Study Finds High Malnutrition and Mortality Rates Among Patients Hospitalized for Celiac Disease

Celiac.com 09/05/2023 - Celiac disease is a T-cell-mediated gluten sensitivity that results in villous atrophy in the small intestine, leading to chronic malabsorption. Patients with celiac disease are prone to malnutrition. A team of researchers recently assessed the impact of malnutrition on in-hospital outcomes in patients with celiac disease.

This study analyzed data from the National Inpatient Sample Database, encompassed 187,310 patients with celiac disease. The team included patients with a primary discharge diagnosis of celiac disease between January 2016 and December 2019 from the National Inpatient Sample Database. Data included patient demographics, hospital characteristics, the Charlson Comorbidity Index, and concomitant comorbidities. The association between malnutrition and outcomes, including mortality, deep vein thrombosis, pulmonary embolism, sepsis, acute kidney injury, length of stay, and total hospitalization charges, was analyzed using the multivariate regression model.

Malnutrition Rate Among Hospitalized Celiacs at 8.3% and 108% Increase in Mortality Rate

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The rate of malnutrition among celiac patients was found to be 8.3%, aligning with similar rates seen in prior research. However, this study adds new insights by demonstrating the link between malnutrition and various detrimental outcomes in hospitalized celiac patients.

The research reveals that malnourished celiac patients are at a significantly higher risk of in-hospital mortality and resource utilization, as well as a range of complications including deep vein thrombosis, sepsis, acute kidney injury, and prolonged length of stay. The heightened mortality risk is particularly alarming, with a staggering 108% increase in mortality rates observed in malnourished celiac patients.

The complex pathophysiology behind malnutrition in celiac disease involves factors like intestinal damage-induced malabsorption and chronic diarrhea. Common nutritional deficiencies in celiac patients encompass iron, zinc, folic acid, vitamin B12, vitamin D, and calcium. Despite these challenges, many celiac patients display malnutrition-related symptoms.

Malnutrition was also associated with an increased risk of deep vein thrombosis, suggesting that diet could influence thrombosis-related factors. Additionally, acute kidney injury was more likely to develop in malnourished celiac patients, possibly due to dehydration and reduced serum creatinine levels. Sepsis, a serious condition, was found to be 43% more likely in patients with malnutrition, linked to their lower immunity caused by inadequate dietary intake.

The study underscores the significance of proper nutrition in celiac patients, both for mitigating immediate complications and preventing long-term adverse effects. However, the study's limitations highlight the need for further investigation into factors such as disease severity, pharmaceutical therapies, and treatment compliance. 

The findings emphasize the importance of a multidisciplinary approach to manage malnutrition in celiac patients, involving nutritional screening, medical therapy, and dietary recommendations, as well as interventions like enteral or parenteral nutrition. 

Lastly, the research highlights the need for further investigations into factors contributing to malnutrition in celiac disease, and the effectiveness of interventions to address it.

Read more in cureus.com

The researchers included Kanwal Bains, Shivam Kalra, Ishandeep Singh, Jay Patel, Isha Kohli, Mukul Dhiman, Dino Dukovic, Aalam Sohal, and Avin Aggarwal. They are variously affiliated with the department of Internal Medicine, University of Arizona College of Medicine, Tucson, USA; the department of Internal Medicine, Trident Medical Center in North Charleston, USA; the department of Internal Medicine, Dayanand Medical College and Hospital in Punjab, IND; the Digestive Disease and Surgical Institute, Cleveland Clinic in Cleveland, USA; the department of Public Health Sciences, Icahn School of Medicine at Mount Sinai in New York , USA; the Internal Medicine, Punjab Institute of Medical Sciences in Punjab, IND; the department of Internal Medicine, Ross University School of Medicine in Bridgetown, BRB; and the department of Internal Medicine, UCSF Fresno in Fresno, USA.