Multidimensional nutritional assessment in Crohn's disease: Cross-sectional comparison of active disease and remission.

Abstract

Malnutrition is a frequent complication of Crohn's disease (CD), but multidimensional nutritional data from South Asian populations remain limited. This cross-sectional study compared nutritional status between active disease and remission among 127 South Asian adults with CD attending a tertiary-care center in Dhaka, Bangladesh. Disease activity was assessed using the Crohn's Disease Activity Index (CDAI), Simple Endoscopic Score for Crohn's Disease (SES-CD), and magnetic resonance enterography (MRE). Nutritional assessment included body mass index (BMI), mid-upper arm circumference (MUAC), calf circumference (CC), triceps skinfold thickness (TSF), mid-arm muscle circumference (MAMC), the Mini Nutritional Assessment (MNA), and biochemical measurements. Protein-energy malnutrition was operationalized using the Global Leadership Initiative on Malnutrition (GLIM) framework, with BMI < 18.5 kg/m2 as the available phenotypic criterion and CD-related inflammatory and gastrointestinal burden as the etiologic criterion. Of 127 participants, 63 had active disease, and 64 were in remission. Overall, 60 participants (47.2%) met the study definition of GLIM malnutrition, with a substantially higher frequency in active disease than in remission (81.0% vs. 14.1%, P < 0.001). Participants with active disease had significantly lower BMI, MUAC, CC, sex-stratified TSF, MAMC, and MNA scores (all P < 0.001). Hemoglobin, serum iron, albumin, and zinc concentrations were also lower in active disease (all P < 0.001), whereas folate (P = 0.411) and vitamin B12 (P = 0.051) did not differ significantly. BMI correlated positively with MUAC, CC, TSF, MAMC, and MNA score (rs = 0.366-0.967; all P < 0.001), with the weakest association observed for MAMC, while correlations with biochemical markers were weaker and were generally not statistically significant after subgroup stratification. The objective disease-activity sensitivity analysis based on SES-CD and/or MRE produced the same active and remission classification as the primary analysis (100% agreement; Cohen's κ = 1.000). These findings demonstrate a substantial burden of protein-energy malnutrition in Bangladeshi adults with CD, particularly during active disease, while also showing that nutritional impairment may persist during remission. Simple anthropometric measures provide useful information on physical tissue depletion, but biochemical abnormalities should be interpreted alongside disease activity because markers such as albumin and zinc may be influenced by systemic inflammation in addition to nutritional status. A multidimensional approach combining anthropometric assessment with targeted biochemical evaluation may therefore provide a more comprehensive assessment of nutritional status in CD.