N09 Association between the clinical activity of Ulcerative Colitis and Inadequate protein intake: a cross-sectional study.

Abstract Background In Ulcerative Colitis (UC), loss of muscle mass has been associated with high disease activity and worse clinical prognosis1. Measures such as appendicular lean mass (ALM) have been used and its height-adjusted index (ALMI), obtained through dual-energy X-ray absorptiometry (DXA), are validated and accepted markers for assessing muscle status, as well as for evaluating muscle function using dynamometry. Linked to muscle mass, Protein intake has been identified as the primary nutrient for maintaining a positive nitrogen balance and preventing sarcopenia2. The RDA for protein is 0.8-1g/kg/day, which is the minimum intake necessary to avoid muscle loss2. However, in patients with active UC, it is recommended to increase the intake to 1.2-1.5g/kg/day3. Aim: To assess whether total protein intake is associated with clinical activity and decreases ALMI. Methods Patients with UC were included. Disease activity was determined using the modified Truelove and Witts criteria. Protein intake was assessed by a 24-hour dietary recall and analyzed with the EvalFinut software. Adequate intake was determinate as ≥1g/kg intake in patients in remission and as ≥1.2g/kg in patients with UC activity. Muscle function was determined using dynamometry, with cutoff points of 16 kg for women and 27 kg for men. ALM was estimated using DXA, and ALMI was calculated. Cutoff points for low lean mass were 5.5 kg/m² in women and 7 kg/m² in men4. The Mann-Whitney U test was used to assess differences between patients with activity and in remission. Odds ratios (OR) were calculated to determine the risk association between inadequate protein intake with clinical activity. Results A total of 53 patients were included, of whom 47% were clinically active and 53% in remission. Active patients showed a higher frequency of inadequate protein intake compared to those in remission (44% vs 14%) and presented with lower ALMI in women but not in men (table 1). Patients with low protein intake were associated with clinical activity, with an OR of 3.1 (95% CI, 1.1–8.4; p = 0.018), but not associated with lower grip strength (p = 0.461). On the other hand, clinical activity, and not low protein intake, was associated with greater likelihood of having decreased ALMI, with an OR of 1.8 (95% CI, 1.1–3.2; p = 0.044). The prevalence of sarcopenia was 13% of this population. Conclusion Inadequate protein intake is associated with clinical activity of UC, and clinical activity is associated with a lower amount of ALMI in women. There were no differences in grip strength between patients according to their activity level; however, follow-up will be needed to determine if those with low ALMI and low protein intake develop sarcopenia. References: 1. Zhang T, Ding C, Xie T, et al. Skeletal muscle depletion correlates with disease activity in ulcerative colitis and is reversed after colectomy. Clin Nutr. Dec 2017;36(6):1586-1592. doi:10.1016/j.clnu.2016.10.004 2. Baum JI, Wolfe RR. The Link between Dietary Protein Intake, Skeletal Muscle Function and Health in Older Adults. Healthcare (Basel). Jul 9 2015;3(3):529-43. doi:10.3390/healthcare3030529 3. Bischoff SC, Bager P, Escher J, et al. ESPEN guideline on Clinical Nutrition in inflammatory bowel disease. Clin Nutr. Mar 2023;42(3):352-379. doi:10.1016/j.clnu.2022.12.004 4. Arnal-Gomez A, Cebria IIMA, Tomas JM, et al. Using the Updated EWGSOP2 Definition in Diagnosing Sarcopenia in Spanish Older Adults: Clinical Approach. J Clin Med. Mar 2 2021;10(5)doi:10.3390/jcm10051018 Conflict of interest: Mendoza Martinez, Viridiana Montsserrat: No conflict of interest Baños Vazquez, Roberto: No conflict of interest Santoyo Chávez, Martha Alison: No conflict of interest Rivera, Ernestina: No conflict of interest De Leon Rendon, Jorge Luis: No conflict of interest López-González, Desirée: No conflict of interest Almiray-Soto, Alma Lidia: No conflict of interest Bueno Hernández, Nallely: No conflict of interest