The number of cases of malnutrition in persons with inflammatory bowel disease (IBD) varies widely, with reported values ranging from 20% to 85%. Malnutrition in IBD and IBS patients is influenced by various factorsincluding reduced food intake, malabsorption, persistent blood and protein loss, and the presence of bacterial growth in the intestine.
Furthermore, recent findings from 2022 show that after reviewing 237 patients with inflammatory bowel disease (IBD), 14% of these individuals are identified at high risk of malnutrition15% of these patients suffered from Crohn's disease and 12% from ulcerative colitis.
Inflammatory bowel disease (IBD) is a term describing conditions in which there is prolonged (chronic) inflammation of the digestive tract. Types of IBD include ulcerative colitis and Crohn's disease.
Before we get into the topic, let's look at the definition of the term "malnutrition". Malnutrition refers to deficiencies or excesses in nutrient intake, imbalances of essential nutrients or impaired nutrient absorption. It can also be described as lack of proper nutrition, caused by inadequate nutrition or inability to absorb the food consumed.
During the course of the disease, protein-energy malnutrition and deficiencies of specific nutrients can present clinical problems in patients with inflammatory bowel disease (IBD), and their prevention is essential to avoid complications. Malnutrition is one of the most important factors associated with poor clinical outcome in patients with IBD. According to some studies, a significant proportion of HF patients affected by sarcopenia (41,5%) have a normal body mass index (BMI) and would therefore not be identified as malnourished by traditional measures. Sacropenia is a term for loss of muscle mass. However, a recent study again demonstrates that the majority of individuals who screen positive for malnutrition have normal or overweight body mass indexshowing that the risk of malnutrition can develop in anyone regardless of a person's weight and BMI.
Systematic study reports that up to 60% of patients with IHD have reduced muscle mass compared to healthy individuals, which may also explain the increased risk of sarcopenia and higher BMI in these patients. Sarcopenia is common in overweight patients with inflammatory bowel disease.
Various factors contribute to malnutrition in people with IHD. One major factor is reduced food intake in patients. The reduction in food intake may be due to multiple mechanisms. Patients with active IBD often experience loss of appetite due to symptoms such as nausea, vomiting, abdominal pain and diarrhea.
In addition, medications prescribed for IBS can cause nausea, vomiting, or disease-related anorexia. For example, the use of glucocorticoids can reduce the absorption of phosphorus, zinc, and calcium, potentially leading to osteoporosis. Prolonged therapy with sulfasalazine, which acts as a folic acid antagonist, may be associated with anemia. The most common micronutrient deficiencies in patients with IBD refer to iron, calcium, selenium, zinc, magnesium, water-soluble vitamins, particularly B12 and folic acid, and fat-soluble vitamins, such as A, D, and K.
Malabsorption is closely associated with mucosal changes, including impaired epithelial transport and loss of epithelial integrity, among other factors. Studies have shown that in patients with Crohn's disease, involvement of the ileum significantly contributes to decreased nutrient absorption. In particular, disturbances in ion transport lead to electrolyte and fluid loss. In addition, prolonged inflammation leads to persistent loss of blood and protein in the intestinal lumen.
Symptoms experienced by people with IHD can lead to loss of appetite and changes in their eating habits and general dietary patterns. Some people may find it difficult to reintroduce certain foods into their diet, leading to a restriction in their overall dietary intake and a reduction in their choices, resulting in a sense of reduced freedom with regard to food. If you eat a yogurt and immediately get cramps, making leaving the toilet difficult, would you choose to eat that yogurt again? Now imagine the same scenario, but with not one food, but many more.
Treatment of patients with inflammatory bowel disease (IBD) is quite challenging due to the lack of well-understood pathophysiology of the disease and the variability of symptoms over its course. However, the greatest importance in the treatment process is given to appropriate nutrition and lifestyle changes.
As there is no one-size-fits-all dietary approach to the management of HF, keeping food diary can be crucial. What works for one person may not be effective for another, so understanding the body's response to different foods can help manage symptoms. It is recommended to monitor foods that worsen symptoms and those that relieve them. A nutritionist can assist in identifying the causes of your symptoms and offer guidance on necessary lifestyle changes.
The gut microbiome acts as both a mediator and a modifier of the metabolic response to our diet. When the microbiome acts as a mediator, what we consume directly affects it, altering its composition and function. As a modifier, the effect of diet on metabolism depends on our microbiome. The gut microbiota is therefore susceptible to changes as a result of diet and specific dietary components, playing a key role in the formation of the composition and activity of the microbiota from birth throughout our lives.
Improving gut health by varied diet and consuming more foods of plant origin is essential. Studies have shown that people who consume at least 30 different vegetables and fruits per week have more diversity in their gut microbiota, indicating a better balance of the gut microbiome. The greater the variety in your menu, the more you are helping your gut produce more diverse enzymes, which are then used to break down the food you eat. This is where people with IBS/ IBS (irritable bowel syndrome) can find it challenging, especially if they have already excluded many foods from their diet. In such cases, they may need to consult a specialist to navigate the process.
Diarrhoea is a leading symptom of IBD. In the presence of severe diarrhea and pain, the urge to stop eating can be strong. However, it is essential to maintain adequate nutrition and hydration. Some people notice that certain high-fibre foods exacerbate their diarrhoea, and in such cases it is advisable to avoid these foods during an exacerbation. However, for some people with low dietary fiber intake, increasing fiber intake may also have a positive effect. In addition, spicy, fatty foods, alcohol and caffeine can also worsen diarrhea.
Increasing fluid intake can help form softer stools. In addition, including more fiber in the diet may be helpful, although this approach may not be right for everyone. Fibre can play a big role in managing the symptoms of irritable bowel syndrome. Therefore, a specialist may suggest that you adjust the amount of fiber in your diet. If constipation bothers you, you may need to discuss it with your doctor and/or nutritionist.
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, which are categories of carbohydrates that are difficult to digest and digest in the intestine, leading to rapid fermentation in the colon. This fermentation process generates gas, causing uncomfortable bloating, and this is why some experts may suggest you try this type of diet.
It is recommended that this process be tracked by Dietitianso the different phases and symptoms can vary from person to person.
Additional factorsthat can affect your inflammatory bowel disease or irritable bowel syndrome include your level of physical activity, stress levels, stress management, hydration, alcohol consumption, sleep quality and duration, and mental health.
