Characteristics of IBD Patients
3.2. Nutritional Characteristics of IBD Patients
3.3. Prevalence of Nutritional Risk
3.4. Screening Tests Agreement
3.5. Reliability of the NS-IBD and Other Screening Tests with GLIM Malnutrition Diagnosis
3.6. Postoperative Length of Stay and Nutritional Risk
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
References
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BMI | Weight Loss | Reduced Food Intake | Severity of Disease | CRP | GI Symptoms ** | AGE | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
NRS-2002 | Score 1 | x | Score 1 | >5% in 3 months | Score 1 | Intake of 50–75% of normal requirement in preceding week | Score 1 | Hip fracture, chronic patients, in particular with acute complications: cirrhosis, COPD. chronic hemodialysis, diabetes, oncology | ≥70: + 1 point | ||||
Score 2 | 18.5–20.5 | Score 2 | >5% in 2 months | Score 2 | Intake of 25–60% of normal requirement in preceding week | Score 2 | Major abdominal surgery, stroke, severe pneumonia, hematologic malignancy | ||||||
Score 3 | <18.5 | Score 3 | >5% in 1 month or >15% in 3 months | Score 3 | Intake of 0–25 of normal requirement in preceding week | Score 3 | Head injury, bone marrow transplantation, intensive care patients. | ||||||
MUST | Score 1 | 18.5–20 | Score 1 | 5–10% in 3–6 months | Score 2 | There has been or is likely to be no nutritional intake for >5 days OR the patients is acutely ill * | |||||||
Score 2 | <18.5 | Score 2 | >10% in 3–6 months | ||||||||||
MST | Score 1 | 1–5 kg | Score 1 | Patient been eating poorly because of a decreased appetite | |||||||||
Score 2 | 6–10 kg | ||||||||||||
Score 3 | 5–11 kg | ||||||||||||
Score 4 | >15 kg | ||||||||||||
Score 2 | Unsure | ||||||||||||
SASKIBD-NR | Score 1 | 2.3–4.5 kg in 1 month | Score 2 | Eating poorly because of a decreased appetite | Score 1 | N° 1–2 | |||||||
Score 2 | 4.5–7 kg in 1 month | Score 2 | Restricting any foods or food groups | Score 2 | N° ≥ 3 | ||||||||
Score 3 | >7 kg in 1 month | ||||||||||||
MIRT | Score 1 | 18.5–20 | Score 2 | 5–10% in 3 months | Score 2 | 5–50 mg/L | |||||||
Score 2 | <18.5 | Score 3 | ≥10% in 3 months | Score 3 | ≥50 mg/L |
Score 0 | Score 1 | Score 2 | |
---|---|---|---|
BMI, kg/m2 | >20.5 or 22 if >70 years | 18.5–20.5 or 20–22 if >70 years | <18.5 or <20 if >70 years |
UWL, % | <5% within past 6 mths | 5–10% within past 3–6 mths or >10% beyond 6 mths | 5–10% within last mth or ≥10% in 3–6 mths |
Chronic diarrhea or ileostomy | no | yes | / |
Other GI symptoms, n° | 0–2 | ≥3 | / |
Previuos surgery for IBD | no | yes | / |
Total score: 0 = low risk; 1 = medium risk; ≥2 high risk |
IBD | CD | UC | p * | |
---|---|---|---|---|
Patients, n (%) | 62 | 46 (74%) | 16 (26%) | |
Age, years, median (IQR) | 54.5 (42.3–62.8) | 53.5 (43–62.2) | 57 (35.7–62.2) | 0.51952 |
Male, n (%) | 36 (58%) | 25 (54%) | 11 (69%) | 0.31461 |
Duration of disease, years, median (IQR) | 10.5 (2.2–18) | 10.5 (2.2–10.5) | 11 (2.5–18.2) | 0.92241 |
First operation, n (%) | 33 (53%) | 28 (61%) | 5 (31%) | 0.04083 |
Presence of stoma, n (%) | 11 (18%) | 1 (2%) | 10 (63%) | <0.001 |
Chronic diarrhoea, n (%) | 18 (29%) | 16 (35%) | 2 (13%) | 0.11746 |
N° of GI symptoms, mean, SD | 0.98 ± 1.13 | 1.21 ± 1.17 | 0.31 ± 0.70 | <0.001 |
<3, n (%) | 55 (89%) | 39 (85%) | 16 (100%) | 0.17498 |
≥3, n (%) | 7 (11%) | 7 (15%) | 0 | |
Crohn’s Disease behaviour | ||||
-stricturing, n (%) | 31 (67%) | |||
-fistulizing, n (%) | 11 (24%) | |||
-inflammatory | 4 (9%) | |||
Crohn’s Disease’s localization | ||||
-Ileal, n (%) | 36 (78%) | |||
-Ileocolonic, n (%) | 5 (11%) | |||
-Colonic, n (%) | 5 (11%) | |||
UC, n (%) | ||||
-Proctitis | 8 (50%) | |||
-Left side colitis | 1 (6%) | |||
-Extensive colitis | 7 (44%) | |||
Postoperative complications | 0.501 | |||
-Anastomotic Leak | 3 (5%) | 2 (4%) | 1 (6%) | |
-Wound infection | 1 (2%) | 0 | 1 (6%) | |
-PONV | 5 (8%) | 5 (11%) | 0 | |
Nutritional Status | ||||
Weight, kg, mean, SD | 64.4 ± 13.75 | 64.1 ± 13.04 | 65.4 ± 16.05 | 0.74574 |
BMI, kg/m2, mean, SD | 22.9 ± 4.03 | 22.9 ± 3.74 | 22.7 ± 4.90 | 0.6582 |
<18.5, n (%) | 8 (13%) | 4 (9%) | 4 (25%) | 0.18724 |
18.5–25, n (%) | 40 (65%) | 30 (65%) | 10 (62%) | 0.84486 |
25–30, n (%) | 11 (18%) | 10 (22%) | 1 (6%) | 0.26074 |
>30, n (%) | 3 (5%) | 2 (4%) | 1 (6%) | 1 |
UWL | ||||
n (%) | 30 (48%) | 19 (41%) | 11 (69%) | 0.08269 |
<5%, n (%) | 7 (11%) | 6 (13%) | 1 (6%) | 0.66553 |
5–10%, n (%) | 13 (21%) | 7 (15%) | 6 (38%) | 0.0791 |
≥10%, n (%) | 10 (16%) | 6 (13%) | 4 (25%) | 0.26605 |
FFM %, mean, SD | 78.7 ± 8.22 | 79.1 ± 8.13 | 77.4 ± 8.62 | 0.46595 |
FFM % (M), mean, SD | 80.9 ± 7.84 | 82.1 ± 7.56 | 78.3 ± 8.17 | 0.18269 |
FFM % (F), mean, SD | 75.3 ± 7.76 | 75.3 ± 7.36 | 75.2 ± 10.18 | 0.9771 |
FFMI, kg/m2, mean, SD | 17.5 ± 2.22 | 17.7 ± 2.21 | 17.2 ± 2.29 | 0.41296 |
FFMI (M), kg/m2, mean, SD | 18.5 ± 2.20 | 18.7 ± 2.27 | 18.1 ± 2.07 | 0.47845 |
FFMI (F), kg/m2, mean, SD | 16.1 ± 1.34 | 16.4 ± 1.13 | 15.0 ± 0.85 | 0.0355 |
FFMI < 17 (M) or < 15 (F), n (%) | 15 (25%) | 9 (20%) | 6 (37.5%) | 0.16266 |
Reduced food intake, n (%) | 12 (19%) | 9 (19%) | 3 (19%) | 1 |
Intake > 75% of TEE, n (%) | 59 (95%) | 43 (94%) | 16 (100%) | |
Intake < 75% of TEE, n (%) | 3 (5%) | 3 (6%) | 0 |
IBD | CD | UC | p * | ||||
---|---|---|---|---|---|---|---|
Nutritional screening tools | n° | % | n° | % | n° | % | |
NS-IBD | 33 | 53 | 20 | 43 | 13 | 81 | 0.01051 |
NRS-2002 | 24 | 39 | 14 | 30 | 10 | 63 | 0.02332 |
MUST | 16 | 26 | 8 | 17 | 8 | 50 | 0.01024 |
MST | 16 | 26 | 9 | 20 | 7 | 44 | 0.05687 |
MIRT | 24 | 39 | 14 | 30 | 10 | 63 | 0.02332 |
SASKIBD-NR | 15 | 24 | 10 | 22 | 5 | 31 | 0.44417 |
Malnutrition diagnosis | n° | % | n° | % | n° | % | |
GLIM | 25 | 40 | 15 | 33 | 10 | 63 | 0.03578 |
- GLIM stage 1 | 10 | 16 | 7 | 15 | 3 | 19 | 0.70878 |
- GLIM stage 2 | 15 | 24 | 8 | 17 | 7 | 44 | 0.03395 |
IBD | |||||||||
Sensitivity | 95% CI | Specificity | 95% CI | PPV | 95% CI | NPV | 95% CI | Youden index | |
NS-IBD | 0.92 | 0.72–0.98 | 0.73 | 0.56–0.86 | 0.7 | 0.51–0.84 | 0.93 | 0.76–0.99 | 0.65 |
NRS-2002 | 0.84 | 0.63–0.95 | 0.92 | 0.77–0.98 | 0.87 | 0.66–0.97 | 0.89 | 0.74–0.96 | 0.76 |
MUST | 0.6 | 0.39–0.78 | 0.97 | 0.84–0.99 | 0.94 | 0.68–0.99 | 0.78 | 0.63–0.88 | 0.57 |
MST | 0.6 | 0.39–0.78 | 0.97 | 0.84–0.99 | 0.94 | 0.68–0.99 | 0.78 | 0.63–0.88 | 0.57 |
MIRT SASKIBD-NR | 0.84 0.52 | 0.63–0.95 0.31–0.72 | 0.92 0.95 | 0.77–0.98 0.80–0.99 | 0.87 0.87 | 0.66–0.97 0.58–0.98 | 0.89 0.74 | 0.74–0.96 0.59–0.85 | 0.76 0.47 |
CD | |||||||||
Sensitivity | 95% CI | Specificity | 95% CI | PPV | 95% CI | NPV | 95% CI | Youden index | |
NS-IBD | 0.86 | 0.58–0.97 | 0.77 | 0.58–0.89 | 0.65 | 0.40–0.83 | 0.92 | 0.73–0.98 | 0.63 |
NRS-2002 | 0.8 | 0.51–0.94 | 0.93 | 0.77–0.98 | 0.85 | 0.56–0.97 | 0.90 | 0.73–0.97 | 0.73 |
MUST | 0.53 | 0.27–0.77 | 1 | 0.86–1 | 1 | 0.59–1 | 0.81 | 0.65–0.91 | 0.53 |
MST | 0.6 | 0.32–0.82 | 1 | 0.86–1 | 1 | 0.62–1 | 0.83 | 0.67–0.93 | 0.53 |
MIRT SASKIBD-NR | 0.8 0.6 | 0.51–0.94 0.32–0.82 | 0.93 0.96 | 0.77–0.98 0.81–0.99 | 0.85 0.9 | 0.56–0.97 0.54–0.99 | 0.90 0.83 | 0.73–0.97 0.66–0.93 | 0.73 0.56 |
UC | |||||||||
Sensitivity | 95% CI | Specificity | 95% CI | PPV | 95% CI | NPV | 95% CI | Youden index | |
NS-IBD | 1 | 0.65–1 | 0.5 | 0.13–0.86 | 0.76 | 0.45–0.93 | 1 | 0.30–1 | 0.50 |
NRS-2002 | 0.9 | 0.54–0.99 | 0.83 | 0.36–0.99 | 0.9 | 0.54–0.99 | 0.83 | 0.34–0.99 | 0.73 |
MUST | 0.7 | 0.35–0.91 | 0.83 | 0.36–0.99 | 0.87 | 0.46–0.99 | 0.62 | 0.25–0.89 | 0.53 |
MST | 0.6 | 0.27–0.86 | 0.83 | 0.36–0.99 | 0.85 | 0.42–0.99 | 0.55 | 0.22–0.84 | 0.43 |
MIRT SASKIBD-NR | 0.9 0.4 | 0.54–0.99 0.13–0.72 | 0.83 0.83 | 0.36–0.99 0.36–0.99 | 0.9 0.8 | 0.54–0.99 0.29–0.98 | 0.83 0.45 | 0.36–0.99 0.18–0.75 | 0.73 0.23 |
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Fiorindi, C.; Dragoni, G.; Scaringi, S.; Staderini, F.; Nannoni, A.; Ficari, F.; Giudici, F. Relationship between Nutritional Screening Tools and GLIM in Complicated IBD Requiring Surgery. Nutrients 2021, 13, 3899. https://doi.org/10.3390/nu13113899
Fiorindi C, Dragoni G, Scaringi S, Staderini F, Nannoni A, Ficari F, Giudici F. Relationship between Nutritional Screening Tools and GLIM in Complicated IBD Requiring Surgery. Nutrients. 2021; 13(11):3899. https://doi.org/10.3390/nu13113899
Chicago/Turabian StyleFiorindi, Camilla, Gabriele Dragoni, Stefano Scaringi, Fabio Staderini, Anita Nannoni, Ferdinando Ficari, and Francesco Giudici. 2021. "Relationship between Nutritional Screening Tools and GLIM in Complicated IBD Requiring Surgery" Nutrients 13, no. 11: 3899. https://doi.org/10.3390/nu13113899
APA StyleFiorindi, C., Dragoni, G., Scaringi, S., Staderini, F., Nannoni, A., Ficari, F., & Giudici, F. (2021). Relationship between Nutritional Screening Tools and GLIM in Complicated IBD Requiring Surgery. Nutrients, 13(11), 3899. https://doi.org/10.3390/nu13113899