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Standard malnutrition screening tools inadequately capture comprehensive nutritional needs in outpatients with
Aileen Xu1, Michelle Schneider2, Elisabeth Gorecki2
1Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States.
Background:
Malnutrition is common in inflammatory bowel disease (IBD) patients and associated with worse outcomes and quality of life. This study aimed to assess the feasibility of referring outpatient IBD patients with qualifying modified malnutrition universal screening tool (mMUST) scores to in-person registered dietitian (RD) evaluations. The secondary aim was to analyze the nutritional data collected.
Methods:
IBD patients seen at a tertiary care center between August and December 2022 were screened with the mMUST. Those with mMUST ≥1 were referred to an RD for comprehensive nutritional evaluation. Data were extracted via chart review and analyzed using t-tests and Fisher's exact tests.
Results:
Of 1698 patients, 990 (58%) were screened with the mMUST. Of those who screened positive and were referred, 19 (20%) completed RD evaluations. Among these, 37% consumed less than 75% of the nutritional needs. Body mass indices were evenly distributed between low, normal, and high. Though 26% of patients met a formal definition for moderate or severe protein-calorie malnutrition, 53% had muscle depletion and 42% had fat depletion.
Conclusions:
A simple screening tool can identify IBD patients at risk for malnutrition; however, patient- and provider-sided barriers prevent appropriate evaluation. The RD evaluations revealed body composition changes and signs of malnutrition that were not reflected in weight or routine labs. These findings highlight the need for routine malnutrition screening and comprehensive dietitian evaluation for all at-risk IBD patients, not just those who appear underweight or frail.
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