Sarcopenia is Associated with Social Determinants of Health in Patients with Inflammatory Bowel Disease

BACKGROUND: Sarcopenia is defined as the loss of skeletal muscle mass and is a modifiable condition that affects between 27 to 61% of patients with inflammatory bowel disease (IBD). Social determinants of health (SDOH) are increasingly being identified as contributors to disparities and health outcomes in IBD. However, the impact of SDOH on sarcopenia in IBD remains understudied. We aimed to perform a comprehensive evaluation of the presence of SODH in sarcopenia within an IBD patient population.

METHODS: Patients (≥18 years) seen at the IBD Center with a confirmed diagnosis of IBD without short bowel syndrome were invited to complete a SARC-F questionnaire to assess for sarcopenia. Sarcopenia on SARC-F was defined as a score ≥4. Patients completed an additional 11-item dichotomous SDOH questionnaire. Retrospective chart review was performed for demographic and disease characteristics for all patients that completed the questionnaires. Each item on the SODH questionnaire was considered a risk factor and compared between the sarcopenia and non-sarcopenia groups using univariable analysis. The false discovery rate was used in multiple hypothesis testing to correct for multiple comparisons (shown as the q-value).

RESULTS: Among 233 patients that completed the SARC-F questionnaire, 44 patients met criteria for sarcopenia with a score ≥4 on SARC-F. Patients with sarcopenia had an average age of 48 and were predominantly Caucasian (95%). Tobacco use (25% vs 3.7%, p < 0.001), history of bowel surgery (59% vs 33%, p < 0.001) and BMI (30 vs 26, p < 0.001) were all associated with sarcopenia on SARC-F. Almost all patients (99%) identified at least one SDOH factor with an average of 3.9 factors. The most common SDOH factors in patients with sarcopenia were limited meetings or interactions with support groups (88%) and religious groups (79%). On univariable analysis, difficulty paying for basic needs such as food, housing, transportation, and medications (51% vs 15%, p < 0.001) was associated with sarcopenia. Patients that identified themselves as a lot or very stressed (60% vs 33%, p < 0.001) or had limited interactions with friends/relatives (47% vs 27%, p=0.013) were also more likely to have sarcopenia. After applying the false discovery rate, these factors remained significant based on q-value.

CONCLUSION(S): Our study identifies a high burden of social barriers amongst IBD patients with sarcopenia and SDOH screening should be considered at the time of diagnosis. Difficulty with basic needs, stress and limited interactions with loved ones are prevalent SDOH associated with sarcopenia in IBD. Multi-disciplinary interventions with social workers and mental health specialists may help address these needs.