| Objective: Ulcerative colitis(UC)is a chronic inflammatory disease of the gastrointestinal tract located in the colorectum that is recurrent and persistent.Malnutrition is a common complication of UC,especially in hospitalized patients.There is no uniform diagnostic criteria for malnutrition in clinical practice,and the global leadership initiative on malnutrition(GLIM)criteria were proposed in 2018 and showed good accuracy,while there are fewer studies related to whether it is applicable to UC.The purpose of this paper is to study the application of GLIM criteria in UC,to analyze the prevalence of malnutrition in UC,to compare the differences in anthropometric parameters,laboratory indices and clinical poor prognosis between the malnutrition and no-malnutrition groups of patients,to assess the independent risk factors for the development of malnutrition in UC and their predictive value,and to provide a basis for the subsequent nutritional treatment.Method: One hundred and four patients with UC who were hospitalized at the Affiliated Hospital of Qingdao University between November 2019 and November 2021 were collected,and all patients were first screened by the nutritional risk screening(NRS)2002scale,and those with malnutrition risk were then diagnosed with malnutrition according to GLIM criteria and divided into malnutrition and no-malnutrition groups.The prevalence of UC malnutrition was studied,and the two groups were compared in terms of gender,age,body mass index(BMI),history of smoking,history of alcohol consumption,history of gastrointestinal surgery,extraintestinal manifestations,modified Mayo score,C reactive protein(CRP),prealbumin(PAB),albumin(ALB),hemoglobin(HB),erythrocyte sedimentation rate(ESR),alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),total bilirubin(TBIL),urea nitrogen(BUN),creatinine(CR),neutrophil/lymphocyte(NLR),neutrophil/monocyte(NMR),lymphocyte/monocyte(LMR),Montreal enteritis typing,therapeutic drugs and body composition differences.The effect of malnutrition on short-term readmission and access to surgical treatment in UC patients was investigated by follow-up.Binary logistic regression analysis was performed to identify independent risk factors for malnutrition in UC,and the predictive value of independent risk factors for the development of malnutrition in UC was assessed by area under the ROC curve and sensitivity and specificity.Results:(1)Among 104 patients with UC,61(58.7%)were males and 43(41.3%)were females,aged 21-69 years.There were 30 patients(28.8%)in the malnutrition group,11 males and 19 females,and 74 patients(71.2%)in the no-malnutrition group,50 males and24 females.(2)There was no significant difference in smoking history,history of gastrointestinal surgery,extraintestinal manifestations,ALT,ALP,CR,and NMR levels between the two groups(P>0.05);the malnutrition group had more young patients,female patients,and those with a history of alcohol consumption(P<0.05),and their modified Mayo score,CRP,ESR,and NLR levels were higher than those of the no-malnutrition group(P<0.05),and BMI,PAB,ALB,HB,TBIL,AST,BUN,and LMR levels were lower than those in the no-malnutrition group(P<0.05).(3)1 case of mild UC,17 cases of moderate UC and 12 cases of severe UC in the malnutrition group,17 cases of mild UC,46 cases of moderate UC and 11 cases of severe UC in the no-malnutrition group,patients with severe UC were more prone to malnutrition than patients with mild to moderate UC(P<0.05).In the malnutrition group,there were 8 cases in the 5-ASA treatment group,17 cases in the 5-ASA combined with hormone treatment group,and 5 cases in the biologic combined with 5-ASA/hormone treatment group;in the no-malnutrition group,there were 50 cases in the 5-ASA treatment group,20 cases in the 5-ASA combined with hormone treatment group,and 4 cases in the biologic combined with 5-ASA/hormone treatment group,and the proportion of patients in the malnutrition group escalating the application of hormones and/or biologics was higher than that in the group without malnutrition(P<0.05).There were 1 case of E1,3cases of E2 and 26 cases of E3 in the malnutrition group,and 13 cases of E1,12 cases of E2 and 49 cases of E3 in the no-malnutrition group,and there was no significant difference between the two groups(P>0.05).(4)Short-term follow-up results showed 12 cases(40%)of readmission and 12 cases(40%)of surgery within 3 months in the malnutrition group and 14 cases(18.9%)of readmission and 10 cases(13.5%)of surgery in the no-malnutrition group,with higher rates of short-term readmission and surgical treatment in the malnutrition group than in the no-malnutrition group(P<0.05).(5)Patients in the malnutrition group had lower body composition content(body fat weight,protein,skeletal muscle mass,segmental muscle,segmental water,waist circumference,left arm circumference,right arm circumference,visceral fat area,basal metabolic rate and body cell content)than the group without malnutrition,except for bone mineral content and left and right skinfold thickness(P<0.05).(6)Binary logistic regression analysis showed that low ALB level and high Mayo score were independent risk factors for UC malnutrition(P<0.05).(7)ROC curves showed that the best threshold values of ALB(AUC=0.895)and modified Mayo score(AUC=0.753)to predict whether malnutrition occurred in UC patients were 34.24 g/L and 8 points,respectively.Conclusions:(1)The GLIM criteria were applied to the diagnosis of malnutrition in inpatients with UC,and the prevalence of malnutrition in UC was 28.8%.(2)Patients in the malnutrition group had higher CRP,modified Mayo scores,and greater disease activity,and were more likely to require timely escalation of hormone or biologic therapy.(3)Low ALB levels and high Mayo scores are independent risk factors for UC malnutrition.When ALB levels are below 34.24 g/L and modified Mayo scores are higher than 8,malnutrition should be alerted. |
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