The Malnutrition Inflammation Risk Tool (MIRT) may be the most sensitive option for identifying malnutrition in patients with inactive or mildly active inflammatory bowel disease (IBD), according to the results of a prospective cohort study.

The Saskatchewan Inflammatory Bowel Disease Nutrition Risk Tool (SaskIBD-NR) demonstrated superior accuracy in predicting Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition and low fat-free mass index (FFMI). Results were presented at the United European Gastroenterology Week in Berlin. 

Researchers evaluated five commonly used nutritional screening instruments—Malnutrition Universal Screening Tool (MUST), MIRT, Mini Nutritional Assessment (MNA), Nutritional Risk Screening 2002 (NRS-2002), and SaskIBD-NR—against the European Society for Clinical Nutrition and Metabolism (ESPEN) 2015 and GLIM criteria. The study included 66 adults with either Crohn’s disease or ulcerative colitis who were in clinical remission or had mild disease activity.

All participants underwent baseline and six-month follow-up assessments. Disease activity was evaluated using the Harvey–Bradshaw Index for Crohn's disease and the partial Mayo score for ulcerative colitis, while body composition was analyzed through bioelectrical impedance analysis. Despite low inflammatory activity, malnutrition prevalence increased over time. At baseline, GLIM-defined malnutrition was 9% and ESPEN-defined malnutrition 26%, rising to 15% and 48%, respectively, at six months. Low FFMI also increased from 8% to 17%, according to Agnese Favale, MD, of the University of Cagliari, Italy, and colleageus.

When predictive performance was analyzed, MIRT showed the highest sensitivity for ESPEN-defined malnutrition (40.5%), while overall accuracy was similar between MIRT (50%) and NRS-2002 (51.5%). For GLIM-defined malnutrition, MIRT again demonstrated the highest sensitivity (50%), but SaskIBD-NR achieved the best accuracy (75.8%). In predicting low FFMI, MIRT, MNA, and NRS-2002 shared the top sensitivity (45.5%), while SaskIBD-NR had the highest accuracy (80%).

These results highlight the importance of choosing a screening tool that aligns with clinical priorities—favoring sensitivity when early detection is critical, or accuracy when precision is paramount. Even in patients with quiescent IBD, nutritional risk and reduced lean mass can adversely affect outcomes.

"MIRT might be the NSTs of choice to predict defined malnutrition and low Fat Free Mass Index at 6 months follow-up in a cohort of inactive/mildly activite IBD patients," concluded Dr. Favale and fellow investigators.

Study limitations included its single-center design, small sample size, six-month follow-up, and reliance on bioelectrical impedance analysis for body composition assessment. 

Source: UEG Week 2025