Older age is a risk factor for inadequate energy intake during acute, severe IBD and is associated with shorter time to relapse

Figures & data

Table 1. Outcomes used as a proxy of a flare or disease activity.

Outcome	Time window
The number of steroid prescriptions	Within 1 year after the primary discharge
Time to the first steroid prescription	Within 1 year after the primary discharge
The number of readmissions	Within 1 year after the primary discharge
The highest calprotectin value	Within 6 months after the primary discharge
Start or intensification of a biological treatment	Within 1 year after the primary discharge
Surgery with bowel resection	During the inpatient period or within 3 months after the primary discharge

Table 2. Demographics, disease characteristics and nutritional predictors.

	n = 91
Age, sex and admission time
Median age^a, year (IQR)	36 (25–55)
Men, n (%)	41 (46)
Median duration of the admission (days)^b, n (IQR)	7 (4–12)
Diagnosis
CD, n (%)	46 (51)
Ileal, n (%)	7 (16)
Colonic, n (%)	21 (48)
Ileocolonic, n (%)	13 (30)
Concomitant upper GI disease, n (%)	3 (7)
CD, disease behaviour, n (%)	43 (100)
Non-stricturing, non-penetrating, n (%)	25 (58)
Stricturing, n (%)	8 (19)
Penetrating, n (%)	10 (23)
UC, n (%)	43 (47)
Proctitis, n (%)	3 (8)
Left-sided colitis (%)	11 (28)
Extensive colitis (%)	26 (65)
IBD-U, n (%)	2 (2)
Left-sided colitis, n (%)	2 (100)
Extensive colitis, n (%)	0 (0)
Age at diagnosis, n (%)	84 (100)
Below 16 years	12 (14)
16–40 years	53 (63)
Over 40 years	19 (23)
Disease duration and earlier disease course
Median disease duration^a, years (IQR)	5 (0–14)
New IBD debut, n (%)	15 (16)
Previous surgery before admission, n (%)	21 (26)
Medication at admission
Oral or iv corticosteroids, n (%)	28 (31)
Local medication (5 ASA or steroids), n (%)	19 (21)
Oral 5-ASA, n (%)	25 (27)
Biological medication, n (%)	13 (14)
Immunosuppressive medication, n (%)	19 (21)
Antibiotics, n (%)	8 (9)
Medication started during the admission
Oral or iv corticosteroids, n (%)	80 (89)
Local medication, n (%)	29 (32)
5-ASA, n (%)	29 (32)
Biological medication, n (%)	21 (23)
Immunosuppressive medication, n (%)	10 (11)
Antibiotics, n (%)	57 (63)
BMI at admission
Median BMI^a in kg/m^2 (IQR)	23.3 (20.2–26.4)
BMI under 18,5 kg/m^2, n (%)	8 (9)
BMI under 20 kg/m^2, n (%)	21 (23)
BMI over 30 kg/m^2, n (%)	13 (14)
Biochemical markers of inflammation
Median CRP^a in mg/l at admission (IQR)	27 (8–93.5)
Median calprotectin^a in µg/g at admission (IQR)	1760 (524–2950)
Nutrition during the inpatient period
Mean number of days with energy intake <30%  of the calculated requirement^a (SD)	0,8 (2,5)
Mean number of days with energy intake <50%  of the calculated requirement^a (SD)	1,5 (3,2)
Mean number of days with energy intake <70 %  of the calculated requirement^a (SD)	2,5 (4,6)
Received parenteral nutrition during inpatient stay, n (%)	35 (38)
Consultation with a dietitian, n (%)	57 (63)

^aThe variable was not normally distributed (p < 0.05).

^bFor patients that did not undergo surgery during the inpatient period.

IQR: interquartile range; CD: Crohn’s disease; UC: ulcerative colitis; IBD-U: inflammatory bowel disease unclassified; CRP: C-reactive protein; n: the total number of subjects; po: per oral; iv: intravenous; 5-ASA: 5-Aminosalicylic acid; PN: parenteral nutrition; SD: standard deviation.

Table 3. Significant risk factors of inadequate nutritional intakeduring the inpatient period, (n = 91).

Outcome	Predictor	k	p Value	95% CI	Obs. (n)
Number of days with energy intake <30% of the calculated requirement	Age at admission	0.03	.012	0.006–0.050	62
Number of days with energy intake <50% of the calculated requirement	Age at admission	0.04	.017	0.007–0.067	62
Number of days with energy intake <70% of the calculated requirement	Age at admission	0.06	.008	0.017–0.107	62

The total number of observations (obs. (n)) indicates how many pairs of predictors and outcomes were available when the association analysis was done.

k: regression coefficient; CI: confidence interval; n: the total number of subjects, obs.: observations; n: number.

Figure 1. Kaplan Meier curves on steroid free survival in patients with respect to number of days inadequate energy intake. (a) The upper panel shows survival curves for patients with no days with energy intake under 30% of calculated requirement and in patients with at least one day with energy intake under 30% of calculated requirement. Difference between survival is statistically significant with p < 0.03. Curves are adjusted for age and sex. The table under the Kaplan Meier curves shows numbers at risk in each category at respective time points. (b) The lower panel shows survival curves for patients with 0, 1, 2 to 3 and 4 or more days with energy intake under 70% of calculated requirement. Differences between curves for patients with 0 days and patients with 1, 2 to 3 or 4 or more days with energy intake under 70% of calculated requirement are not statistically significant (p = 0.6, 0.4, and 0.1 respectively). Curves are adjusted for age and sex. The table under the Kaplan Meier curves shows numbers at risk in each category at respective time points.

Table 4. Factors significantly associated with disease course.

Outcome	Predictor	HR	p Value	95% CI	Obs. (n)
Time to the first steroid prescription	Total length of the inpatient period	1.04	.011	1.01–1.08	82
	Number of days with energy intake <30% of the calculated requirement	1.3	.016	1.1–1.6	57
	Number of days with energy intake <70% of the calculated requirement	1.1	.034	1.0–1.3	57
Number of readmissions	Immunosuppressive or biological medication at admission	0.9	.015	0.2–1.6	82
	Total weight gain during the admission	0.4	.038	0.0–0.7	81

All the patients (n = 91) were used for the outcome ‘Surgery during the inpatient period or during the first three months after discharge’ and only patients that did not undergo surgery during the inpatient period (n = 83) for other outcomes. The total number of observations (obs. (n)) indicates how many pairs of predictors and outcomes were available when the association analysis was done.

k: regression coefficient; CI: confidence interval; obs.: observations; n: the total number of subjects; FU: follow-up; n: number; y/n: yes or no; BMI: body mass index; HR: hazard ratio.