They have a chronic and recurrent trend. They present with periods of exacerbation alternating with phases of remission. And they can also affect the little ones, considering that around 25% of new diagnoses concern pediatric patients. They manifest themselves mainly with diarrhea, often accompanied by traces of blood, abdominal pain, vomiting, asthenia, fever, and are characterized by alternation between periods of exacerbation and periods of remission. Not only that. There are cases in which in addition to the digestive tract, other organs are also involved.
This brief identikit is sufficient to explain the impact of IBD (Chronic Inflammatory Intestinal Diseases), in particular Crohn’s disease and ulcerative colitis, on those who suffer from it. Thanks to care, treatments are increasingly effective. But we must not forget about the nutritional balance of patients. An investigation reveals how much this does not happen, however, with repercussions on the person’s well-being and on the management of the pathological condition.
A merciless analysis
Approximately 80% of patients never receive a nutritional evaluation. The result is that approximately 20% of the 250 thousand Italian patients with IBD (Crohn’s disease and ulcerative colitis), more or less 50 thousand people, are in a nutritional risk condition.
This is reported by a new national survey promoted by AMICI Italia, presented in view of the World Day of Chronic Inflammatory Intestinal Diseases, which will be celebrated on May 19th. On the occasion of the event, AMICI Italia launches the screening campaign “Do you lose weight? Don’t waste time!” with the patronage of the Italian Society of Artificial Nutrition and Metabolism (SINPE).
What are the most frequent deficiencies for patients? In IBD, chronic inflammation predisposes to the development of malnutrition in 13-27% of cases and sarcopenia – the loss of muscle mass and function – in over 40% of patients. Added to this is the fact that 78% have deficiencies of essential micronutrients such as vitamin D, zinc, iron, vitamin B9, B12 and calcium, due to chronic diarrhea, intestinal malabsorption and reduced appetite, often linked to post-prandial pain. Furthermore, 28% of patients have a BMI less than 20 which, if associated with involuntary weight loss and nutritional deficiencies, can represent a warning sign for the risk of malnutrition.
“The campaign aims to increase the awareness of patients with IBD on the risk of malnutrition. For this reason we have made available on the site a simple validated test which, with very few questions, allows patients to evaluate their nutritional status and to contact their doctor in case of risk of malnutrition”
explains Salvo Leone, general director of AMICI Italia.
The photograph of the situation
In the AMICI Italia survey, approximately 80% of patients declared that they had never received a malnutrition risk assessment from a healthcare professional or that they had no memory of one. Therefore, while the disease is treated pharmacologically or, in more complex cases, surgically, monitoring the nutritional status often remains neglected, despite the fact that malnutrition can reduce the effectiveness of therapies, increase the risk of post-operative complications and compromise the patient’s clinical recovery.
Yet, approximately 20% of the sample is already in a condition of high or acute nutritional risk. The consequences are not just physical: disease-related malnutrition translates into worse clinical outcomes, including more frequent relapses, reduced response to pharmacological treatments, greater post-operative complications, longer hospital stays and reduced quality of life. Addressing malnutrition promptly therefore becomes an essential element of the treatment process. To do this, multidisciplinary management involving gastroenterologists and dieticians is essential.
The tailor-made test
To assess the situation, we rely on the MUST (Malnutrition Universal Screening Tool) test, rapid and internationally validated, which is based on a short questionnaire of six questions (also to be used in self-assessment) which analyzes three main parameters to determine the patient’s health status.
The first element considered is the body mass index, followed by an evaluation of any involuntary weight loss that has occurred in recent months and the impact of the acute illness on the ability to eat regularly. The objective is to provide the patient with a practical tool to share with their doctor to better manage the nutritional complications related to the pathology.
“Despite nutrition representing a fundamental pillar in the treatment of chronic intestinal diseases, the attention paid to screening for the risk of malnutrition, early diagnosis and adequate nutritional support is still very lacking and inconsistent. In fact, around 80% of patients declare that they have never received a nutritional assessment from a healthcare professional, or that they have no memory of one. While the disease is treated pharmacologically, monitoring nutritional status often remains a neglected aspect”
underlines Antonella Lezo, president of the Italian Society of Artificial Nutrition and Metabolism (SINPE).
