Data Sheet 1_Nutritional risk stratification management is associated with reduced disease relapse and improved quality of life in IBD patients: a retrospective study.docx

ObjectivesTo investigate the effects of nutritional risk stratification management on relapse control and quality of life (QoL) in patients with Inflammatory Bowel Disease (IBD), and to evaluate the clinical value of systematic nutritional intervention in the comprehensive management of IBD.
MethodsThis single-center retrospective cohort study analyzed 752 IBD patients (408 with ulcerative colitis and 344 with Crohn’s disease) who were managed in the Department of Gastroenterology at the Affiliated Hospital of Nantong University between January 2024 and December 2024. Patients were classified into an intervention group if they were managed under an institutional nutritional risk stratification pathway, which included dietitian-led screening with NRS-2002 or MUST and individualized nutrition plans with scheduled reassessment. Patients who received conventional care without entering this structured pathway served as the comparison group. All data, including nutritional status, inflammatory markers, disease activity, relapse events, hospitalization outcomes, and quality of life (IBDQ), were obtained retrospectively from electronic medical records and follow-up databases. Time-to-relapse was analyzed with Cox regression, and changes in continuous outcomes were evaluated using linear mixed-effects models. Propensity score matching and inverse probability of treatment weighting were used to mitigate measured confounding.
ResultsIn this observational analysis, significant improvements from baseline were observed in the intervention group for body weight, BMI, and laboratory nutritional indicators (all p < 0.001). Increases in albumin and prealbumin showed a significant negative correlation with the decrease in inflammatory markers (r = −0.42, p < 0.001). The median CRP level decreased from 15.2 to 9.6 mg/L (p < 0.001), and fecal calprotectin decreased from 298 to 184 μg/g (p < 0.001). Disease activity scores (HBI and Mayo) significantly decreased in both CD and UC patients (all p < 0.001). After a median follow-up of 9.8 months, the relapse rate was significantly lower in the intervention group (20.5%) compared to the control group (34.8%) (p < 0.001). Cox regression analysis indicated that nutritional management was independently associated with a reduced risk of relapse (adjusted HR = 0.61, 95% CI: 0.46–0.83, p = 0.001). Furthermore, the intervention group had significantly lower hospitalization rates (12.7% vs. 20.9%, p = 0.009) and shorter hospital stays (6 days vs. 8 days, p = 0.015). Regarding QoL, the total IBDQ score increased significantly in the intervention group (Δ = +13.5, p < 0.001), and the significant time × group interaction (p < 0.001) suggested sustained, cumulative improvement. Subgroup and sensitivity analyses yielded consistent results, supporting the robustness of this association (IPTW HR = 0.59, 95% CI: 0.44–0.81, p = 0.001).
ConclusionIn this single-center retrospective cohort, exposure to nutritional risk stratification management was associated with better nutritional status, lower inflammatory markers and disease activity, reduced relapse and hospitalization rates, and improved quality of life in IBD patients. These findings support the hypothesis that integrating structured nutritional risk screening and individualized nutrition management into routine IBD care may be beneficial. However, given the observational design and potential residual confounding, the observed associations should not be interpreted as definitive causal effects, and prospective multicenter randomized studies are needed to confirm these results and guide clinical practice.

研究目的：本研究旨在探讨营养风险分层管理对炎症性肠病（Inflammatory Bowel Disease, IBD）患者疾病复发控制与生活质量（Quality of Life, QoL）的影响，并评估系统性营养干预在炎症性肠病综合管理中的临床价值。
研究方法：本项单中心回顾性队列研究纳入2024年1月至2024年12月于南通大学附属医院消化内科管理的752例炎症性肠病患者，其中溃疡性结肠炎408例、克罗恩病344例。根据管理路径将患者分为两组：遵循机构营养风险分层管理路径者纳入干预组，该路径包括由营养师主导的营养风险筛查（采用NRS-2002或MUST量表），以及制定个体化营养方案并定期重新评估营养状况；未进入该结构化管理路径、仅接受常规诊疗者作为对照组。研究从电子病历及随访数据库中回顾性提取所有相关数据，包括营养状态、炎症标志物、疾病活动度、复发事件、住院结局及生活质量（Inflammatory Bowel Disease Questionnaire, IBDQ）。采用Cox回归分析复发时间，使用线性混合效应模型评估连续型结局指标的变化。为校正混杂因素，本研究采用倾向得分匹配及治疗逆概率加权法进行分析。
研究结果：本项观察性分析显示，干预组患者的体重、体质量指数（Body Mass Index, BMI）及实验室营养指标较基线均获得显著改善（所有p < 0.001）。血清白蛋白及前白蛋白水平的升高与炎症标志物水平的降低呈显著负相关（r = −0.42，p < 0.001）。中位C反应蛋白（C-reactive Protein, CRP）水平从15.2 mg/L降至9.6 mg/L（p < 0.001），粪便钙卫蛋白水平从298 μg/g降至184 μg/g（p < 0.001）。克罗恩病及溃疡性结肠炎患者的疾病活动度评分（HBI及Mayo评分）均显著降低（所有p < 0.001）。中位随访9.8个月后，干预组复发率（20.5%）显著低于对照组（34.8%，p < 0.001）。Cox回归分析显示，营养管理与复发风险降低独立相关（校正后风险比（Hazard Ratio, HR）=0.61，95%置信区间（Confidence Interval, CI）：0.46~0.83，p=0.001）。此外，干预组住院率显著更低（12.7% vs. 20.9%，p=0.009），平均住院时长更短（6天 vs. 8天，p=0.015）。在生活质量方面，干预组的IBDQ总分显著升高（Δ=+13.5，p < 0.001），且时间×组间交互作用具有统计学意义（p < 0.001），提示生活质量呈持续累积性改善。亚组分析及敏感性分析结果均一致，证实了该关联的稳健性（逆概率加权后HR=0.59，95%CI：0.44~0.81，p=0.001）。
研究结论：本项单中心回顾性队列研究显示，接受营养风险分层管理的炎症性肠病患者营养状态更佳、炎症标志物及疾病活动度更低、复发率与住院率更低，且生活质量得到改善。上述研究结果支持"将结构化营养风险筛查与个体化营养管理纳入炎症性肠病常规诊疗流程可使患者获益"这一假说。但由于本研究为观察性研究设计，且可能存在残余混杂因素，因此本研究观察到的关联不应被认定为明确的因果关系，未来需开展多中心前瞻性随机对照研究以验证上述结果并指导临床实践。