Patients with liver disease often experience nutritional insufficiency due to an interplay of metabolic disturbances and dietary alterations leading to decreased muscle mass and the development of protein-calorie malnutrition (PCM). This study aimed to evaluate the prevalence of PCM in patients with steatotic liver disease (alcohol-associated liver disease (ALD) and metabolic dysfunction-associated steatotic liver disease (MASLD)) and their impacts on mortality and healthcare utilization. We identified hospitalizations with ALD, MASLD, and PCM using International Classification of Diseases codes in the National Inpatient Sample from 2016 to 2020. Descriptive analyses compared hospitalizations with and without PCM. Multivariable linear models adjusting for confounders evaluated the association between PCM and inpatient mortality, length of stay (LOS), and total charges. PCM was found to be significantly more prevalent among hospitalizations with ALD or MASLD than those with neither (ALD 175.5 versus 51.8; MASLD 149.0 vs. 50.7; neither: 49.3 per 1000 hospitalizations; p < 0.001). Among hospitalizations with ALD nor MASLD, PCM was significantly associated with higher mortality (ALD adjusted odds ratio [aOR] 1.61; 95

BACKGROUND:Diet impacts symptoms and inflammation in inflammatory bowel disease (IBD), but limited food access restricts options and hampers adherence to diets that may help in the management of IBD. This study aims to measure the prevalence of food insecurity and characterize its risk factors in the adult population across the United States. METHODS:The 2023, 2016, and 2015 National Health Interview Surveys were queried for individuals with and without IBD. Food insecurity prevalence and sociodemographic characteristics were compared. Multivariable logistic regression identified factors associated with food insecurity risk, while considering the survey's complex sampling design. RESULTS:In 2023, a significantly higher proportion of individuals with IBD (n = 4 289 979) reported food insecurity compared to those without IBD (n = 253 490 081) (13.48% vs 8.96%, P = 0.01). The pooled 2015-2016 data showed similar findings (12.43% vs 9.43%, P < 0.01). No significant difference was found across these periods (P = 0.63). Multivariable models linked higher food insecurity risk with IBD status (OR 1.85, P < 0.01), female sex (OR 1.16, P < 0.01), Hispanic ethnicity (OR 1.24, P < 0.01), non-Hispanic Black race (OR 1.88, P < 0.01), having Medicaid (OR 1.85, P < 0.01), being uninsured (OR 2.02, P < 0.01), and use of Supplemental Nutrition Assistance Program (SNAP) (OR 2.49, P < 0.01). CONCLUSIONS:Individuals with IBD face a persistently higher risk of food insecurity. Some of the most important predictors included being non-Hispanic Black, being uninsured or having Medicaid insurance, and using SNAP. Clinicians should regularly screen patients with IBD for food insecurity and address it through a multidisciplinary approach, involving dietitians and social workers to enhance patient care and outcomes.

Background: Malnourished patients hospitalized with inflammatory bowel disease (IBD) have a high risk of morbidity and mortality. Risk stratification can help identify patients who are most in need of medical and nutritional intervention. Goal: This study aimed to develop a machine-learning model that accurately predicts mortality in hospitalized IBD patients with protein-calorie malnutrition (PCM). Study: Hospitalized adults with IBD and PCM were identified in the 2016 to 2019 National Inpatient Sample (NIS). Random Forest Classifier (RFC) and Extreme Gradient Boosting (XGB) models were constructed using a 70% randomly sampled training set from the years 2016 to 2018, tested using the remaining 30% of 2016 to 2018 data, and externally validated using 2019 data. Patient characteristics were evaluated using weighted estimates that accounted for the complex sampling design of the NIS. Results: Among 879,730 malnourished patients hospitalized for IBD, 1930 (0.2%) died. Compared with malnourished patients who survived, those who died were generally older, White, had ulcerative colitis with multiple comorbidities, and admitted on the weekend. The accuracy, precision, sensitivity, and specificity for both models were 0.99, 0.98, 0.99, and 0.99, respectively. The area under the receiver operating characteristic curve was 0.91 for both models. Conclusion: Machine learning models can accurately predict mortality in malnourished patients hospitalized with IBD, while solely relying on readily available clinical data. Further integration of these tools into clinical practice could improve risk stratification of IBD patients with PCM and potentially reduce mortality in this high-risk population by prompting earlier intervention.

Goals: We described the temporal trend of substance use disorder (SUD) and SUD subtypes among patients hospitalized with inflammatory bowel disease (IBD), accounting for readmissions within the calendar year. Background: One in six patients with IBD is estimated to have a concomitant SUD. SUD has had mounting morbidity and mortality rates since 2010 and has been shown to adversely affect IBD activity. Study: We performed a retrospective analysis of patients hospitalized at least once with IBD from 2010 through 2020 using the Nationwide Readmissions Database. Multivariable logistic regression analysis evaluated associations between SUD and age, sex, insurance type, income for the ZIP Code, and geographic region. Results: Of 2,532,450 patients hospitalized with IBD, 26.5% and 17.0% involved SUD in Crohn's disease (CD) and ulcerative colitis (UC), respectively. Between 2010 and 2020, the prevalence of patients with SUD increased from 23.8% to 27.9% in CD (P-trend<0.001) and 14.2% to 19.4% in UC (P-trend<0.001). Rates of alcohol, opioid, and cannabis use disorders increased (P-trend<0.001 for all). Patients with SUD were more likely to be male [CD: OR: 1.26; 95% CI: 1.24-1.27; UC: 1.34, (1.31-1.36)], have Medicaid insurance compared with Medicare [CD: 1.59, (1.55-1.63); UC: 1.84, (1.78-1.90)], and be in a lower income quartile [lowest to highest quartile, CD: 1.54, (1.51-1.58); UC: 1.56, (1.52-1.61)]. Conclusions: SUD among IBD patients continued to increase over time, with the predominant substances used shifting from alcohol to opioids and cannabis. Rates of SUD among patients hospitalized with CD were consistently higher than those with UC or with non-IBD-related hospitalizations.

Alterations in gastrointestinal function (digestion, absorption, motility, secretion, and elimination) play important roles in the pathophysiology of many gastrointestinal disorders. Food also strongly influences gastrointestinal health and disease. Some foods act as antigens that trigger an enteric immune response, while others can serve as substrates with direct or indirect biological effects. Food can also be metabolized by gut microbes into bioactive molecules that alter physiology. This review discusses the current research evidence and the clinical use of "food as medicine" through dietary therapies for the management of various gastrointestinal conditions, including disorders of gut-brain interaction, eosinophilic esophagitis, celiac disease, inflammatory bowel disease, gastroparesis, and short bowel syndrome with intestinal failure.

A significant proportion of patients with inflammatory bowel disease (IBD) continue to experience gastrointestinal symptoms despite achieving endoscopic remission. These irritable bowel syndrome (IBS)-like symptoms may result from gut-brain axis dysfunction or low-grade immune activation. We aimed to determine whether extra-intestinal autoimmune comorbidities are associated with IBS-like symptoms in quiescent IBD. We conducted a retrospective cohort study of adult patients with IBD with endoscopic remission, excluding patients with prior IBS or less than 12 months of follow-up. The primary outcome was the development of IBS-like symptoms within 12 months of baseline colonoscopy. Multivariable Cox regression and Kaplan–Meier survival analysis were used to identify risk factors and assess time to symptom development. Among 399 patients, 80 (20.1

PurposeShort- and medium-term safety profiles of anti-TNF therapies are well-established, but data on their long-term safety, especially beyond five years, remain limited. This study aims to compare the risk of adverse events (AEs) in patients on stable anti-TNF therapy for less than five years versus more than five years.MethodsA retrospective cohort study was conducted in an outpatient IBD clinic from April 2015 to November 2023. Patients were divided into short-term (less than five years) and long-term (more than five years) therapy groups. AEs were tracked across multiple systems, and time-adjusted risks were compared using multivariable Cox proportional hazards models.ResultsWe identified 640 patients (785 instances) receiving stable anti-TNF therapy. A total of 82 AEs were reported over 1774 person-years. The AE incidence per 100 person-years was 5.12 in the short-term group and 3.50 in the long-term group with no significant adjusted risk between groups (aHR, 0.62; 95% CI 0.35 to 1.11). However, patients with CD on long-term infliximab therapy signaled a lower risk of AEs compared to short-term users (aHR, 0.33; 95% CI 0.11 to 1.00). Dermatologic events were the most common AEs.ConclusionLong-term anti-TNF therapy appears to have a similar safety profile to short-term therapy, with no significant increase in overall AE risk. These findings may offer cautious reassurance regarding extended anti-TNF use, particularly in patients with CD on infliximab.

Artificial intelligence (AI) is increasingly being applied in healthcare, with growing relevance to clinical nutrition. This narrative review examines current and emerging uses of AI in nutrition care within the Nutrition Care Process framework, with attention to assessment, monitoring and evaluation, diagnosis, intervention, and clinical support tools. Current applications include AI-assisted dietary assessment using image recognition, wearable sensors, analysis of continuous glucose and other physiologic data for early risk detection, and support for malnutrition screening and diagnosis. AI is also being explored for identifying micronutrient deficiencies and complications of nutrient excess, as well as for screening and early intervention in eating disorders. In nutrition intervention, AI has potential to support personalized dietary planning, nutrition support in intensive care settings, behavioral interventions, and precision nutrition approaches such as digital twins. Additional applications include clinical decision support and documentation assistance. However, despite its usefulness, concerns about AI systems exist. Its performance depends on the quality of the data used to train it; it can introduce bias, and it can produce inaccurate or misleading outputs. In addition, overreliance on AI may also reduce clinician attentiveness and contribute to cognitive errors. For these reasons, AI should be regarded as a support tool rather than a replacement for human clinical care. Overall, AI offers substantial opportunities to improve the personalization, efficiency, and scalability of clinical nutrition practice, but its safe and effective implementation will require continued validation, careful oversight, and integration with clinical expertise.

BACKGROUND:It has been theorized that age related immunosenescence reduces the risk of developing anti-drug antibodies (ADAs). This has significant implications regarding choice of therapy and need for routine drug monitoring in this group. We investigated the incidence of ADAs in older adults compared to younger adults with inflammatory bowel disease (IBD). METHODS:We conducted a multicenter retrospective cohort study including all older adults (ages ≥60 years) with IBD treated with a tumor necrosis factor inhibitors (TNFi); adults ages 18-59 years old were included in a 4:1 ratio. Kaplan-Meier and Cox regression methods compared longitudinal risk of ADA development between groups. Multivariable models evaluated the association of potential risk factors with ADA development. RESULTS:182 (19.7%) older adults and 738 (80.2%) younger adults were included in the study. The risk of ADAs was higher in older adults compared to younger adults (adjusted hazard ratio [aHR] 2.20; 95% confidence interval [CI] 1.44-3.36). Proactive therapeutic drug monitoring (TDM) was inversely associated with ADA development (aHR 0.36; 95% CI 0.25-0.52). CONCLUSION:Older adults are more likely to develop ADAs against TNFi compared to younger adults. Proactive TDM may be considered in this population for early identification of ADAs and subtherapeutic trough levels, enabling timely dose escalation or treatment modification.

Background and Aims:Patients with inflammatory bowel disease (IBD) are at increased risk of malnutrition, which is associated with worse outcomes and has prompted recommendations for regular nutrition screening. This study details a current state analysis of outpatient gastroenterology (GI) malnutrition screening practices for patients with IBD and evaluates risk factors for lack of screening. Methods:This retrospective cohort study included adults with IBD on advanced therapies seen at the University of California, Los Angeles, between 2018 and 2024. Patient data were abstracted from outpatient GI encounters via electronic medical records. A root cause analysis for lack of malnutrition screening was created using a Gemba walk and stakeholder interviews. Multivariable logistic regression evaluated risk factors for lack of screening. Results:Of 283 included patients, the mean age was 44.4, mean body mass index was 25.9, 53.7% were female, 62.9% were White, and 50.0% had Crohn's disease. Most (70.7%) had their GI encounters via telehealth. Malnutrition screening was performed at 56% of encounters. When patients were screened, a validated screening tool was used in 12% of encounters. Screening identified malnutrition risk in 11% of encounters and prompted ordering of registered dietician referrals 44% and nutrition labs 56% of the time. Malnutrition screening was less likely if the encounter was via telehealth (vs in-person, odds ratio 0.43, confidence interval [0.23-0.80]). Conclusion:Improved malnutrition screening among GI physicians for IBD patients is needed. Given telehealth visits were strongly associated with lack of screening, strategies to address this care gap are needed since telehealth has become more common.

Background: Malnutrition is associated with adverse clinical and economic outcomes. We recently reported that the hospital mortality rate in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected inpatients was higher in malnourished patients than in those without malnutrition. The present study aimed to determine if SARS-CoV-2-infected inpatients who received oral nutrition supplementation (ONS) had improved survival. We performed a retrospective cohort study including 37,215 adults (aged 18 and older) admitted with COVID-19 to five Johns Hopkins–affiliated hospitals between 1 March 2020, and 31 March 2023. Malnutrition risk was initially screened using the Malnutrition Universal Screening Tool (MUST), with cases subsequently confirmed by registered dietitians via a standardized, validated assessment protocol. Logistic regression analysis predicting hospital mortality examined the association of ONS with hospital survival in SARS-CoV-2-infected inpatients, incorporating covariates and weights for ONS receipt. Results: Malnutrition was an independent predictor of higher hospital mortality from COVID-19 illness. The prevalence of malnutrition among adult inpatients with SARS-CoV-2 infection in our cohort was 15.22%. Inpatient adults with moderate or severe malnutrition in the context of acute illness or injury who were given ONS had lower odds of inpatient mortality (moderate OR = 0.72, 95% CI 0.62–0.85; severe OR = 0.76, 95% CI 0.67–0.87; both p < 0.001). Overweight and obese patients who received ONS had higher odds of inpatient mortality (overweight OR = 1.15, 95% CI 1.08–1.22, p < 0.0001; obese OR = 1.08, 95% CI 1.01–1.14, p = 0.02, respectively). For inpatients who were underweight, receiving ONS was protective against inpatient mortality (OR = 0.78, 95% CI 0.68–0.88, p = 0.0001). Thus, among adult inpatients with SARS-CoV-2 infection, malnourished and underweight individuals appeared to experience improved survival when provided with oral nutritional supplements (ONS), whereas overweight or obese patients remain at an elevated risk of mortality. The timing of ONS receipt in hospitalized patients with SARS-CoV-2 influenced mortality. Patients who had earlier time to ONS had 13% lower odds of inpatient mortality (OR = 0.87, 95% CI 0.79–0.97, p = 0.0105). Conclusions: In a cohort of SARS-CoV-2 adult inpatients, those with confirmed malnutrition receiving oral nutrition supplements had a higher likelihood of hospital survival. This is the first study demonstrating an association of oral nutrition intervention with reduced hospital mortality in malnourished SARS-CoV-2-infected adults.

Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are distinct gastrointestinal conditions, but they frequently share overlapping clinical symptoms such as abdominal pain, bloating, and altered bowel habits. IBD is defined by the presence of chronic immune-mediated inflammation, and IBS is characterized by gastrointestinal symptoms in the absence of endoscopic and histologic inflammation. When patients with IBD continue to experience IBS-like symptoms despite remission of inflammation, this phenomenon is commonly referred to as IBD-IBS overlap. These patients pose diagnostic and therapeutic challenges, as symptom persistence may reflect lingering immune activation, disrupted barrier function, visceral hypersensitivity, gut-brain axis dysfunction, or microbiome alterations. This review synthesizes emerging evidence on the shared mechanisms underlying IBD and IBS and outlines a multimodal treatment approach that includes pharmacologic management, dietary interventions, mind–body therapies, and microbiome-directed strategies such as probiotics and fecal microbiota transplantation.

Patients with inflammatory bowel disease (IBD) often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to patients with IBD, health maintenance issues need to be addressed by the gastroenterology team. In particular, documentation and recommendation for vaccinations are crucial because more than 70% of patients with IBD will at some time be on immune-modifying therapies that may increase the risk for infections, many of which are preventable with vaccinations. Health maintenance recommendations addressed in this guideline include the safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer and screening for depression, anxiety, and need for smoking cessation. To accomplish these health maintenance goals, coordination among the primary care provider, gastroenterology team, and other specialists is necessary.

BACKGROUND & AIMS:Diets can help induce remission in patients with Crohn's disease (CD). However, given inconsistent recommendations across purportedly beneficial anti-inflammatory diets and prior studies highlighting benefits of plant-based diet patterns, we hypothesized that the benefit of diet therapy stems from the overall "healthfulness" of diet patterns. METHODS:In a randomized controlled trial, adults with mild-to-moderate CD were assigned to receive guidance on a natural whole food diet that comprised principles of a healthful diet versus continuation of one's habitual diet. Primary outcomes included clinical remission and change in calprotectin in weeks 4 and 8. Secondary outcomes included nutritional parameters (nutrient and energy intake, body composition, metabolic rate) and adverse events. Healthy Eating Index (HEI) served as a surrogate of diet quality and adherence. RESULTS:Twenty-eight participants with active CD were randomized. In intention-to-treat analysis, whole food diet led to overall greater clinical remission (odds ratio [OR] 1.41; 95 % CI 1.03-1.93; P = 0.03) and similar change in calprotectin. In per protocol analysis, adherence to a healthful diet was associated with clinical remission (OR 1.18; 95 % CI 1.02-1.38; P = 0.03) and change in calprotectin (-234; 95 % CI -465 to -3; P = 0.047). There was no increased risk of nutritional deficiency or reported adverse events. CONCLUSION:Following a natural whole food diet based on principles of a "healthful" diet was safe and effective for inducing clinical remission and reducing fecal calprotectin concentrations in mild-to-moderate CD. Further investigation is needed to confirm these findings and to identify mechanisms to improve adherence to healthy anti-inflammatory diets. CLINICALTRIALS: GOV REGISTRATION:NCT04431700.

BACKGROUND:Prebiotics are nondigestible carbohydrates fermented by gut bacteria into metabolites that confer health benefits. However, evidence on their role for inflammatory bowel disease (IBD) is unclear. This study systematically evaluated the research on prebiotics for treatment of IBD. METHODS:A search was performed in PubMed, Embase, Cochrane, and Web of Science. Eligible articles included randomized controlled trials or prospective observational studies that compared a prebiotic with a placebo or lower-dose control in patients with IBD. Meta-analyses were performed using random-effects models for the outcomes of clinical remission, clinical relapse, and adverse events. RESULTS:Seventeen studies were included. For induction of clinical remission in ulcerative colitis (UC), the fructooligosaccharide (FOS) kestose was effective (relative risk, 2.75, 95% confidence interval, 1.05-7.20; n = 40), but oligofructose-enriched inulin (OF-IN) and lactulose were not. For maintenance of remission in UC, germinated barley foodstuff trended toward preventing clinical relapse (relative risk, 0.40; 95% confidence interval, 0.15-1.03; n = 59), but OF-IN, oat bran, and Plantago ovata did not. For Crohn's disease, OF-IN and lactulose were no different than controls for induction of remission, and FOS was no different than controls for maintenance of remission. Flatulence and bloating were more common with OF-IN; reported adverse events were otherwise similar to controls for other prebiotics. CONCLUSION:Prebiotics, particularly FOS and germinated barley foodstuff, show potential as effective and safe dietary supplements for induction and maintenance of remission in UC, respectively. The overall certainty of evidence was very low. There would be benefit in further investigation on the role of prebiotics as treatment adjuncts for IBD.

Malnutrition, defined as deficiency, excess, or imbalance of nutrients, is a common complication in patients with liver disease, especially those with cirrhosis. Malnutrition may present as an isolated micronutrient deficiency, such as zinc deficiency, and it commonly presents as frailty and/or sarcopenia in patients with advanced liver disease. Patients with cirrhosis and/or alcohol-associated hepatitis should be assessed for malnutrition because it adversely affects patient outcomes including mortality, as well as waitlist and posttransplant outcomes among liver transplant candidates. The prevalence of malnutrition varies based on the method of assessment and disease severity, being higher in those with advanced liver disease. Among stable outpatients with cirrhosis, counseling should be done to eat small frequent meals, a night-time snack between 7 PM and 10 PM, and 2 or more cups of coffee daily. In selected patients with metabolic dysfunction-associated steatohepatitis, vitamin E 800 IU/d should be provided. Among hospitalized patients with cirrhosis, nutritional supplementation preferably by enteral route should be implemented in those with poor oral intake of daily requirements of proteins and/or calories. Protein intake should not be restricted including patients with decompensated cirrhosis and hepatic encephalopathy. A vegetable source of protein seems to be better tolerated than an animal source of protein in patients with hepatic encephalopathy. Branched chain amino acids augment the efficacy of lactulose and rifaximin in the treatment of hepatic encephalopathy. Level of evidence and strength of recommendations were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations system. This guideline was developed under the auspices of the American College of Gastroenterology Practice Parameters Committee.

BACKGROUND AND AIMS:The impact of dietary sugar intake on the risk of developing inflammatory bowel disease is unclear, with inconsistent findings across studies. The aim of this systematic review and meta-analysis was to clarify how sugar consumption contributes to the risk of developing inflammatory bowel disease (IBD) using the most recently available data. METHODS:A library informationist retrieved relevant articles from PubMed, EMBASE, CINAHL, Cochrane Central, Web of Science, and Scopus. Two independent reviewers screened the abstracts and full texts, yielding 45 studies for inclusion. Meta-analyses estimated odd ratios using random effect models. RESULTS:11 prospective and 34 retrospective studies reported data on sugar intake and IBD risk. Pooled analysis showed that added sugar intake was associated with increased risk of Crohn's disease (OR 1.66; 95% Cl 1.21-2.29; n = 523,730; 14 studies) and ulcerative colitis (OR 1.59; 95% CI 1.25-2.02; n = 787,228; 18 studies). Similarly, soda/sweetened beverage intake was associated with increased risk of Crohn's disease (OR 1.58; 95% CI 1.18-2.12; n = 328,716; 12 studies) and ulcerative colitis (OR 1.72; 95% CI 1.23-2.391; n = 328,642; 13 studies). CONCLUSIONS:Sugar and soda/sweetened beverage intake were associated with an increased risk of developing both Crohn's disease and ulcerative colitis. Although additional prospective investigation is warranted, current data suggest that reduction of sugar consumption might help reduce the risk of inflammatory bowel disease.