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Nutrition Deprivation Common in Hospitalized IBD Patients

by Lynne Peeples

Many patients hospitalized with inflammatory bowel disease may be deprived of protein and calories critical to their health and recovery, researchers have found.

Malnutrition in these patients can cause functional impairment and jeopardize tissue repair. It may also result in increased morbidity and mortality, decreased quality of life, higher health care costs, and longer and more frequent trips to the hospital.

The new study shows that more than half of patients hospitalized with IBD for at least five days became malnourished during their stay—despite the understanding among specialists that the need for adequate nutrition is critical during a bowel flare.

“During a flare is when they need nutrition the most,” said Kimberly Kolkhorst, DO, a gastroenterologist at the University of South Florida, in Tampa, who led the study. Dr. Kolkhorst and her colleagues presented their findings at the 2014 Advances in Inflammatory Bowel Diseases annual conference (abstract P-54).

Patients with Crohn’s disease or ulcerative colitis already face the risk for malnutrition. Dr. Kolkhorst said that health care providers should avoid making the situation worse. Up to an estimated 85% of hospitalized patients with IBD may suffer from protein-calorie malnutrition, she added.

The consequences of such untimely reductions in calories can include increased morbidity, mortality, hospital stays and health care costs.

After noticing how frequently their hospital’s primary care teams would order patients with abdominal pain and nausea to discontinue consumption of any food or drink via mouth (NPO), Dr. Kolkhorst and her colleagues decided to investigate the rate of iatrogenic malnutrition in patients hospitalized with IBD.

The team reviewed all inpatient gastroenterology consults to Tampa’s James A. Haley VA Hospital, between Jan. 1, 2013, and July 31, 2014, including records from hospital days 1 through 7 for patients with IBD. They defined iatrogenic malnutrition as patients with orders for NPO or a clear liquid diet for three or more days when hospitalized for at least five days.

Of 71 patients with IBD, 34 (48%) were hospitalized for at least five days. The researchers found iatrogenic malnutrition in 18 of these patients (53%).

“We thought it was going to be high but we didn’t think it would be that high,” Dr. Kolkhorst said, adding that her team is continually adding patients to increase the power of their study. “Clearly this is an issue that needs more attention.”

Only four of the 18 patients should have been NPO because they required surgery, she said.

“Optimal nutrition status should become part of the strategic quality care measures for hospitalized IBD patients,” Dr. Kolkhorst said. “Efforts need to be made to prevent overzealous NPO orders, lack of attention to diet orders, delayed endoscopies and delayed GI [gastroenterology] consults.”

Sunanda Kane, MD, a gastroenterologist and professor of medicine at Mayo Clinic, in Rochester, Minn., said the new study provides a “good teachable moment. Many clinicians assume that a patient hospitalized with IBD needs to be NPO or on restricted caloric intake.”

However, she pointed out an important limitation to the study: Patients with ulcerative colitis and Crohn’s disease were lumped together. “A patient with an obstruction certainly should not be fed but a patient with an abscess or just active ulcerative colitis can be,” Dr. Kane said.

Maria Abreu, MD, a gastroenterologist at the University of Miami’s Miller School of Medicine, in Florida, said the findings point to the need to use electronic health records “to encourage doctors to reassess a patient’s ability to eat solid food or at least nutritional drinks.“Most of us doctors don’t realize how awful it is to not eat,” she said.