Comprehensive assessment of nutritional and functional status of patients with ulcerative colitis and their impact on quality of life

Introduction Patients with ulcerative colitis (UC) are likely to have poor nutritional intake and increased gut losses. This study was designed to study the prevalence and predictors of nutritional defciencies in patients with UC and their impact on the quality of life (QOL). Methods A prospective study was conducted among consenting patients with UC (cases) and healthy relatives of the cases (controls) visiting a university teaching hospital. They were assessed for clinical, demographic, endoscopic (Mayo score) and histological profle (Robart's score). They were assessed for the presence of macronutrient and micronutrient defciency, anthropometry, functional status (muscle strength by dynamometer and sit-to-stand test) and the quality of life (short infammatory bowel disease questionnaire [SIBDQ]). A SIBDQ score of <= 50 was considered poor QOL. Results We studied 126 cases and 57 healthy controls (age [mean +/- SD] 37.7 +/- 13.2 years vs. 34.40 +/- 11.05 years; [p=0.10] females [38.1% vs. 38.7%]; p=0.94). Cases more often were underweight (28% vs. 3.5%; p<0.001), had low mid arm circumference (45% vs. 12%; p<0.0001), lower functional status in the form of weaker hand grip strength (67% vs. 45.6%; p=0.007) and weaker lower limb strength (80% vs. 42%; p<0.0001). Cases more often had the evidence of macronutrient defciencies: total serum protein defciency (31% vs. 3.5%; p<0.0001), serum albumin defciency (25.4% vs. 0.00%; p<0.0001) and cholesterol defciency (63% vs. 28%; p<0.0001). Micronutrient defciencies were highly prevalent among cases: calcium (44%), phosphate (21%), magnesium (11%), zinc (76%), iron (87%), folate (16%), vitamin B12 (10%) and vitamin D (81%). Most cases had a poor quality of life (85/126; 67.5%). Factors associated with poor QOL were low hemoglobin, serum albumin, zinc and vitamin D levels and histologically active disease. On multi-variate analysis, low vitamin D levels (odds ratio [OR]=6.1; 95% confdence interval [CI]: 1.9-19.7) and histologically active disease (OR=4.0; 95% CI: 1.6-9.9) were identifed as independent predictors of poor QOL. Conclusions Macronutrient deficiency, micronutrient deficiency, lower functional status and poorer QOL are highly prevalent among patients with UC. The independent predictors of poor QOL were histologically active disease and low serum vitamin D levels. Identifying and correcting the deficiencies may help in improving the QOL of patients with UC.