People living with inflammatory bowel disease (IBD) face a significant and often underrecognized risk of malnutrition, but early screening and treatment can make a meaningful difference.
IBD refers to conditions that cause chronic inflammation of the digestive tract. The two most common types are Crohn’s disease and ulcerative colitis. Crohn’s disease can affect any part of the digestive tract, while ulcerative colitis targets the large intestine.
People with IBD have a significant risk of malnutrition, which may present as weight loss, loss of muscle mass or function, or lower levels of vitamins and minerals (micronutrient deficiencies). Malnutrition affects 20–80% of individuals with IBD and is more common in those with Crohn’s disease, hospitalized patients, and those with active disease. It can result from decreased oral intake, food avoidance, medication effects, malabsorption, altered anatomy from prior surgery, and increased nutritional needs from inflammation.
Malnutrition leads to poor outcomes, including higher infection rates, longer hospital stays, prolonged recovery time after surgery, reduced quality of life, and increased healthcare costs. Assessing risk, and diagnosing and treating malnutrition are essential parts of care.
Screening for risk of malnutrition
Malnutrition risk can be identified through nutrition screening by a physician, nurse, dietitian, or trained healthcare professional. Validated tools such as the Malnutrition Universal Screening Tool (MUST) and the Saskatchewan IBD Nutrition Risk Tool (SaskIBD-NR) effectively detect risk. These tools assess body mass index, weight changes, GI symptoms, food restriction, and disease severity. If a patient is identified to be at risk, a full nutrition assessment should be conducted by a registered dietitian or nutrition provider.
What can you do? Ask about your nutrition
People with IBD should ask their healthcare provider about their nutrition if they experience symptoms like unplanned weight loss, loss of appetite, difficulty eating or eating only small amounts, fatigue or weakness, or swelling or fluid accumulation.
Diagnosis and treatment
A nutrition assessment evaluates the causes and severity of malnutrition and checks levels of key vitamins and minerals, including iron, zinc, magnesium, selenium, and calcium, which may be low. Once diagnosed, dietary counseling is critical to prevent further decline and restore an optimal nutrition status.
Treatment may include targeted vitamin and mineral supplementation, dietary modifications to avoid food triggers while increasing calories and protein, and oral nutrition supplements. If malnutrition is severe or IBD limits adequate intake, tube feeding (liquid nutrition delivered through a tube into the stomach, also called enteral nutrition) or IV nutrition (nutrition delivered directly into a vein, also called parenteral nutrition) may be necessary. Ongoing follow-up is needed to ensure the therapies are working.
Risk of malnutrition is common in IBD. Early screening and treatment can help prevent complications, improve recovery, and improve quality of life.
