NUTRITIONAL ASSESSMENT AND ITS IMPACT ON QUALITY OF LIFE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE IN COLOMBIA: NUTRIBD - COLABSTRACT
Background: Inflammatory bowel disease (IBD) significantly affects patients’ nutritional status and quality of life (QoL). Nutritional deficiencies are frequent and may worsen disease outcomes. The aim of this study is to assess the association between nutritional status and quality of life in patients with IBD.
Methods: A cross-sectional study was conducted in a specialised IBD centre. Nutritional status was evaluated using the MUST and MIRT tools in adults and the “Strong Kids” scale in paediatrics. An individualised nutritional support protocol was implemented. Quality of life was assessed with the EQ-5D and IBDQ-32 instruments.
Results: Among 90 patients, 26.6% required hospitalisation, predominantly adults and females. The mean age was 36.7 years. Crohn’s disease (CD) was more prevalent (58.3%), and 83.3% received biological therapy. Malnutrition risk in hospitalised patients with ulcerative colitis (UC) and CD was significantly increased, with odds ratios of 8.33 (95%CI: 1.16-27) and 25 (95%CI: 11.6-45.2), respectively. All hospitalised patients with severe disease presented with malnutrition. In the paediatric group, 87.5% received enteral nutrition and 25% required parenteral nutrition. Nutritional support improved nutritional status in 75% of cases within three months. Malnutrition was significantly associated with poorer QoL, particularly affecting mobility, self-care, and daily activities (P<0.05).
Conclusion: Malnutrition has a substantial negative impact on quality of life in IBD patients. Early detection using tools such as MUST, MIRT, and strong kids is essential. Integrating systematic nutritional screening and tailored support into routine clinical practice is imperative to improve outcomes and promote recovery.
Keywords:
Inflammatory bowel diseases; nutritional status; quality of life; malnutrition; enteral nutrition; nutritional assessment
HIGHLIGHTS
•Descriptive, cross-sectional study in a Colombian IBD Centre of Excellence (adults and paediatrics, inpatients and outpatients).
•To assess the association between nutritional status and quality of life in patients with inflammatory bowel disease (IBD).
•MUST and MIRT (adults); STRONG Kids (paediatrics); EQ-5D and IBDQ-32 for quality of life.
•Malnutrition was present in >60% of hospitalised patients; strongly associated with poor quality of life. Nutritional support improved outcomes.
•Study conducted by a team of gastroenterologists, nutritionists, paediatricians, and clinical researchers.
•First study in Colombia evaluating nutritional status and QoL in IBD patients using structured screening and follow-up.
•Recommends routine nutritional screening and support as essential components of IBD management.
RESUMO
Contexto: As doenças inflamatórias intestinais (DII) afetam significativamente o estado nutricional e a qualidade de vida (QV) dos pacientes. As deficiências nutricionais são frequentes e podem agravar os desfechos clínicos da doença. O objetivo deste estudo foi avaliar a associação entre o estado nutricional e a qualidade de vida em pacientes com DII.
Métodos: Estudo transversal realizado em um centro especializado em DII. O estado nutricional foi avaliado utilizando os instrumentos MUST e MIRT em adultos e a escala “Strong Kids” em pacientes pediátricos. Foi implementado um protocolo individualizado de suporte nutricional. A qualidade de vida foi avaliada com os instrumentos EQ-5D e IBDQ-32.
Resultados: Entre 90 pacientes, 26,6% necessitaram de hospitalização, predominantemente adultos e do sexo feminino. A média de idade foi de 36,7 anos. A doença de Crohn (DC) foi mais prevalente (58,3%), e 83,3% dos pacientes recebiam terapia biológica. O risco de desnutrição em pacientes hospitalizados com retocolite ulcerativa (RCU) e DC foi significativamente aumentado, com razões de chances de 8,33 (IC95%: 1,16-27) e 25 (IC95%: 11,6-45,2), respectivamente. Todos os pacientes hospitalizados com doença grave apresentaram desnutrição. No grupo pediátrico, 87,5% receberam nutrição enteral e 25% necessitaram de nutrição parenteral. O suporte nutricional melhorou o estado nutricional em 75% dos casos em três meses. A desnutrição foi significativamente associada a pior qualidade de vida, afetando especialmente a mobilidade, o autocuidado e as atividades diárias (P<0,05).
Conclusão: A desnutrição tem um impacto negativo importante na qualidade de vida dos pacientes com DII. A detecção precoce por meio de ferramentas como MUST, MIRT e Strong Kids é essencial. A integração de triagem nutricional sistemática e suporte individualizado à prática clínica de rotina é fundamental para melhorar os desfechos e promover a recuperação.
Palavras-chave:
Doenças inflamatórias intestinais; estado nutricional; qualidade de vida; desnutrição; nutrição enteral; avaliação nutricional
INTRODUCTION
Inflammatory bowel disease (IBD), encompassing Crohn’s disease (CD) and ulcerative colitis (UC), represents a growing global health challenge, with rising incidence in newly industrialised countries1. Beyond chronic intestinal inflammation, malnutrition is one of its most critical and underrecognised complications, significantly impacting clinical outcomes and patients’ quality of life2.
Malnutrition in IBD arises from a multifactorial interplay, including impaired nutrient absorption, reduced dietary intake, and adverse effects of pharmacological therapies3,4. Up to 75% of patients in active disease phases are malnourished, and even during remission, prevalence can reach 38%5,6. Sarcopenia-marked by loss of muscle mass and strength-has also emerged as a frequent complication, worsening disease progression and diminishing therapeutic response7,8. Reported malnutrition prevalence in IBD varies widely, ranging from 5.7% to 82.8%, depending on the population and assessment methods used6. Despite significant advances in IBD management, malnutrition remains a persistent and underestimated barrier to optimal care, even in settings with high access to specialised services5. Its consequences include increased hospitalisation rates, postoperative complications, and impaired quality of life9. Malnutrition in patients with IBD imposes a substantial clinical, economic, and social burden. Hospitalised IBD patients are 2.9-3.1 times more likely to present with protein-calorie malnutrition, which is linked to longer hospital stays, higher readmission and mortality rates, and increased healthcare costs. Although enteral and parenteral nutritional support may reduce readmissions, it has also been associated with higher mortality and hospital expenditures, underscoring the need for optimised interventions10.
To counter these effects, systematic nutritional assessment is essential. Tools such as the malnutrition universal screening tool (MUST) and the malnutrition inflammation risk tool (MIRT) for adults, alongside “strong kids” for paediatric populations, have proven effective in early risk detection among IBD patients9. Malnutrition in patients with IBD has been associated with impaired immune response, increased risk of postoperative complications, and reduced efficacy of pharmacological therapies, including biologics-highlighting its role as a key modifiable factor in disease prognosis11-13. Although regional data on IBD-related malnutrition remain scarce, it is widely recognised as a frequent complication driven by chronic inflammation, malabsorption, and treatment side effects-warranting early detection and intervention. Also, no studies in Colombia have comprehensively assessed the nutritional status of IBD patients or its relationship with quality of life. This study seeks to address this knowledge gap by evaluating the nutritional status and self-perceived quality of life in patients treated at the Centre of Excellence for Inflammatory Bowel Disease at the Hospital Internacional de Colombia (HIC), with a particular focus on adults at risk of malnutrition. We hypothesise that an increased risk of malnutrition is independently associated with lower quality of life, irrespective of IBD subtype or care setting (inpatient vs. outpatient). This research was designed and executed as a multidisciplinary study, integrating the expertise of gastroenterologists, nutritionists, paediatric specialists, epidemiologists, and clinical researchers. Each discipline contributed to the conceptualisation, data collection, nutritional assessment, quality of life evaluation, and statistical analysis. This collaborative framework was essential to comprehensively address the complex interaction between nutritional status and quality of life in both adult and paediatric populations with IBD.
METHODS
A descriptive, cross-sectional observational study was conducted at the Inflammatory Bowel Disease Centre of Excellence at the Hospital Internacional de Colombia (HIC) between January and December 2023. Consecutive paediatric and adult patients with a confirmed diagnosis of inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), were prospectively enrolled during routine inpatient or outpatient visits. A total of 102 patients were initially screened; 12 were excluded due to incomplete nutritional or clinical data or refusal to participate, leaving 90 patients for final analysis. Of these, 78 completed the 3-month nutritional follow-up, while 12 were lost to follow-up due to relocation or discontinuation of care. Patients were excluded if they declined to provide informed consent, had incomplete clinical or nutritional data, or were lost to follow-up before completing the nutritional reassessment.
Nutritional intervention protocol
All patients received structured and individualised nutritional care, implemented by dietitians in collaboration with gastroenterologists. Interventions followed a step-wise algorithm:
1.Dietary counselling with tailored macronutrient and micronutrient recommendations.
2.Oral nutritional supplementation when caloric intake was <75% of estimated requirements.
3.Enteral nutrition (via nasogastric or nasojejunal tube, or orally with hypercaloric, high-protein polymeric formulas) when oral intake remained insufficient.
4.Parenteral nutrition reserved for patients with severe malabsorption, intestinal failure, or contraindication to enteral feeding.
5.Monitoring and follow-up: anthropometry, biochemical parameters, and functional assessments at baseline and at 3 months.
Assessment tools, data collection and statistical analysis
A total of 90 patients were evaluated. The nutritional screening was tailored by age group: adults were assessed using the Malnutrition Universal Screening Tool (MUST)14 and the Malnutrition Inflammation Risk Tool (MIRT)15, whereas paediatric patients were evaluated with the Strong Kids screening tool16. Additionally, anthropometric standards from the World Health Organization (WHO) were applied for children under two years of age, and those from the Centers for Disease Control and Prevention (CDC) for children older than two years.
In adults, the MUST14 evaluates body mass index (BMI), unintentional weight loss over the previous six months, and the presence of acute illness to classify patients into low (0 points), moderate (1 point), or high (≥2 points) malnutrition risk. The MIRT15 incorporates BMI, recent weight loss, and serum C-reactive protein (CRP) levels to integrate both nutritional and inflammatory components of risk. Parameters related to sarcopenia were also assessed, including muscle strength, muscle mass, and physical performance, according to international consensus definitions.
The strong kids tool16, used in paediatric patients, assigns a risk score based on four clinical criteria: high-risk underlying disease (2 points), reduced nutritional intake in recent days (1 point), recent weight loss or underweight (1 point), and impaired growth (1 point). Scores range from 0 to 5, categorising nutritional risk as low (0), moderate (1-3), or high (4-5).
Quality of life (QoL) in adult patients was assessed using the Inflammatory Bowel Disease Questionnaire (IBDQ-32)17, which consists of 32 items distributed across four domains: intestinal symptoms (10 items), systemic symptoms (5 items), emotional well-being (12 items), and social functioning (5 items). Each item is rated on a 7-point Likert scale, with 1 representing the worst and 7 the best quality of life, yielding a total score between 32 and 224. Additionally, the EQ-5D questionnaire18 was used due to its validated utility in capturing multidimensional QoL outcomes across chronic disease populations and enabling comparisons between health states.
The nutritional screening tools used in this study-MUST14, MIRT15, and strong kids16-have been previously translated and adapted for use in Spanish-speaking populations, with documented applicability in Latin American clinical settings19,20.
Data were collected prospectively at baseline and after a 3-month follow-up for patients receiving nutritional intervention. Nutritional interventions were individualised and implemented by a multidisciplinary team, including registered dietitians, gastroenterologists, and nursing staff. To minimise selection bias, consecutive sampling was employed, and patients with incomplete records or who declined participation were excluded. Information bias was reduced through prospective data collection by trained clinical staff using standardised forms. Disease severity at hospital admission was defined using validated clinical indices: the Mayo Score for ulcerative colitis, the Harvey-Bradshaw Index for Crohn’s disease, and, in children, PUCAI or PCDAI as appropriate. Complementary laboratory parameters such as serum albumin, C-reactive protein (CRP), and hemoglobin levels were also considered to corroborate clinical assessments.
Statistical analyses were performed using SPSS version 25.0. Descriptive statistics summarised demographic and clinical characteristics, including age, sex, disease duration, and IBD activity scores. A multivariate logistic regression model was constructed to identify independent predictors of malnutrition, adjusting for age, sex, type of IBD (CD vs UC), hospitalisation status, disease activity, and use of biologics. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Associations between nutritional status and QoL outcomes (EQ-5D and IBDQ-32) were analysed using chi-square tests for categorical variables and either Student’s t-test or the Mann-Whitney U test for continuous variables, depending on distribution. A P-value <0.05 was considered statistically significant.
This study was conducted in accordance with the ethical principles set forth in the declaration of helsinki by the world medical association. Informed consent was obtained from all participants or legal guardians. The study protocol was reviewed and approved by the Clinical Research Ethics Committee of the Hospital Internacional de Colombia, ensuring adherence to national and international standards of biomedical research and patient confidentiality.
Ethical considerations
The authors affirm that this study was conducted in accordance with the ethical standards of the World Medical Association (Declaration of Helsinki) for research involving human subjects. Informed consent was obtained from all participants, and all privacy rights were respected. The study was approved by the Clinical Research Ethics Committee of the Hospital Internacional de Colombia.
RESULTS
Study population
Over a 12-month period, 102 patients were screened, of whom 90 met the eligibility criteria and were included in the analysis. A total of 78 patients (86.7%) completed the three-month nutritional follow-up, while 12 (13.3%) were excluded from the longitudinal analysis due to incomplete data or loss to follow-up. Overall, 26.6% of the cohort required hospitalisation for disease exacerbation, predominantly adults and females (Table 1). The mean age of hospitalised patients was 36.7 years (range:4-81 years; SD:32.6), underscoring the wide age spectrum affected by disease severity. Notably, 58.3% of the cohort had a diagnosis of Crohn’s disease (CD), and a striking 83.3% of hospitalised individuals initiated biologic therapy during the study period (Table 1 and Table 2), reflecting both the burden of severe disease and the high therapeutic demands in this population.
Nutritional assessment - adult population
Hospitalised patients with ulcerative colitis (UC) demonstrated a significantly elevated risk of malnutrition, with an odds ratio (OR) of 8.33 (95%CI: 1.16-27). This risk was even more pronounced in those with Crohn’s disease (CD), where the OR reached 25 (95%CI: 11.6-45.2), as shown in Figure 1. All hospitalised adults exhibited biochemical abnormalities, most notably moderate-to-severe hypoalbuminaemia, and 25% were diagnosed with sarcopenia. Nutritional support was provided to 49% of the total adult cohort, and importantly, 100% of hospitalised patients with severe disease were found to be malnourished. Following targeted nutritional intervention, more than 80% of these patients experienced substantial improvement in their nutritional status.
Body mass index by initial nutritional risk in hospitalized patients with inflammatory bowel disease.
In the outpatient adult cohort (Table 3), 20 individuals underwent formal nutritional screening. Of these, 30% were identified as being at high risk of malnutrition using the Malnutrition Universal Screening Tool (MUST), and 25% had a clinically significant nutritional risk as defined by a MIRT score ≥3. These findings underscore the hidden yet critical burden of nutritional impairment in patients who are not acutely hospitalised, highlighting the importance of routine screening even in the ambulatory setting.
Paediatric population
Among hospitalised paediatric patients, 100% received nutritional support as part of their clinical management. Of these, 62.5% exhibited some degree of malnutrition, while 37.5% were categorised as having high nutritional risk. Within this cohort, 25% required parenteral nutrition, and 87.5% received enteral nutrition, predominantly using hypercaloric and high-protein formulas. Notably, during hospitalisation, 87.5% of patients demonstrated weight gain and clinical improvement in nutritional status, with 75% achieving a normal nutritional profile at the 3-month follow-up.
However, one critically ill paediatric patient with severe chronic malnutrition and refractory disease, unresponsive to multiple lines of medical therapy, died in the early postoperative period following a colectomy. This tragic outcome underscores the life-threatening nature of nutritional failure in complex paediatric IBD and highlights the urgent need for early, aggressive, and individualised nutritional strategies.
Quality of life assessment - IBDQ-32
Malnourished patients consistently exhibited lower quality of life scores compared with well-nourished counterparts. After adjusting for age, sex, IBD subtype, hospitalisation, and use of biologics, malnutrition remained an independent predictor of impaired QoL, with significantly higher odds of reduced IBDQ-32 total scores and deficits in intestinal symptoms, emotional well-being, and social functioning (Table 4). Complementary analyses further showed severe impairments in mobility (P=0.278; 95%CI: 2.03-64.1), self-care (P=0.003; 95%CI: 9.45-90.5), and daily activities (P=0.146; 95%CI: 1.14-58.2). Worse nutritional profiles were also linked to heightened pain perception (P=0.197; 95%CI: 0.53-53.3) and significantly lower visual analogue scale scores (P=0.012; 95%CI: 22.9-88.4) (Figure 2). Taken together, these results confirm the robust and independent association between nutritional status and health-related quality of life in IBD, highlighting early nutritional intervention as a central pillar of comprehensive disease management.
Relationship between nutritional status and quality of life in hospitalized patients with inflammatory bowel disease.
DISCUSSION
This study highlights the strong association between malnutrition and impaired quality of life in IBD, independent of disease type or care setting. Importantly, after adjusting for age, sex, hospitalisation, and biologic use, malnutrition remained a significant predictor of lower QoL scores. This finding underscores malnutrition as an independent determinant of outcomes rather than merely a correlate of disease severity.
Mechanistically, the bidirectional relationship between inflammation and malnutrition in IBD is mediated by proinflammatory cytokines (e.g., TNF, IL-6, IL-17), gut microbiota dysbiosis, and protein depletion21. Chronic inflammation impairs nutrient absorption, increases intestinal permeability, and promotes muscle catabolism, while dysbiosis exacerbates immune dysregulation and mucosal damage-contributing to a vicious cycle that perpetuates both malnutrition and disease activity22,23.
Among ambulatory adult patients, 30% were identified as being at high nutritional risk using the MUST tool, and 25% had a clinically relevant score on the MIRT (≥3 points), supporting the necessity of systematic screening even outside hospital settings. The MUST and MIRT tools have emerged as reliable instruments in assessing nutritional risk in IBD. MUST, which evaluates body mass index, unintentional weight loss, and the impact of acute illness, has shown moderate to high sensitivity in identifying malnutrition compared with GLIM criteria5,24. Meanwhile, MIRT adds value by incorporating inflammatory biomarkers such as C-reactive protein (CRP), with a sensitivity of 84% in detecting malnutrition and a demonstrated association with adverse clinical outcomes, including hospitalisation and need for surgery9.
These findings reaffirm that both tools are practical and clinically useful, with MUST being widely validated and MIRT offering added sensitivity through the inclusion of systemic inflammation. The early identification of malnutrition using these tools enables timely intervention, potentially mitigating complications and improving disease trajectory.
Our malnutrition prevalence rates are consistent with international cohorts. Studies from Europe and North America report malnutrition rates in IBD patients ranging from 6.1% to 69.7%, depending on disease activity, clinical setting, and diagnostic criteria25. A multicentre European study found a disease-related malnutrition (DRM) prevalence of 23%, while 36% of newly diagnosed IBD patients met the ESPEN malnutrition definition5. Even in clinical remission, up to 39.5% of patients may be at risk26. These findings highlight the global relevance of routine nutritional screening and confirm the applicability of our data in broader contexts.
In the inpatient setting, malnutrition was strongly associated with disease severity. Patients with UC had an odds ratio of 8.33 for malnutrition, while those with CD had an even higher risk (OR=25), reflecting the profound nutritional vulnerability among hospitalised individuals. Furthermore, 100% of patients with severe disease were malnourished, and 25% exhibited sarcopenia. Importantly, nutritional intervention led to clinical improvement in over 80% of cases, underscoring the therapeutic impact of targeted nutritional strategies.
Similarly, hospitalised paediatric patients exhibited alarming rates of malnutrition (62.5%) and high nutritional risk (37.5%), requiring intensive support. The majority received hypercaloric enteral nutrition, with a high response rate in terms of weight gain and improved nutritional status, and 75% achieving normalisation within three months. One fatal case, despite advanced nutritional and medical interventions, illustrates the high-risk nature of severe chronic malnutrition in refractory IBD.
Low body mass index (BMI <22kg/m²) and active disease have been previously identified as independent predictors of malnutrition in adult IBD27, findings corroborated by our cohort. These underscore the need for disease-specific screening tools that go beyond conventional criteria used in general populations. The heterogeneity of malnutrition between IBD subtypes also highlights the importance of personalised nutritional strategies28.
Our results are consistent with prior literature showing higher malnutrition rates among paediatric patients, attributable to more extensive disease presentations, increased inflammatory burden, malabsorption, and growth failure29. The documented delay in pubertal development, higher prevalence of stricturing and fistulising disease in CD, and fulminant colitis in UC add complexity to nutritional management in children.
Critically, this study highlights the profound impact of nutritional status on quality of life. Malnourished patients showed significantly lower scores across all domains of the IBDQ-32, including mobility, self-care, daily activities, and pain perception. These findings reinforce the notion that nutritional care should not be a secondary consideration but an integral component of comprehensive IBD management.
Early implementation of structured nutritional screening and support protocols in IBD can reduce the burden of complications, improve treatment response, and enhance the patient experience. These interventions should be standard practice in both outpatient and hospital-based care. In the Latin American context, evidence on nutrition and quality of life in IBD remains limited. A multicentre Brazilian study found that moderate-to-severe disease activity was associated with impaired quality of life, increased surgical rates, and decreased work productivity in patients with CD and UC30. Additionally, research from Mexico demonstrated distinct patterns of gut microbiota composition in IBD patients, highlighting the role of dietary and geographic factors in disease pathogenesis31. Emerging evidence suggests that native Latin American food byproducts with anti-inflammatory and prebiotic properties, such as passion fruit, pineapple, and pumpkin, may offer novel therapeutic potential in IBD dietary management32. These findings open new avenues for exploring culturally relevant nutritional interventions in the region. The structured nutritional protocol implemented-progressing from counselling to oral, enteral, and parenteral support-proved effective, with three-quarters of patients showing improved nutritional status at 3 months. These results demonstrate the feasibility and clinical impact of systematic, algorithm-based nutritional intervention in IBD care.
A key limitation of this study is the relatively small sample size, particularly within the paediatric subgroup, which may limit the statistical power and generalisability of the findings. While the screening tools employed (MUST, MIRT, Strong Kids)14-16 are widely used internationally, they have not yet been formally validated in Colombian or broader Latin American populations, which may affect cultural and contextual applicability. Another important limitation is the cross-sectional design, which does not allow for assessment of the long-term impact of nutritional status on disease remission, relapse rates, or sustained quality of life improvements. These results should be interpreted in light of certain limitations, including the limited sample size in the paediatric cohort, the lack of formal validation of screening tools in the local context, and the absence of longitudinal follow-up to evaluate the impact of nutritional interventions on long-term disease outcomes.
Despite promising results, this study also identifies critical areas for further research. firstly, the lack of validated, disease-specific nutritional assessment tools in Spanish remains a major barrier. While tools like the IMPACT-III questionnaire have been adapted for Spanish-speaking paediatric populations33, instruments such as the GLIM criteria and Subjective Global Assessment (SGA) require further validation in IBD cohorts. Additionally, structured nutritional interventions, including web-based and multidisciplinary models, have shown promise in improving food-related quality of life34, yet remain underexplored in Latin America. Longitudinal studies with larger, multicentre cohorts are urgently needed to validate our findings and assess causality. These should incorporate standardised nutritional protocols and culturally adapted QoL instruments to better capture the full impact of malnutrition in IBD.
CONCLUSION
Malnutrition is highly prevalent in IBD and exerts a profound, independent effect on quality of life. Early, structured, and multidisciplinary nutritional intervention must be incorporated as a standard of care in both inpatient and outpatient settings. Early screening and timely, individualised nutritional intervention should become standard practice across all stages of disease. Future research must prioritise the validation of disease-specific tools and structured interventions in Spanish-speaking populations to ensure equitable, high-quality care. Failure to systematically address malnutrition may undermine otherwise effective therapeutic strategies. Nutrition must be elevated to a central pillar in IBD management.
ACKNOWLEDGEMENTS
We express our sincere gratitude to Andrea Juliana Reatiga Pedraza, Juliep Sarmiento-Navarro, Johon Garces Camacho, Sandra Milena Flechas Amaya, Andrés Guillermo Barco, and Danilo Solorzano, members of the Inflammatory Bowel Disease Center of Excellence at the Hospital Internacional de Colombia, for their valuable support and contributions throughout the development of this study.
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Not applicable - The study did not use research data
Boxplot comparing body mass index (BMI) in hospitalized patients with inflammatory bowel disease (IBD), stratified by nutritional risk status at admission. Although median BMI was lower in those classified as malnourished (Group 1), the difference was not statistically significant (P=0.12, Mann-Whitney U test). The data highlight a clinically relevant trend toward lower nutritional reserves among high-risk individuals, warranting routine screening and intervention. Notes: the whiskers represent the minimum and maximum values within 1.5 times the interquartile range. No extreme outliers were detected. BMI was assessed at the time of admission, prior to any nutritional support. BMI: body mass index. IBD: inflammatory bowel disease.
Boxplot comparing disease-specific quality of life, measured by the Inflammatory Bowel Disease Questionnaire (IBDQ), between hospitalized patients with and without nutritional risk at admission. Patients classified as malnourished showed a lower median IBDQ score compared to their well-nourished counterparts. Note: Although the trend is clinically relevant, the difference did not reach statistical significance (P=0.095, Mann-Whitney U test). IBDQ: inflammatory bowel disease questionnaire. IBD: inflammatory bowel disease.