S2021 Basic Screening Parameters for Malnutrition in IBD: Assessment Trends in Gastroenterology vs Primary Care

Introduction: Malnutrition in inflammatory bowel disease (IBD) can lead to macronutrient and micronutrient deficiencies. Screening tools are available to predict the risk of malnutrition, which include biochemical parameters, physical exam findings, and dietary intake. Osteoporosis (OP) and sarcopenia (SP) are common complications that affect functional status and overall health. Malnutrition screening remains low, especially without infrastructure to increase provider knowledge. Additionally, only 33% of gastroenterologists routinely screen for malnutrition. We analyzed screening trends at a rural hospital to assess the need for practice improvement. Methods: A retrospective review was completed for Crohn’s Disease (CD) and ulcerative colitis (UC) patients seen by gastroenterology (GI) and primary care (PC) from July 2021 to June 2024. Patients were reviewed for assessment of energy goal (EG), protein goal (PG), weight loss (WL), muscle mass/bulk (MMB), edema, and dual-energy X-ray absorptiometry (DEXA) completion. Primary outcomes were assessment of MMB (SP screening), WL and edema (general malnutrition screening), and DEXA (OP screening). Odds ratios (OR) were calculated with a 95% confidence interval (CI). Results: We identified 99 patients, 51 CD and 48 UC. Of all IBD patients, 29.3% were evaluated for EG, 27.3% for PG, 93.9% for WL, 14.1% for MMB, 96.0% for edema, and 24.2% had a completed DEXA. There was a statistical difference in assessment for EG (OR 0.03, CI 0.001-0.491, P = 0.01) between PC and GI. There was no statistical difference in assessment for EG (OR 0.56, CI 0.23-1.35, P = 0.20), PG (OR 1.02, CI 0.42-2.47, P = 0.97), WL (OR 1.07, CI 0.20-5.56, P = 0.94), MMB (OR 1.30, CI 0.42-4.07, P = 0.65), edema (OR 1.06, CI 0.14-7.88, P = 0.95), and DEXA completion (OR 1.80, CI 0.70-4.63, P = 0.21) between CD and UC, and PG (OR 0.61, CI 0.15-2.46, P = 0.49) between PC and GI. Conclusion: None of the screening tools available were utilized in our hospital. Therefore, we used surrogate markers to infer screening trends. Biochemical parameters and physical exam findings were comparable; likely due to limited malnutrition awareness. WL and edema were the most assessed, likely due to being part of the standard physical exam. In contrast with MMB, which is a more specific exam. OP screening was low, despite being routine in the general population. The higher EG assessment by PC supports lack of special nutrition expertise. Overall, quality improvement measures targeted at malnutrition screening practices are needed.