Katja Kulmala 1, Jan Björk 2, Sara Andersson 3, Ann-Sofie Backman 1,2, Francesca Bresso 2, Charlotte R.H. Hedin 2

Affiliates

1 Karolinska Institutet, Department of Medicine, Solna, Unit of Internal Medicine, Stockholm, Sweden, 2 Karolinska University Hospital, Gastroenterology Unit, Patient Area Gastroenterology, Dermatovenereology and Rheumatology, Stockholm, Sweden, 3 Karolinska University Hospital, Department of Clinical Nutrition, Stockholm, Sweden

Abstract

Background: Current data suggest that malnutrition during IBD flare predicts in-hospital mortality, surgery, and length of admission. However, specific effects of nutrition on IBD flare resolution are unknown. We hypothesised that nutritional factors during hospitalisation for acute severe IBD are associated with risk of subsequent relapse. We also studied which factors are associated with suboptimal energy intake.
Methods: Patients admitted to the Karolinska Hospital Gastroenterology ward with IBD flare during 2015 and 2016 were retrospectively identified and contacted to give informed consent. Data on nutritional intake, disease factors, inflammatory markers, and daily energy requirement were extracted from hospital records and the National Swedish IBD Register (SWIBREG). Relapse was defined with: requirement of new steroid prescription, intensification of biological therapy, readmission, surgery, and calprotectin level. Follow-up was one year after discharge. Patients who underwent a resection of all inflamed tissue during admission or up to three months after discharge discontinued follow-up at surgery and were excluded from analyses requiring full follow-up. Adjustments for age and gender were made where appropriate.
Results: In total, 91 patients were included. Overall, 19%, 31%, and 45% of patients had days with energy intake <30, <50, and <70% of calculated need. Older age at admission was significantly associated with the number of days with energy intake <30, <50, and <70% of calculated need (regression coefficient 0.03, 0.04, 0.06 respectively, p=0.012, 0.017, 0.008). Number of days with energy intake <30 and <70% of the need and total length of the inpatient period were associated with shorter time to new steroid prescription (hazard ratio 1.3, 1.1, 1.04 respectively, p=0.016, 0.034, 0.011). CRP and calprotectin were not associated with steroid-requiring relapse. Also, other outcomes were not associated with any of the factors tested.
Conclusion: Older age is a predictor of suboptimal energy intake during acute severe IBD. Suboptimal energy intake adjusted for age and gender during hospitalisation for acute, severe IBD is a better predictor of time to the next relapse than disease factors and inflammatory markers. We speculate that suboptimal nutrition may adversely affect attainment of durable remission by impeding either epithelial cell regeneration or microbial restitution.