Stephanie L. Gold, MD

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Patients with inflammatory bowel disease (IBD) and sarcopenia are at an increased risk of negative outcomes.

A team, led by Stephanie L. Gold, MD, The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, reviewed the mechanisms of sarcopenia in patients with IBD and identified novel modalities to assess and treat impaired muscle mass or function.

Sarcopenia

Sarcopenia is the loss of skeletal muscle mass or function, which affects up to 50% of patients with IBD. The condition is also associated with poor clinicalpoor clinical outcomes, such as increased hospitalizations, the need for surgery, and post-operative complications.

While the rate of sarcopenia is high in patients with IBD, very few patients undergo routine muscle evaluation.

In the study, the investigators searched various databases for studies up to February 2023.

While the pathogenesis of sarcopenia in IBD is not well defined, there has been research that supports the role of malabsorption, reduced protein intake, chronic inflammation, dysbiosis, decreased physical activity, medication effects and hormone signaling from visceral adiposity.

Some traditional sarcopenia assessment techniques included direct measurements on cross sectional imaging, but cross sectional imaging also comes with increased time, cost, and radiation exposure.

This has led to new bedside tools developed to estimate muscle mass, such as the assessment of grip strength, mid upper arm circumference and body composition utilizing bioelectrical impedance analysis.

The investigators also found novel biomarkers for assessing muscle mass and techniques utilizing point of care ultrasounds could eventually make sarcopenia evaluation are more streamlined in the IBD clinic.

“Sarcopenia is associated with poor clinical outcomes independent of IBD activity and therefore muscle health should be assessed in all IBD patients at routine intervals,” the authors wrote. “Future studies to better our understanding of the pathophysiology as well as most effective management of sarcopenia in IBD will help guide clinical care and reduce disease related complications.”

IBD and Malnutrition

Last year, investigators found patients with IBD to an increased risk of malnutrition and sarcopenia.

A team, led by Arshdeep Singh, MD, Department of Gastroenterology, Dayanand Medical College and Hospital, evaluated the nutritional status of patients with IBD and determined the threshold values of different parameters of nutritional assessment to identify malnutrition.

In the single-center cross-sectional analysis, the investigators examined adult patients with IBD who underwent anthropometry [body mass index (BMI), mid upper arm circumference (MUAC) and triceps-fold thickness (TSF)], body composition analysis and assessment for sarcopenia [hand-grip strength and skeletal muscle index (SMI) at L3 vertebral level)].

The BMI, MUAC, TSF thickness, fat and lean mass, hand-grip strength, and SMI at L3 vertebral level were lower in patients with IBD compared to the healthy control group.

Malnutrition rates were similar between patients with ulcerative colitis and patients with Crohn’s disease. In the ulcerative colitis subgroup, 24.40% (n = 82) were diagnosed with malnutrition, while 28.57% (n = 20) of the Crohn’s disease subgroup were diagnosed with malnutrition.

The cutoff values of MUAC and TSF thickness to identify malnutrition were 23.25 cm and 25.25 cm in female patients, respectively, and 16.50 mm and 8.50 mm in male patients, respectively.

References:

Gold, S. L., Raman, M., Sands, B. E., Ungaro, R., & Sabino, J. (2023). Review article: Putting some muscle into sarcopenia—the pathogenesis, assessment and clinical impact of muscle loss in patients with inflammatory bowel disease. Alimentary Pharmacology & Therapeutics. https://doi.org/10.1111/apt.17498