S816 Food Insecurity: The Impact of Food Deserts in IBD Malnutrition Screening

Introduction: Inflammatory bowel disease (IBD) increases the risk of malnutrition, which is compounded by food insecurity. The U.S. Department of Agriculture (USDA) defines “low access” as living more than a mile from grocery stores in urban areas or 10 miles away in rural areas. Food deserts often lack transportation to obtain healthy food. Guidelines recommend annual screening for micronutrient deficiencies to lessen disease burden. We analyzed trends in micronutrient deficiency screening at a gastroenterology (GI) clinic in a food desert. Methods: A retrospective review was completed for IBD patients seen by GI from July 2021 to June 2024. Patients were stratified by food access and insurance type (federally funded [FF] and commercial [C]). Low access (LA) zip codes were identified by using the USDA’s Food Access Research Atlas. Completion of albumin (AL), calcium (CA), iron (FE), folate, B12, B vitamins (VITs), vitamin D (VD), VITs E, K, A, and C, magnesium (MG), zinc, and selenium testing were assessed. Primary outcomes were completion of each micronutrient assessment (MA). Odds ratios (OR) were calculated with a 95% confidence interval (CI). Results: We identified 99 IBD patients. All were screened for CA. 96.0% of patients were screened for AL, 51.5% for FE, 31.3% for folate, 47.5% for B12, 49.5% for VD. Less than 6 patients were assessed for B VITs, VITs E, K, A, and C, zinc, and selenium. There was a statistical difference in MA completion for MG (OR 2.62, CI 1.11-6.22, P = 0.03) between FF and C. There was no statistical difference in MA completion for AL (OR 0.80, CI 0.08-8.00, P = 0.85), FE (OR 0.54, CI 0.22-1.32, P = 0.18), folate (OR 0.65, CI 0.26-1.63, P = 0.36), B12 (OR 0.78, CI 0.33-1.87, P = 0.59), VD (OR 0.72, CI 0.30-1.73, P = 0.47), and MG (OR 1.13, CI 0.47-2.70, P = 0.79) between LA and adequate access (AA), and MA completion for AL (OR 0.69, CI 0.09-5.10, P = 0.71), FE (OR 1.36, CI 0.58-3.17, P = 0.47), folate (OR 2.34, CI 0.95-5.78, P = 0.06), B12 (OR 1.71, CI 0.73-3.99, P = 0.21), and VD (OR 0.45, CI 0.19-1.05, P = 0.06) between FF and C. Conclusion: MA was geographically comparable regardless of food access. Insurance type did not affect MA except for MG, assessed more for FF. This is not surprising, as rural clinics have less resources and funding allocated to specialty services including nutrition and case managers. Multidisciplinary care is often not as robust, and quality improvement projects are not as prominent. To better serve patients with low food access, such projects should be implemented.