P0588 - Factors Associated With the Development of Malnutrition Among Patients With Inflammatory Bowel Disease in a Large Community-Based Healthcare System

Liat Gutin, MD¹, Shiyun Zhu, MPH², Aida Shirazi, PhD¹, Jeffrey Lee, MD, MPH¹, Fernando Velayos, MD, MPH^1
1Kaiser Permanente, San Francisco, CA; ²Kaiser Permanete Division of Research, Oakland, CA

Introduction: Patients with inflammatory bowel disease (IBD) constitute a high-risk population for malnutrition, however little is known regarding the risk factors for malnutrition outside of referral centers. The Malnutrition Universal Screening Tool (MUST) is a nutritional screening tool recommended for a variety health conditions, including IBD. It is comprised of body mass index (BMI), recent weight loss and whether a patient will not have nutritional intake for more than 5 days. In the present study, we applied the MUST score to outpatients with IBD in a large, integrated healthcare system to identify predictors of malnutrition.

Methods: This was a multi-center cross-sectional study that included 12,095 patients with either Ulcerative Colitis (UC) or Crohn’s Disease (CD) in the Kaiser Permanente Northern California region. Patients were included if they had ≥2 diagnoses of UC or CD between 1/1/2009 and 12/31/2019 on at least 2 different dates, and if they had at least 2 outpatient BMI measurements 3-6 months apart after the IBD diagnosis date. The primary outcome was MUST score. Demographics were obtained and baseline clinical characteristics were extracted within one year prior to MUST score calculation. We assessed associations between demographic and clinical characteristics with malnutrition risk (as defined by the MUST score) using logistic regression.

Results: Using the MUST score, 10,475 (86.6%) patients were categorized as low risk for malnutrition and 1620 (13.4%) were categorized as medium or high risk. In univariate analysis, age, female sex, Asian race, CD, Charlson Comorbidity Index (CCI), prior abdominal surgery, and immunomodulator, biologic and steroid use were all associated with increased risk of malnutrition (Table 1). In the final multivariable model, female sex (OR 1.4; 95%CI: 1.3-1.6), CD (OR 1.2; 95%CI: 1.1-1.3), CCI (OR 1.3; 95%CI: 1.1-1.6), prior abdominal surgery (OR 2.1; 95%CI: 1.5-2.7) and prior use of corticosteroids (OR 1.3; 95%CI: 1.2-1.5) remained significant predictors of medium/high malnutrition risk (Table 1). Age had a protective effect (OR 0.94, 95%CI: 0.92-0.95, per 5-year unit)

Discussion: Crohn’s disease and markers of increased disease activity are important predictors of malnutrition risk, further supporting the role of disease control in malnutrition risk. Novel observations regarding age, gender, race, and comorbidity with malnutrition risk merit further study.

	Unadjusted OR (95% CI)	Adjusted OR (95% CI)
Age (5-year unit)	0.94 (0.92, 0.95)	0.94 (0.92, 0.95)
Female vs. Male - Female - Male*	1.40 (1.26, 1.56) 1.00	1.41 (1.27, 1.58) 1.00
Race - White* - Black - Asian - Hispanic - Others/unknown	1.00 0.95 (0.77, 1.19) 1.54 (1.30, 1.81) 0.68 (0.56, 0.83) 0.88 (0.64, 1.21)
IBD Type - CD - UC*	1.20 (1.08, 1.33) 1.00	1.18 (1.06, 1.32) 1.00
CCI - 0* - 1-2 - ≥3	1.00 0.86 (0.76, 0.97) 1.02 (0.87, 1.21)	1.00 0.95 (0.83, 1.08) 1.30 (1.08, 1.57)
Prior abdominal surgery - Yes - No*	2.32 (1.76, 3.05) 1.00	2.03 (1.54, 2.68) 1.00
5ASA - Yes - No*	0.87 (0.78, 0.96) 1.00
Immunomodulators/Biologics - Yes - No*	1.16 (1.02, 1.31) 1.00
Corticosteroids - Yes - No*	1.38 (1.24, 1.54) 1.00	1.34 (1.20, 1.50) 1.00

Table: 95%CI = 95% Confidence Interval
*Reference level
**Stepwise selection was used to identify factors that are related to risk score. A significance level of 0.2 was required to allow a variable into the model and to stay in the model. After adjustment, age, sex, IBD type, CCI, prior abdominal surgery, and use of corticosteroids are independently associated with medium/high risk score.



Disclosures:
Liat Gutin indicated no relevant financial relationships.
Shiyun Zhu indicated no relevant financial relationships.
Aida Shirazi indicated no relevant financial relationships.
Jeffrey Lee indicated no relevant financial relationships.
Fernando Velayos indicated no relevant financial relationships.


Liat Gutin, MD¹, Shiyun Zhu, MPH², Aida Shirazi, PhD¹, Jeffrey Lee, MD, MPH¹, Fernando Velayos, MD, MPH¹. P0588 - Factors Associated With the Development of Malnutrition Among Patients With Inflammatory Bowel Disease in a Large Community-Based Healthcare System, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.