A new national survey reveals a care gap in the management of inflammatory bowel diseases: 20% of patients are already at nutritional risk. The “Lose weight? Don’t waste time!” campaign begins with online screening and testing.
There is a paradox that silently runs through the management of chronic inflammatory bowel diseases (IBD) in Italy: symptoms and inflammation are treated more and more effectively with drugs, but one of the most crucial aspects for the patient’s prognosis, namely the nutritional status, continues to be neglected. According to a new national survey promoted by FRIENDS Italywell 4 out of 5 patients have never received a nutritional evaluation or they have no memory of it. A fact that photographs a structural void in the management of a complex chronic pathology such as Crohn’s disease and the ulcerative colitiswhich in Italy affects approximately 250 thousand people. The result is anything but marginal: approximately 20% of patients with IBD are already in a nutritional risk conditionequal to approximately 50 thousand citizens in potential clinical danger.
“We treat the intestine with drugs, without worrying about nutrition”, is the bitter summary that emerges from the investigation presented on the eve of the World Chronic Inflammatory Bowel Disease Day. To fill this healthcare gap, AMICI Italia has started the national campaign “Lose weight? Don’t waste time!”sponsored by Italian Society of Artificial Nutrition and Metabolism (SINPE)with the aim of bringing nutrition back to the center of the therapeutic path.
Nutritional risk in IBD: numbers, causes and often underestimated clinical consequences
The theme of malnutrition in inflammatory bowel diseases it is not marginal, but structural. The clinical data recalled by the investigation highlight a complex picture: chronic intestinal inflammation predisposes to malnutrition in 13-27% of caseswhile the sarcopenia – the loss of muscle mass and function – concerns more than the 40% of patients. Added to this is a further critical element: about the 78% of patients have essential micronutrient deficienciesincluding vitamin D, zinc, iron, vitamin B9, B12 and calcium. The causes are multifactorial and include chronic diarrhea, intestinal malabsorption and reduced appetite, often linked to post-prandial pain. Another significant indicator is the 28% of patients with BMI less than 20a threshold which, associated with involuntary weight loss and nutritional deficits, represents an early warning signal. It’s not just about numbers. The consequences of malnutrition associated with IBD are clinically relevant: reduction in the effectiveness of drug therapies, increase in post-operative complications, more frequent relapses, longer hospital stays and worsening of quality of life.
As he points out Antonella Lezo, president of SINPEthe problem is systemic: “Despite nutrition representing a fundamental pillar in the treatment of chronic intestinal pathologies, screening for the risk of malnutrition and nutritional support are still very lacking and uneven”. An emblematic fact confirms this: approximately 80% of patients say they have never received a nutritional assessment from a healthcare professional.
AMICI Italia’s response: screening, online tests and a national network to intercept the risk
Faced with this scenario, AMICI Italia has decided to intervene with a structured strategy that combines information, prevention and digital tools. The countryside “Lose weight? Don’t waste time!” develops along three main lines: one roadmap of 10 local events in the main Italian IBD centers (including Milan, Rome, Naples, Turin, Palermo, Padua, Pisa, Modena and Bari), awareness-raising activities in the waiting rooms of the clinics and a series of informative video pills with nutrition specialists disseminated on the association’s digital channels. The heart of the project, however, is the screening tool: the MUST test (Malnutrition Universal Screening Tool)an internationally validated questionnaire, composed of a few questions, which allows an initial self-assessment of nutritional risk. The test analyzes three fundamental parameters: body mass index, recent unintentional weight loss and impact of the disease on the ability to eat. The objective is to provide a simple but clinically useful indication to share with the treating doctor. “Our goal is to increase patient awareness of the risk of malnutrition,” he explains Salvo Leone, general director of AMICI Italia. “The test allows for early detection of a condition that is too often recognized only when it is already advanced.” The final message is clear and shared by specialists: the management of IBD can no longer ignore a multidisciplinary approach that integrates gastroenterology and clinical nutrition. Because, as experts point out, malnutrition is not a secondary consequence, but a factor that directly affects the progress of the disease. The final appeal is addressed to three levels: to doctors, so that nutritional screening becomes a systematic part of follow-up; to patients, so that they do not underestimate even minimal weight changes; and to the institutions, called to recognize clinical nutrition as a structural component of treatment paths, like what already happens in other areas such as oncology.
