{"paper_id":"23e95ef2-ee1a-40ac-845f-ad173ee4d83e","body_text":"Frailty Prevalence And Evaluation Of The FRAIL Scale Questionnaire In Patients with Inflammatory Bowel Disease | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Frailty Prevalence And Evaluation Of The FRAIL Scale Questionnaire In Patients with Inflammatory Bowel Disease Janak Bahirwani, Joshua Elmer, Hany Eskarous, Suruchi Jai Kumar Ahuja, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5815707/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Apr, 2025 Read the published version in Digestive Diseases and Sciences → Version 1 posted 9 You are reading this latest preprint version Abstract Background Inflammatory bowel disease (IBD) predisposes individuals to frailty, linked with adverse outcomes. While the Fried Frailty Index (FFI) is a well-established phenotypic tool to assess frailty, its administration is cumbersome. The FRAIL scale, simpler but not widely used in IBD patients, presents an alternative. We aimed to assess the prevalence of frailty and compare the FRAIL scale with the FFI. Methods Two hundred and nine confirmed IBD patients underwent assessment using both the FFI and the FRAIL scale. Patients were categorized as non-frail, pre-frail, or frail. Pearson coefficients evaluated correlation, and unadjusted analyses assessed frailty risk factors. ROC curve analysis evaluated the FRAIL scale. Results Among participants (53.5% female, median age 44), 37% were non-frail, 50% pre-frail, and 13% frail. The FRAIL scale exhibited strong correlation with the FFI for all three categories. Age showed no significant association with frailty. Frail individuals displayed higher inflammatory markers and more severe clinical disease, with frailty more prevalent in UC than CD patients. Frail individuals also exhibited lower hemoglobin, creatinine, and albumin levels. Conclusion Frailty and pre-frailty are prevalent in the IBD population, not necessarily linked with older age. The FRAIL scale demonstrated excellent correlation with the FFI, offering a practical tool for identifying frailty in IBD without physical measurements. Future studies should explore multivariable models incorporating frailty risk factors and interventions to mitigate adverse outcomes in the IBD population. Frailty Inflammatory bowel disease (IBD) FRAIL Scale (FS) Fried Frailty Index (FFI) prevalence Figures Figure 1 Figure 2 INTRODUCTION The global prevalence of inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s Disease (CD) has witnessed an escalation. The number of individuals affected by IBD across the globe increased from 3.7 million in 1990 to 6.8 million in 2017 and the incidence is rising 1 , partly attributable to improved patient survival, especially in North America and Western European nations. Those with IBD may be at increased risk for the development of frailty, a complex, multi-dimensional syndrome that increases vulnerability to stress and reserve decline across multiple physiologic systems. 2 Although age is a known risk factor for frailty, younger individuals with IBD may also be at risk due to complications such as nutritional deficiencies, inflammation and sarcopenia. 3 Frailty in the general population has been associated with adverse clinical outcomes, including postoperative complications, increased hospital readmissions, increased mortality, and decreased physical and mental health-related quality of life 4 , 5 . In a prospective study of causes of disability in community-dwelling adults in the last year of life, frailty was found to be the leading cause of death. 6 Given the substantial risk of harm for patients with frailty, it is essential to recognize frailty risk factors and estimate frailty prevalence in the IBD patient population. While certain risk factors like female sex, lower education, active inflammation, anemia, and decreased immune function have been studied in the general population, there is a lack of IBD- specific frailty data using validated tools. 7 Frailty is a modifiable condition, with transitions between non-frail, pre-fail and frail. Therefore, identifying those at risk can lead to interventions such as exercise and nutritional rehabilitation. 8 Since there is lack of IBD-specific frailty data, there is also a lack of specific interventions related to frailty in IBD. Numerous tools are available for assessing frailty, such as the Linda Fried Frailty Index (FFI) and the FRAIL scale (FS). The FFI is considered a well-established phenotypic tool to assess frailty. 9 , 10 While the FFI involves physical measurements and assessments of grip strength and ambulation, limiting its applicability in diverse patient populations, the FS, consisting of a five-question survey encompassing fatigue, resistance, ambulation, illness and loss of weight offers a more practical approach for large and varied patient groups. Despite the heightened vulnerability of individuals with IBD to frailty across all age groups, there is a lack of literature examining the associated risk factors for frailty in this patient population. A comprehensive understanding of frailty in the IBD population holds promise for addressing and preventing this issue through disease management and therapies available for IBD. In light of the variability among existing frailty assessment tools, our study aims to assess the prevalence of frailty and evaluate the FRAIL scale in IBD patients while investigating factors linked to frailty in this patient population. Our objectives include estimating the prevalence of frailty in the IBD population, comparing the FFI and FS across non-frail, pre-fail and frail IBD patients and exploring the association between various modifiable and non-modifiable factors and frailty in a cohort of IBD patients. METHODS 1- Study design and setting We conducted a cross-sectional study to assess the presence of frailty in our IBD cohort using the standard FFI and FS questionnaire. (attached as supplementary material) The study was conducted at St Luke’s University Health Network (SLUHN) across three outpatient gastroenterology clinics with a focus on managing complicated IBD patients: St Luke’s Bethlehem, Allentown, and Coaldale. The study was conducted from September of 2021 to September of 2023. The FFI has 5 components: involuntary weight loss, reduced grip strength, difficulty initiating movements, reduced walking speed and fatigue. After collecting these measurements from patients, we entered the results into the Johns Hopkins Frailty Assessment calculator. 11 Based on the calculator's thresholds, which vary according to age and sex for certain measurements like grip strength and slowness, we classified patients into three groups: non-frail (0 abnormalities), pre-frail (< 2 abnormalities), and frail (3 or more abnormalities). We used a CAMRY Digital Hand Dynamometer to assess grip strength of all included patients. The FS questionnaire consists of five key components: fatigue, resistance, ambulation, weight loss, and medical comorbidities. Once each piece is scored individually, the cumulative score was grouped into non-frail (score 0), pre-frail (score 1–2), or frail (score 3–5). The questionnaires administered are attached as a supplementary file. Using both scales, we identified and stratified individuals into non-frail, pre-frail and frail and then we compared the two frailty scales to see how much they overlapped and if the FS could be used as a substitute to FFI. Our comparative variables of interest were grouped into patient demographics, disease activity measures, and disease-related history and included age, sex, BMI, ethnicity, tobacco and alcohol use, age at diagnosis, duration of disease, prior surgical history, the presence of IBD related arthritis, prior hospitalizations, prior flares, frequency, disease activity and relevant laboratory values- Hemoglobin, Ferritin, Fecal calprotectin, C- reactive protein (CRP), creatinine, white blood cell (WBC) count and albumin. Disease severity was measured using clinical criteria- Harvey Bradshaw Index for CD patients and Mayo score for UC patients. For patients who had undergone a colonoscopy within the past year, endoscopic severity was used instead of clinical criteria if there was a discrepancy between the two. 2- Study participants All adult (age ≥ 18 years) IBD patients receiving their care at one of our three IBD clinics, were offered participation in the study. We excluded patients refusing to participate in the study, patients with active malignancy, active infections, recent hospitalization within the past 8 weeks, recent surgery within the past 8 weeks or any autoimmune diseases. Patients who had a telemedicine or virtual video visit were not offered to participate in the study. Informed consent was implied with the completion of the questionnaire. The introductory text explained that participation is voluntary and confidential, and that all information will be used for aggregate data reporting and will not identify any individual subject by name. The questionnaires were administered in-person during the patient’s office visit. 3- Outcomes The primary outcome was the prevalence of frailty in the entire cohort using data from FFI and FS as well as within risk factors-based categories. Our secondary outcomes were to compare the FFI and FS across non-frail, pre-fail and frail IBD patients in order to evaluate the FS and to examine univariate associations between various modifiable and non-modifiable factors and frailty in a cohort of IBD patients. 4- Statistical analysis Due to the exploratory nature of our study, coupled with our limited subgroups samples, we conducted separate unadjusted comparisons between our frailty groups using chi square tests for our categorical variables and one-way analysis of variance (ANOVA) or Kruskal Wallis tests for our normally distributed and skewed continuous variables, respectively. For all comparisons, p < .05 denotes statistical significance, with no adjustment for multiple testing. ROC curve plots were obtained to evaluate the Frail Scale (FS) and an area under the curve (AUC) was obtained. AUC is the area under the ROC curve and provides a scalar value to summarize the overall performance of the classifier. We used SPSS version 27 (Armonk, NY: IBM Corp) to analyse our data. 5- Ethical considerations SLUHN Institutional Board Review (IRB) approval was obtained for the study. The IRB reviewed all patient questionnaires prior to the study being conducted. The questionnaires kept the identity of the patient confidential in compliance with the health insurance portability and accountability act. RESULTS Two hundred and forty-six patients were seen in the IBD clinic during the study period. Out of these, two hundred and nine patients were included in the study. The flowchart depicts the reasons for exclusion (Fig. 1) The median age was 44 years. The interquartile range was 29 years. A total of fifty-one patients were over the age of 60. A majority of the patients were female (53.5%) and Caucasian (77.5%). Slightly more than half patients had a diagnosis of Crohn’s disease. The most common IBD medication used in the group was mesalamine and the most common biologic was vedolizumab. Approximately 30% of the patients had undergone surgery for their disease and approximately half of these patients had undergone a total colectomy (none in the past 8 weeks since they were excluded). Their baseline characteristics are detailed in Table 1 . Based on the FFI, 37% of these patients were non-frail, 50% were pre-frail and 13% were frail. Table.2 shows the results of unadjusted comparisons for pre-defined factors that may be associated with frailty. Notably, age was not significantly associated with frailty, despite our study having about a quarter of patients above the age of 60. There was no statistically significant difference between frail and non-frail patients with regards to gender, smoking status, disease duration, number of prior IBD related surgeries, the existence of osteoporosis or low Vitamin D, the level of fecal calprotectin, BUN or disease-associated anxiety, depression, arthritis. There were statistically significant differences in some of the other lab values trend towards higher inflammatory markers for those with frailty. A higher proportion of patients with frailty had severe clinical disease. Frailty was more prevalent in those with UC compared to CD. There was a trend towards lower hemoglobin, creatinine, and albumin values in the frail group. Disease activity was shown to be strongly associated with frailty (p-value of < 0.001). The FS and FFI correlated well (area under the curve 0.94, p-value < 0.01), and when divided by category (frail vs non-frail: rho = 1.00, pre-frail vs non-frail: rho = 0.88, p < .001, frail vs pre-frail: rho = 0.73, p < .001). The ROC curve is depicted in Fig. 1 and as can be seen that the ROC curve lies at the top left corner indicating good sensitivity and specifity across various thresholds. The ROC curve lies above the diagonal reference line representing the performance is better than the random classifier (AUC = 0.5). (Fig. 2) DISCUSSION Our study, administered in the outpatient setting, included patients who were not recently hospitalized or underwent any recent surgery within the past 8 weeks, revealed that pre-frailty and frailty are prevalent in our IBD cohort regardless of the patient’s age. Our study evaluates the FS, which shares some features with the FFI but is much easier to administer in the clinical setting and demonstrates its comparability to the widely used FFI in assessing frailty in this cohort of patients. Frail individuals displayed higher inflammatory markers and more severe clinical disease, with frailty more prevalent in UC than CD patients. Additionally, frail individuals exhibited lower hemoglobin, creatinine, and albumin levels. Frailty represents a complex syndrome characterized by diminished resilience to biological stressors, posing significant risks to quality of life, health outcomes, and healthcare resource utilization. Extensive research across various health conditions, including cancers, infections, osteoporosis, chronic kidney disease, cirrhosis and chronic inflammatory states, consistently demonstrates poorer outcomes in patients with coexisting pre-frailty or frailty. 12 , 13 , 14 , 15 IBD, as systemic chronic conditions characterized by bacterial dysbiosis and immune dysregulation, often exhibit features associated with frailty, such as weight loss, fatigue, and sarcopenia. 16 As with all chronic inflammatory conditions, IBD causes interference with anabolic signalling resulting in progressive muscle wasting and dysfunction. 17 A retrospective study was conducted to identify the impact of treatment with anti-TNF agents on frailty in IBD and found that nearly 85% of patients who were frail prior to treatment demonstrated some degree of improvement in frailty following treatment. 18 This study also found that the mean pre-treatment CRP was higher in those who were characterized as frail. Moreover, similar to our study, there was no difference in the degree of improvement between patients younger or older than 60 years, suggesting that frailty is linked to inflammation and not just age. Thus, it is important to identify and treat frail patients with IBD regardless of age, as treatment of IBD can also lead to improvement in frailty parameters. The initial investigations into frailty among IBD patients focused on evaluating outcomes following ileoanal pouch surgery in adults with UC. These studies assessed various frail traits, including the presence of chronic obstructive pulmonary disease, hypertension, diabetes mellitus, congestive heart failure, functional status, and weight loss of at least 10%. Among individuals stratified by age- less than 50 years, between 51 and 60 years, and over 60 years- the estimated prevalence of frailty (defined as having at least one \"frail trait\") was 14%, 32%, and 54%, respectively. 19 However, these studies had several limitations, such as using \"frailty traits\" rather than a validated tool for frailty assessment and focusing exclusively on UC patients undergoing ileoanal pouch surgery, thus limiting generalizability to all IBD patients. Subsequent literature on frailty in IBD has predominantly relied on large database analyses using diagnosis codes to estimate frailty prevalence. For instance, Kochar et al. utilized the Frailty Risk Score (FRS), an algorithm incorporating ICD diagnosis codes, and found a twofold increase in treatment-related infections and a threefold increase in mortality among frail individuals, regardless of age. 20 Similarly, Qian et al. analyzed National Readmissions Data (NRD) and revealed that 33% of hospitalized patients in 2013 met the criteria for frailty according to the FRS, associated with a 57% rise in mortality and a 21% increase in readmission risk. 3 Faye et al., analyzing NRD data from 2010 to 2014, observed a gradual increase in frailty prevalence from 10.2% in 2010 to 11.5% in 2014, potentially attributed to the aging IBD population. 21 Frailty emerged as an independent predictor of 30-day readmission and 30-day readmission mortality, even after adjusting for age, sex, comorbidities, and surgical status. 21 However, a notable drawback of these database studies lies in the validation of frailty codes, primarily established in elderly patients rather than those with IBD, which may introduce misclassification and missing data, leading to inaccuracies in estimating frailty prevalence. One large prospective study by Asscher et al. on geriatric assessment in IBD patients found that approximately half had two or more deficits. 22 However, since this study was only done in patients over the age of 65, its findings are not fully generalizable to the entire IBD population. Therefore, it is imperative to assess frailty prevalence through standard well established tests in the IBD cohort across all age groups, a goal our study successfully achieved. The FFI defines frailty based on the presence of three out of five interconnected attributes: unintentional weight loss, self-reported exhaustion, low energy expenditure, slow gait speed, and weak grip strength. 10 Widely regarded as a well-established tool in frailty assessment, the FFI offers a standardized framework with demonstrated accuracy, both immediate and predictive, in identifying frail individuals. Additionally, it identifies an intermediate stage, effectively pinpointing individuals at heightened risk of developing frailty. However, while the FFI is well established and cost-effective, its administration can be burdensome and time-consuming, particularly due to the requirement of measuring hand grip strength using a dynamometer. In contrast, the FS presents a more streamlined approach, comprising just five components easily administered in a clinical setting. Thus, evaluating the FS within our IBD cohort becomes pivotal, potentially providing a valuable resource to identify frailty or heightened risk of frailty development among IBD patients in the future. Given the increasing number of aging population and life expectancy, the number of older adults with IBD is rising. In 2018, The US Centers for Disease Control (CDC) reported that 0.40% and 0.64% of 25.1 million of population aged ≥ 67 years had received a diagnosis of either CD or US. 23 Previous studies showed frailty is associated with aging. 4 Older adults with IBD have a worse disease and treatment-related outcomes than younger adults with IBD. There are several changes to the immune system that occur with age as the proliferation rate of B and T cells falls off with higher levels of apoptosis, a proinflammatory cascade eventually generated. 24 In our study focusing on IBD patients, there is no association found between age and the presence of frailty, despite our study having about a quarter of patients above the age of 60. This is possibly because those afflicted with IBD may be at an increased risk for frailty across all age groups given the chronic and relapsing nature of the disease, which is often associated with significant protein malnutrition, repeated use of corticosteroids, and recurrent hospitalizations and surgeries that can lead to physical deconditioning. In addition, CD-related complications can include strictures and intra-abdominal fistulas. Together, these disease manifestations and related symptoms can lead to decreased food intake, impaired absorption of nutrients, and protein-losing enteropathy. Those afflicted with IBD are at increased risk for significant malnutrition and malnutrition is strongly associated with frailty. This may explain the significant correlation found in the frail group with low albumin, creatinine, and HGB. Our study's primary strength lies in its administration of two distinct frailty scales within a cohort of IBD patients, successfully evaluating the FS by demonstrating its strong correlation with the established FFI effectively categorizing patients into non-frail, pre-frail, and frail groups. Unlike previous studies, we avoided reliance on databases with hospital codes, mitigating the risk of misclassification. Furthermore, our inclusion of the entire spectrum of IBD patients, irrespective of disease severity or age, provides a more accurate representation of real-world frailty prevalence. Nonetheless, our study faces limitations. The relatively small cohort size hindered robust subgroup analysis, underscoring the need for larger cohorts to achieve sufficient statistical power. This limited our ability to also conduct a multivariate analysis. The educational status of the patients was not considered in the questionnaire. While we utilized the established FFI to minimize information bias in our patient-directed survey, inherent selection bias may have influenced participation, potentially skewing the representation of frailty risk levels among participants. CONCLUSIONS AND FUTURE DIRECTIONS Given the minimal literature examining frailty in the IBD population, this study fills a gap in the medical literature. Furthermore, it can lay the groundwork for future research regarding this vulnerable population, including work examining health outcomes for those with IBD and frailty, and understanding ways to prevent or treat frailty. Frailty and pre-frailty are common in the IBD population but were not associated with older age. We found that the FRAIL scale had an excellent correlation to the FFI. Given its ease of use and the absence of physical measurements, it can be employed widely to identify frailty in those with IBD. Future research should incorporate multivariable regression modeling to clarify independent risk factors for frailty, with inclusion of validated frailty measures, focusing on the implications in IBD patients. Declarations Acknowledgments None Funding None Disclosure of conflict of interest JB: None JE: None HE: None SA: None MC: None DD: None JS: None YS: None Conference submissions No previous conference presentations Author Contribution JB: Formulated the idea, drafted the manuscriptJE: Collected patient dataHE: Collected patient dataSA: Statistical analysisMC: Edited the manuscriptDD: Edited the manuscript, Statistical analysisJS: Edited the manuscript, Statistical analysisYS: Formulated the idea, collected patient data, revised manuscript References Alatab S, Sepanlou SG, Ikuta K, et al . The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990–2017: a systematic analysis for the global burden of disease study 2017. 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Dahlhamer J, Zammitti E, Ward B, et al . Prevalence of inflammatory bowel disease among adults aged ⩾18 years - United States, 2015. MMWR Morb Mortal Wkly Rep 2016; 65: 1166–1169. Montecino-Rodriguez E, Berent-Maoz B and Dorshkind K. Causes, consequences, and reversal of immune system aging. J Clin Invest 2013; 123: 958–965. Tables Table 1- Baseline demographics of the entire cohort (n=209) Characteristic Value 1 Age in years (median) 44 (18-89) IQR: 29 2 Sex (n; %) · Female · Male 112; 53.5 97; 46.5 3 Race (n; %) · White · Black · Asian · Hispanic · Other/Unknown 162; 77.5 10; 4.7 2; 1 20; 9.5 15; 7.3 4 BMI (mean) 27.09 5 Diagnosis (n; %) · Ulcerative colitis · Crohn’s disease · Indeterminate 79; 37.7 113; 54 17; 8.3 6 Disease location (n;%) · Colon (UC + CD) · Small bowel · Ileocolonic · Upper GI 113; 54 33; 15.8 61; 29.1 1; 0.4 7 Current IBD medications (n;%) · Vedolizumab · Mesalamine · Adalimumab · Ustekinumab · Infliximab · Combination therapy · Prednisone · Other · No treatment 33; 15.7 32; 15.3 29; 13.8 26; 12.4 24; 11.4 8; 3.8 8; 3.8 32; 15.3 17; 8.5 8 Primary sclerosing cholangitis (n;%) · No · Yes 198; 94.7 6; 5.3 Table.2 Unadjusted Comparisons for Non-frail versus pre-frail vs Frail patients Variable Non-Frail (n= 77) Pre-Frail (n=106) Frail (n=26) p-value* Age (mean + SD) 42.4 + 16.0 48.5 + 18.5 46.2 + 22.2 .08 Gender Assigned at Birth (n,%) 41 female (36.6%) 36 male (37.1%) 56 female (50%) 50 male (51.6%) 15 female (13.4%) 11 male (11.3%) .84 Current Weight (mean + SD) 174.4 + 42.2 175.8 + 42.1 150.4 + 46.5 .04 Smoking Status (n,%) Current: 4 (5.2%) Prior: 18 (23.3%) Never: 55 (71.5%) Current: 13 (12.3%) Prior: 38 (35.8%) Never: 55 (51.9%) Current: 2 (7.7%) Prior: 6 (23%) Never: 18 (69.2%) .10 Diagnosis (n,%) Crohn’s Disease: 40 (52%) Ulcerative colitis: 28 (35.9%) Crohn’s Disease: 65 (57.5%) Ulcerative colitis: 36 (46.2%) Crohn’s Disease: 8 (7.1%) Ulcerative colitis: 15 (17.9%) .02 Duration (Months) (median, range) 84 (2 – 720) 96 (0 – 612) 78 (0 – 624) .62 Disease Activity (n,%) (*missing data for 15 patients) Mild: 30 (42.9%) Moderate: 14 (23.35) Severe: 2 (16.7%) Inactive: 28 (56%) Mild: 35 (50%) Moderate: 37 (61.7%) Severe: 4 (33.3%) Inactive: 20 (40%) Mild: 5 (7.1%) Moderate: 9 (15%) Severe: 7 (50%) Inactive: 3 (4%) < .001 IBD Arthritis (n,%) Yes: 21 (27.2%) No: 56 (72.8%) Yes: 42 (39.6%) No: 64 (60.3%) Yes: 12 (46.2%) No: 14 (53.8%) .06 Concomitant Depression or Anxiety (n,%) Yes to one or both: 19 (28.4%) No to both: 58 (42.3%) Yes to one or both: 40 (59.7%) No to both: 66 (46%) Yes to one or both: 8 (11.9%) No to both: 18(11.7%) .14 Surgical History (n,%) None: 58 (75.3%) Small bowel resection: 2 (2.5%) Colonic resection: 9 (11.7%) Ileocolonic resection: 8 (10.5%) None: 73 (68.9%) Small bowel resection: 7 (6.7%) Colonic resection: 13 (12.2%) Ileocolonic resection: 13 (12.2%) None: 18 (69.2%) Small bowel resection: 0 Colonic resection: 3 (11.5%) Ileocolonic resection: 5 (19.3%) .60 Osteoporosis or Osteopenia (n,%) (*missing data for 132 patients) None: 16 (30.8%) Osteopenia: 8 (50%) Osteoporosis: 3 (33.3%) None: 31 (59.6%) Osteopenia: 7 (43.8%) Osteoporosis: 4 (44.4%) None: 5 (9.6%) Osteopenia: 1 (6.3%) Osteoporosis: 2 (22.2%) .47 Vitamin D (ng/mL) (median, range) 30.8 (8.5 – 59.3) 29 (0 – 88) 31 (7.1 – 55.7) .48 HGB (g/dL) (median, range) 13.4 (9.5 – 16.6) 13.2 (7.1 – 17.8) 11.2 (8.3 – 14.9) < .001 Ferritin (ng/mL) (median, range) 47 (4 – 1130) 51 (3 – 346) 96 (4 – 2392) .07 Fecal Calprotectin (mcg/g) (median, range) 171 (10 – 28151) 194.5 (16 – 9298) 402.5 (20 – 6454) .43 CRP (mg/L) (median, range) 4 (.90 – 90) 5.75 (.50 – 122) 9.8 (3 – 102.8) .07 BUN (mg/dL) (median, range) 12 (5 – 27) 12 (4 – 27) 12.5 (4 – 25) .99 Cr (mg/dL) (median, range) .84 (.53 – 1.87) .81 (.29 – 2.34) .70 (.38 – 1.17) .05 Albumin (g/dL) (median, range) 3.8 (1.3 – 4.5) 3.6 (2.3 – 5.2) 3.0 (1.3 – 4.8) <.001 * Based on separate chi-square tests for categorical variables and one-way analysis of variance (ANOVA) or Kruskal Wallis tests for normally distributed and continuous variables, respectively Additional Declarations No competing interests reported. Supplementary Files FrailtyQuestionnaire.pdf Cite Share Download PDF Status: Published Journal Publication published 29 Apr, 2025 Read the published version in Digestive Diseases and Sciences → Version 1 posted Editorial decision: Revision requested 31 Jan, 2025 Reviews received at journal 30 Jan, 2025 Reviews received at journal 22 Jan, 2025 Reviewers agreed at journal 21 Jan, 2025 Reviewers agreed at journal 20 Jan, 2025 Reviewers invited by journal 15 Jan, 2025 Editor assigned by journal 14 Jan, 2025 Submission checks completed at journal 14 Jan, 2025 First submitted to journal 12 Jan, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-5815707\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":402692112,\"identity\":\"e02817ed-7563-42ae-b71e-670f397ea701\",\"order_by\":0,\"name\":\"Janak 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selection\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure1.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5815707/v1/aee394da53a60b02bd0ba8b4.jpg\"},{\"id\":74075402,\"identity\":\"e3dfd67d-32a4-49bb-8f93-beba63246843\",\"added_by\":\"auto\",\"created_at\":\"2025-01-17 13:37:24\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":11568,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eROC curve\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure22.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5815707/v1/ca07aff2ef64b88e2619d32d.png\"},{\"id\":81987699,\"identity\":\"5ba58aa8-adf1-48fc-b2f6-9ab7cd3925a3\",\"added_by\":\"auto\",\"created_at\":\"2025-05-05 16:04:57\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":814084,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5815707/v1/af2ec205-1c7e-4aa8-a925-48b591258e4c.pdf\"},{\"id\":74074699,\"identity\":\"e312b75b-a619-4033-9ecc-ce3771f0d779\",\"added_by\":\"auto\",\"created_at\":\"2025-01-17 13:29:24\",\"extension\":\"pdf\",\"order_by\":2,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":105176,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"FrailtyQuestionnaire.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5815707/v1/19757a2e71e38bb9a5efc01d.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Frailty Prevalence And Evaluation Of The FRAIL Scale Questionnaire In Patients with Inflammatory Bowel Disease\",\"fulltext\":[{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cp\\u003eThe global prevalence of inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn\\u0026rsquo;s Disease (CD) has witnessed an escalation. The number of individuals affected by IBD across the globe increased from 3.7\\u0026nbsp;million in 1990 to 6.8\\u0026nbsp;million in 2017 and the incidence is rising\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e, partly attributable to improved patient survival, especially in North America and Western European nations. Those with IBD may be at increased risk for the development of frailty, a complex, multi-dimensional syndrome that increases vulnerability to stress and reserve decline across multiple physiologic systems.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e Although age is a known risk factor for frailty, younger individuals with IBD may also be at risk due to complications such as nutritional deficiencies, inflammation and sarcopenia.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e Frailty in the general population has been associated with adverse clinical outcomes, including postoperative complications, increased hospital readmissions, increased mortality, and decreased physical and mental health-related quality of life\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e. In a prospective study of causes of disability in community-dwelling adults in the last year of life, frailty was found to be the leading cause of death.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eGiven the substantial risk of harm for patients with frailty, it is essential to recognize frailty risk factors and estimate frailty prevalence in the IBD patient population. While certain risk factors like female sex, lower education, active inflammation, anemia, and decreased immune function have been studied in the general population, there is a lack of IBD- specific frailty data using validated tools.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e Frailty is a modifiable condition, with transitions between non-frail, pre-fail and frail. Therefore, identifying those at risk can lead to interventions such as exercise and nutritional rehabilitation.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e Since there is lack of IBD-specific frailty data, there is also a lack of specific interventions related to frailty in IBD.\\u003c/p\\u003e \\u003cp\\u003eNumerous tools are available for assessing frailty, such as the Linda Fried Frailty Index (FFI) and the FRAIL scale (FS). The FFI is considered a well-established phenotypic tool to assess frailty.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e While the FFI involves physical measurements and assessments of grip strength and ambulation, limiting its applicability in diverse patient populations, the FS, consisting of a five-question survey encompassing fatigue, resistance, ambulation, illness and loss of weight offers a more practical approach for large and varied patient groups. Despite the heightened vulnerability of individuals with IBD to frailty across all age groups, there is a lack of literature examining the associated risk factors for frailty in this patient population. A comprehensive understanding of frailty in the IBD population holds promise for addressing and preventing this issue through disease management and therapies available for IBD. In light of the variability among existing frailty assessment tools, our study aims to assess the prevalence of frailty and evaluate the FRAIL scale in IBD patients while investigating factors linked to frailty in this patient population. Our objectives include estimating the prevalence of frailty in the IBD population, comparing the FFI and FS across non-frail, pre-fail and frail IBD patients and exploring the association between various modifiable and non-modifiable factors and frailty in a cohort of IBD patients.\\u003c/p\\u003e\"},{\"header\":\"METHODS\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e1- Study design and setting\\u003c/h2\\u003e \\u003cp\\u003eWe conducted a cross-sectional study to assess the presence of frailty in our IBD cohort using the standard FFI and FS questionnaire. (attached as supplementary material) The study was conducted at St Luke\\u0026rsquo;s University Health Network (SLUHN) across three outpatient gastroenterology clinics with a focus on managing complicated IBD patients: St Luke\\u0026rsquo;s Bethlehem, Allentown, and Coaldale. The study was conducted from September of 2021 to September of 2023.\\u003c/p\\u003e \\u003cp\\u003eThe FFI has 5 components: involuntary weight loss, reduced grip strength, difficulty initiating movements, reduced walking speed and fatigue. After collecting these measurements from patients, we entered the results into the Johns Hopkins Frailty Assessment calculator.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e Based on the calculator's thresholds, which vary according to age and sex for certain measurements like grip strength and slowness, we classified patients into three groups: non-frail (0 abnormalities), pre-frail (\\u0026lt;\\u0026thinsp;2 abnormalities), and frail (3 or more abnormalities). We used a CAMRY Digital Hand Dynamometer to assess grip strength of all included patients.\\u003c/p\\u003e \\u003cp\\u003eThe FS questionnaire consists of five key components: fatigue, resistance, ambulation, weight loss, and medical comorbidities. Once each piece is scored individually, the cumulative score was grouped into non-frail (score 0), pre-frail (score 1\\u0026ndash;2), or frail (score 3\\u0026ndash;5). The questionnaires administered are attached as a supplementary file. Using both scales, we identified and stratified individuals into non-frail, pre-frail and frail and then we compared the two frailty scales to see how much they overlapped and if the FS could be used as a substitute to FFI.\\u003c/p\\u003e \\u003cp\\u003eOur comparative variables of interest were grouped into patient demographics, disease activity measures, and disease-related history and included age, sex, BMI, ethnicity, tobacco and alcohol use, age at diagnosis, duration of disease, prior surgical history, the presence of IBD related arthritis, prior hospitalizations, prior flares, frequency, disease activity and relevant laboratory values- Hemoglobin, Ferritin, Fecal calprotectin, C- reactive protein (CRP), creatinine, white blood cell (WBC) count and albumin. Disease severity was measured using clinical criteria- Harvey Bradshaw Index for CD patients and Mayo score for UC patients. For patients who had undergone a colonoscopy within the past year, endoscopic severity was used instead of clinical criteria if there was a discrepancy between the two.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003e2- Study participants\\u003c/h3\\u003e\\n\\u003cp\\u003eAll adult (age\\u0026thinsp;\\u0026ge;\\u0026thinsp;18 years) IBD patients receiving their care at one of our three IBD clinics, were offered participation in the study. We excluded patients refusing to participate in the study, patients with active malignancy, active infections, recent hospitalization within the past 8 weeks, recent surgery within the past 8 weeks or any autoimmune diseases. Patients who had a telemedicine or virtual video visit were not offered to participate in the study.\\u003c/p\\u003e \\u003cp\\u003e Informed consent was implied with the completion of the questionnaire. The introductory text explained that participation is voluntary and confidential, and that all information will be used for aggregate data reporting and will not identify any individual subject by name. The questionnaires were administered in-person during the patient\\u0026rsquo;s office visit.\\u003c/p\\u003e \\u003c/p\\u003e\\n\\u003ch3\\u003e3- Outcomes\\u003c/h3\\u003e\\n\\u003cp\\u003eThe primary outcome was the prevalence of frailty in the entire cohort using data from FFI and FS as well as within risk factors-based categories. Our secondary outcomes were to compare the FFI and FS across non-frail, pre-fail and frail IBD patients in order to evaluate the FS and to examine univariate associations between various modifiable and non-modifiable factors and frailty in a cohort of IBD patients.\\u003c/p\\u003e\\n\\u003ch3\\u003e4- Statistical analysis\\u003c/h3\\u003e\\n\\u003cp\\u003eDue to the exploratory nature of our study, coupled with our limited subgroups samples, we conducted separate unadjusted comparisons between our frailty groups using chi square tests for our categorical variables and one-way analysis of variance (ANOVA) or Kruskal Wallis tests for our normally distributed and skewed continuous variables, respectively. For all comparisons, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.05 denotes statistical significance, with no adjustment for multiple testing. ROC curve plots were obtained to evaluate the Frail Scale (FS) and an area under the curve (AUC) was obtained. AUC is the area under the ROC curve and provides a scalar value to summarize the overall performance of the classifier. We used SPSS version 27 (Armonk, NY: IBM Corp) to analyse our data.\\u003c/p\\u003e\\n\\u003ch3\\u003e5- Ethical considerations\\u003c/h3\\u003e\\n\\u003cp\\u003e SLUHN Institutional Board Review (IRB) approval was obtained for the study. The IRB reviewed all patient questionnaires prior to the study being conducted. The questionnaires kept the identity of the patient confidential in compliance with the health insurance portability and accountability act.\\u003c/p\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cp\\u003eTwo hundred and forty-six patients were seen in the IBD clinic during the study period. Out of these, two hundred and nine patients were included in the study. The flowchart depicts the reasons for exclusion (Fig.\\u0026nbsp;1) The median age was 44 years. The interquartile range was 29 years. A total of fifty-one patients were over the age of 60. A majority of the patients were female (53.5%) and Caucasian (77.5%). Slightly more than half patients had a diagnosis of Crohn\\u0026rsquo;s disease. The most common IBD medication used in the group was mesalamine and the most common biologic was vedolizumab. Approximately 30% of the patients had undergone surgery for their disease and approximately half of these patients had undergone a total colectomy (none in the past 8 weeks since they were excluded). Their baseline characteristics are detailed in Table \\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003eBased on the FFI, 37% of these patients were non-frail, 50% were pre-frail and 13% were frail. Table.2 shows the results of unadjusted comparisons for pre-defined factors that may be associated with frailty. Notably, age was not significantly associated with frailty, despite our study having about a quarter of patients above the age of 60. There was no statistically significant difference between frail and non-frail patients with regards to gender, smoking status, disease duration, number of prior IBD related surgeries, the existence of osteoporosis or low Vitamin D, the level of fecal calprotectin, BUN or disease-associated anxiety, depression, arthritis.\\u003c/p\\u003e \\u003cp\\u003eThere were statistically significant differences in some of the other lab values trend towards higher inflammatory markers for those with frailty. A higher proportion of patients with frailty had severe clinical disease. Frailty was more prevalent in those with UC compared to CD. There was a trend towards lower hemoglobin, creatinine, and albumin values in the frail group. Disease activity was shown to be strongly associated with frailty (p-value of \\u0026lt;\\u0026thinsp;0.001).\\u003c/p\\u003e \\u003cp\\u003eThe FS and FFI correlated well (area under the curve 0.94, p-value\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01), and when divided by category (frail vs non-frail: rho\\u0026thinsp;=\\u0026thinsp;1.00, pre-frail vs non-frail: rho\\u0026thinsp;=\\u0026thinsp;0.88, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001, frail vs pre-frail: rho\\u0026thinsp;=\\u0026thinsp;0.73, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001). The ROC curve is depicted in Fig.\\u0026nbsp;1 and as can be seen that the ROC curve lies at the top left corner indicating good sensitivity and specifity across various thresholds. The ROC curve lies above the diagonal reference line representing the performance is better than the random classifier (AUC\\u0026thinsp;=\\u0026thinsp;0.5). (Fig.\\u0026nbsp;2)\\u003c/p\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eOur study, administered in the outpatient setting, included patients who were not recently hospitalized or underwent any recent surgery within the past 8 weeks, revealed that pre-frailty and frailty are prevalent in our IBD cohort regardless of the patient’s age. Our study evaluates the FS, which shares some features with the FFI but is much easier to administer in the clinical setting and demonstrates its comparability to the widely used FFI in assessing frailty in this cohort of patients. Frail individuals displayed higher inflammatory markers and more severe clinical disease, with frailty more prevalent in UC than CD patients. Additionally, frail individuals exhibited lower hemoglobin, creatinine, and albumin levels.\\u003c/p\\u003e \\u003cp\\u003eFrailty represents a complex syndrome characterized by diminished resilience to biological stressors, posing significant risks to quality of life, health outcomes, and healthcare resource utilization. Extensive research across various health conditions, including cancers, infections, osteoporosis, chronic kidney disease, cirrhosis and chronic inflammatory states, consistently demonstrates poorer outcomes in patients with coexisting pre-frailty or frailty.\\u003csup\\u003e\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e\\u003c/sup\\u003e IBD, as systemic chronic conditions characterized by bacterial dysbiosis and immune dysregulation, often exhibit features associated with frailty, such as weight loss, fatigue, and sarcopenia.\\u003csup\\u003e\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e\\u003c/sup\\u003e As with all chronic inflammatory conditions, IBD causes interference with anabolic signalling resulting in progressive muscle wasting and dysfunction.\\u003csup\\u003e\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e\\u003c/sup\\u003e A retrospective study was conducted to identify the impact of treatment with anti-TNF agents on frailty in IBD and found that nearly 85% of patients who were frail prior to treatment demonstrated some degree of improvement in frailty following treatment.\\u003csup\\u003e\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e\\u003c/sup\\u003e This study also found that the mean pre-treatment CRP was higher in those who were characterized as frail. Moreover, similar to our study, there was no difference in the degree of improvement between patients younger or older than 60 years, suggesting that frailty is linked to inflammation and not just age. Thus, it is important to identify and treat frail patients with IBD regardless of age, as treatment of IBD can also lead to improvement in frailty parameters.\\u003c/p\\u003e \\u003cp\\u003eThe initial investigations into frailty among IBD patients focused on evaluating outcomes following ileoanal pouch surgery in adults with UC. These studies assessed various frail traits, including the presence of chronic obstructive pulmonary disease, hypertension, diabetes mellitus, congestive heart failure, functional status, and weight loss of at least 10%. Among individuals stratified by age- less than 50 years, between 51 and 60 years, and over 60 years- the estimated prevalence of frailty (defined as having at least one \\\"frail trait\\\") was 14%, 32%, and 54%, respectively.\\u003csup\\u003e\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e\\u003c/sup\\u003e However, these studies had several limitations, such as using \\\"frailty traits\\\" rather than a validated tool for frailty assessment and focusing exclusively on UC patients undergoing ileoanal pouch surgery, thus limiting generalizability to all IBD patients. Subsequent literature on frailty in IBD has predominantly relied on large database analyses using diagnosis codes to estimate frailty prevalence. For instance, Kochar et al. utilized the Frailty Risk Score (FRS), an algorithm incorporating ICD diagnosis codes, and found a twofold increase in treatment-related infections and a threefold increase in mortality among frail individuals, regardless of age.\\u003csup\\u003e\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e\\u003c/sup\\u003e Similarly, Qian et al. analyzed National Readmissions Data (NRD) and revealed that 33% of hospitalized patients in 2013 met the criteria for frailty according to the FRS, associated with a 57% rise in mortality and a 21% increase in readmission risk.\\u003csup\\u003e\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u003c/sup\\u003e Faye et al., analyzing NRD data from 2010 to 2014, observed a gradual increase in frailty prevalence from 10.2% in 2010 to 11.5% in 2014, potentially attributed to the aging IBD population.\\u003csup\\u003e\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e\\u003c/sup\\u003e Frailty emerged as an independent predictor of 30-day readmission and 30-day readmission mortality, even after adjusting for age, sex, comorbidities, and surgical status.\\u003csup\\u003e\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e\\u003c/sup\\u003e However, a notable drawback of these database studies lies in the validation of frailty codes, primarily established in elderly patients rather than those with IBD, which may introduce misclassification and missing data, leading to inaccuracies in estimating frailty prevalence. One large prospective study by Asscher et al. on geriatric assessment in IBD patients found that approximately half had two or more deficits.\\u003csup\\u003e\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e\\u003c/sup\\u003e However, since this study was only done in patients over the age of 65, its findings are not fully generalizable to the entire IBD population. Therefore, it is imperative to assess frailty prevalence through standard well established tests in the IBD cohort across all age groups, a goal our study successfully achieved.\\u003c/p\\u003e \\u003cp\\u003eThe FFI defines frailty based on the presence of three out of five interconnected attributes: unintentional weight loss, self-reported exhaustion, low energy expenditure, slow gait speed, and weak grip strength.\\u003csup\\u003e\\u003cb\\u003e\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e\\u003c/b\\u003e\\u003c/sup\\u003e Widely regarded as a well-established tool in frailty assessment, the FFI offers a standardized framework with demonstrated accuracy, both immediate and predictive, in identifying frail individuals. Additionally, it identifies an intermediate stage, effectively pinpointing individuals at heightened risk of developing frailty. However, while the FFI is well established and cost-effective, its administration can be burdensome and time-consuming, particularly due to the requirement of measuring hand grip strength using a dynamometer. In contrast, the FS presents a more streamlined approach, comprising just five components easily administered in a clinical setting. Thus, evaluating the FS within our IBD cohort becomes pivotal, potentially providing a valuable resource to identify frailty or heightened risk of frailty development among IBD patients in the future.\\u003c/p\\u003e \\u003cp\\u003eGiven the increasing number of aging population and life expectancy, the number of older adults with IBD is rising. In 2018, The US Centers for Disease Control (CDC) reported that 0.40% and 0.64% of 25.1\\u0026nbsp;million of population aged ≥ 67 years had received a diagnosis of either CD or US.\\u003csup\\u003e\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e\\u003c/sup\\u003e Previous studies showed frailty is associated with aging.\\u003csup\\u003e\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e\\u003c/sup\\u003e Older adults with IBD have a worse disease and treatment-related outcomes than younger adults with IBD. There are several changes to the immune system that occur with age as the proliferation rate of B and T cells falls off with higher levels of apoptosis, a proinflammatory cascade eventually generated.\\u003csup\\u003e\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e\\u003c/sup\\u003e In our study focusing on IBD patients, there is no association found between age and the presence of frailty, despite our study having about a quarter of patients above the age of 60. This is possibly because those afflicted with IBD may be at an increased risk for frailty across all age groups given the chronic and relapsing nature of the disease, which is often associated with significant protein malnutrition, repeated use of corticosteroids, and recurrent hospitalizations and surgeries that can lead to physical deconditioning. In addition, CD-related complications can include strictures and intra-abdominal fistulas. Together, these disease manifestations and related symptoms can lead to decreased food intake, impaired absorption of nutrients, and protein-losing enteropathy. Those afflicted with IBD are at increased risk for significant malnutrition and malnutrition is strongly associated with frailty. This may explain the significant correlation found in the frail group with low albumin, creatinine, and HGB.\\u003c/p\\u003e \\u003cp\\u003eOur study's primary strength lies in its administration of two distinct frailty scales within a cohort of IBD patients, successfully evaluating the FS by demonstrating its strong correlation with the established FFI effectively categorizing patients into non-frail, pre-frail, and frail groups. Unlike previous studies, we avoided reliance on databases with hospital codes, mitigating the risk of misclassification. Furthermore, our inclusion of the entire spectrum of IBD patients, irrespective of disease severity or age, provides a more accurate representation of real-world frailty prevalence. Nonetheless, our study faces limitations. The relatively small cohort size hindered robust subgroup analysis, underscoring the need for larger cohorts to achieve sufficient statistical power. This limited our ability to also conduct a multivariate analysis. The educational status of the patients was not considered in the questionnaire. While we utilized the established FFI to minimize information bias in our patient-directed survey, inherent selection bias may have influenced participation, potentially skewing the representation of frailty risk levels among participants.\\u003c/p\\u003e\"},{\"header\":\"CONCLUSIONS AND FUTURE DIRECTIONS\",\"content\":\"\\u003cp\\u003eGiven the minimal literature examining frailty in the IBD population, this study fills a gap in the medical literature. Furthermore, it can lay the groundwork for future research regarding this vulnerable population, including work examining health outcomes for those with IBD and frailty, and understanding ways to prevent or treat frailty. Frailty and pre-frailty are common in the IBD population but were not associated with older age. We found that the FRAIL scale had an excellent correlation to the FFI. Given its ease of use and the absence of physical measurements, it can be employed widely to identify frailty in those with IBD. Future research should incorporate multivariable regression modeling to clarify independent risk factors for frailty, with inclusion of validated frailty measures, focusing on the implications in IBD patients.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e\\u003cu\\u003eAcknowledgments\\u003c/u\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNone\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cu\\u003eFunding\\u003c/u\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNone\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cu\\u003eDisclosure of conflict of interest\\u003c/u\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eJB: None\\u003c/p\\u003e\\n\\u003cp\\u003eJE: None\\u003c/p\\u003e\\n\\u003cp\\u003eHE: None\\u003c/p\\u003e\\n\\u003cp\\u003eSA: None\\u003c/p\\u003e\\n\\u003cp\\u003eMC: None\\u003c/p\\u003e\\n\\u003cp\\u003eDD: None\\u003c/p\\u003e\\n\\u003cp\\u003eJS: None\\u003c/p\\u003e\\n\\u003cp\\u003eYS: None\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cu\\u003eConference submissions\\u003c/u\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNo previous conference presentations\\u003c/p\\u003e\\n\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eJB: Formulated the idea, drafted the manuscriptJE: Collected patient dataHE: Collected patient dataSA: Statistical analysisMC: Edited the manuscriptDD: Edited the manuscript, Statistical analysisJS: Edited the manuscript, Statistical analysisYS: Formulated the idea, collected patient data, revised manuscript\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eAlatab S, Sepanlou SG, Ikuta K, \\u003cem\\u003eet al\\u003c/em\\u003e. The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990\\u0026ndash;2017: a systematic analysis for the global burden of disease study 2017. Lancet Gastroenterol Hepatol 2020; 5: 17\\u0026ndash;30.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eProietti M, Cesari M. Frailty: What Is It? Adv Exp Med Biol. 2020;1216:1\\u0026ndash;7. doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/978-3-030-33330-0_1\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/978-3-030-33330-0_1\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. PMID: 31894541.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eQian AS, Nguyen NH, Elia J, \\u003cem\\u003eet al\\u003c/em\\u003e. 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Epub ahead of print 1 May 2021. DOI: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s10620-021-06990-8\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s10620-021-06990-8\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCohan JN, Bacchetti P, Varma MG, \\u003cem\\u003eet al\\u003c/em\\u003e. Outcomes after ileoanal pouch surgery in frail and older adults. J Surg Res 2015; 198: 327\\u0026ndash;333.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKochar B, Cai W, Cagan A, Ananthakrishnan AN. Frailty is independently associated with mortality in 11 001 patients with inflammatory bowel diseases. Aliment PharmacolTher. 2020;52:311\\u0026ndash;318\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFaye AS, Wen T, Soroush A, Ananthakrishnan AN, Ungaro R, Lawlor G, et al. Increasing prevalence of frailty and its association with readmission and mortality among hospitalized patients with IBD. Dig Dis Sci. (Epub ahead of print). doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1007/s10620-020-06746-w\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s10620-020-06746-w\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAsscher VER, Waars SN, van der Meulen-de Jong AE, Stuyt RJL, Baven-Pronk AMC, van der Marel S, Jacobs RJ, Haans JJL, Meijer LJ, Klijnsma-Slagboom JD, Duin MH, Peters MER, Lee-Kong FVYL, Provoost NE, Tijdeman F, van Dijk KT, Wieland MWM, Verstegen MGM, van der Meijs ME, Maan ADI, van Deudekom FJ, Mooijaart SP, Maljaars PWJ. Deficits in Geriatric Assessment Associate With Disease Activity and Burden in Older Patients With Inflammatory Bowel Disease. Clin Gastroenterol Hepatol. 2022;20(5):e1006-e1021. doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.cgh.2021.06.015\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.cgh.2021.06.015\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. Epub 2021 Jun 19. Erratum in: Clin Gastroenterol Hepatol. 2023;21(13):3466. doi: 10.1016/j.cgh.2023.08.018. PMID: 34153476.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDahlhamer J, Zammitti E, Ward B, \\u003cem\\u003eet al\\u003c/em\\u003e. Prevalence of inflammatory bowel disease among adults aged ⩾18 years - United States, 2015. MMWR Morb Mortal Wkly Rep 2016; 65: 1166\\u0026ndash;1169.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMontecino-Rodriguez E, Berent-Maoz B and Dorshkind K. Causes, consequences, and reversal of immune system aging. J Clin Invest 2013; 123: 958\\u0026ndash;965.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003eTable 1- Baseline demographics of the entire cohort (n=209)\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 67.6302%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCharacteristic\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 22.2542%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eValue\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 67.6302%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAge in years (median)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 22.2542%;\\\"\\u003e\\n \\u003cp\\u003e44 (18-89)\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;IQR: 29\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 67.6302%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSex (n; %)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Female\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Male\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 22.2542%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;112; 53.5\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;97; 46.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 67.6302%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eRace (n; %)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; White\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Black\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Asian\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Hispanic\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Other/Unknown\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 22.2542%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;162; 77.5\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;10; 4.7\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;2; 1\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;20; 9.5\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;15; 7.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 67.6302%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBMI (mean)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 22.2542%;\\\"\\u003e\\n \\u003cp\\u003e27.09\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 67.6302%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDiagnosis (n; %)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Ulcerative colitis\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Crohn\\u0026rsquo;s disease\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Indeterminate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 22.2542%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;79; 37.7\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;113; 54\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;17; 8.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 67.6302%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDisease location (n;%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Colon (UC + CD)\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Small bowel\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Ileocolonic\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Upper GI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 22.2542%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;113; 54\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;33; 15.8\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;61; 29.1\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;1; 0.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 67.6302%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCurrent IBD medications (n;%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Vedolizumab\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Mesalamine\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Adalimumab\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Ustekinumab\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Infliximab\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Combination therapy\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Prednisone\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Other\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; No treatment\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 22.2542%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;33; 15.7\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;32; 15.3\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;29; 13.8\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;26; 12.4\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;24; 11.4\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;8; 3.8\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;8; 3.8\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;32; 15.3\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;17; 8.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 67.6302%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePrimary sclerosing cholangitis (n;%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; No\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026middot; Yes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 22.2542%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;198; 94.7\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;6; 5.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cu\\u003eTable.2 Unadjusted Comparisons for Non-frail versus pre-frail vs Frail patients\\u003c/u\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"587\\\" style=\\\"margin-right: calc(1%); width: 99%;\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eVariable\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNon-Frail\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;(n= 77)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePre-Frail\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;(n=106)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFrail\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;(n=26)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003ep-value*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003eAge\\u003c/p\\u003e\\n \\u003cp\\u003e(mean \\u003cu\\u003e+\\u003c/u\\u003e SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003e42.4 \\u003cu\\u003e+\\u003c/u\\u003e 16.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003e48.5 \\u003cu\\u003e+\\u003c/u\\u003e 18.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003e46.2 \\u003cu\\u003e+\\u003c/u\\u003e 22.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003e.08\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003eGender Assigned at Birth\\u003c/p\\u003e\\n \\u003cp\\u003e(n,%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003e41 female (36.6%)\\u003c/p\\u003e\\n \\u003cp\\u003e36 male (37.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003e56 female (50%)\\u003c/p\\u003e\\n \\u003cp\\u003e50 male (51.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003e15 female (13.4%)\\u003c/p\\u003e\\n \\u003cp\\u003e11 male (11.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003e.84\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003eCurrent Weight\\u003c/p\\u003e\\n \\u003cp\\u003e(mean \\u003cu\\u003e+\\u003c/u\\u003e SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003e174.4 \\u003cu\\u003e+\\u003c/u\\u003e 42.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003e175.8 \\u003cu\\u003e+\\u003c/u\\u003e 42.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003e150.4 \\u003cu\\u003e+\\u003c/u\\u003e 46.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003e.04\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003eSmoking Status\\u003c/p\\u003e\\n \\u003cp\\u003e(n,%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003eCurrent: 4 (5.2%)\\u003c/p\\u003e\\n \\u003cp\\u003ePrior: 18 (23.3%)\\u003c/p\\u003e\\n \\u003cp\\u003eNever: 55 (71.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003eCurrent: 13 (12.3%)\\u003c/p\\u003e\\n \\u003cp\\u003ePrior: 38 (35.8%)\\u003c/p\\u003e\\n \\u003cp\\u003eNever: 55 (51.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003eCurrent: 2 (7.7%)\\u003c/p\\u003e\\n \\u003cp\\u003ePrior: 6 (23%)\\u003c/p\\u003e\\n \\u003cp\\u003eNever: 18 (69.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003e.10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003eDiagnosis\\u003c/p\\u003e\\n \\u003cp\\u003e(n,%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003eCrohn\\u0026rsquo;s Disease: 40 (52%)\\u003c/p\\u003e\\n \\u003cp\\u003eUlcerative colitis: 28 (35.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003eCrohn\\u0026rsquo;s Disease: 65 (57.5%)\\u003c/p\\u003e\\n \\u003cp\\u003eUlcerative colitis: 36 (46.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003eCrohn\\u0026rsquo;s Disease: 8 (7.1%)\\u003c/p\\u003e\\n \\u003cp\\u003eUlcerative colitis: 15 (17.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003e.02\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003eDuration (Months)\\u003c/p\\u003e\\n \\u003cp\\u003e(median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003e84 (2 \\u0026ndash; 720)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003e96 (0 \\u0026ndash; 612)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003e78 (0 \\u0026ndash; 624)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003e.62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003eDisease Activity\\u003c/p\\u003e\\n \\u003cp\\u003e(n,%)\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;(*missing data for 15 patients)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003eMild: 30 (42.9%)\\u003c/p\\u003e\\n \\u003cp\\u003eModerate: 14 (23.35)\\u003c/p\\u003e\\n \\u003cp\\u003eSevere: 2 (16.7%)\\u003c/p\\u003e\\n \\u003cp\\u003eInactive: 28 (56%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003eMild: 35 (50%)\\u003c/p\\u003e\\n \\u003cp\\u003eModerate: 37 (61.7%)\\u003c/p\\u003e\\n \\u003cp\\u003eSevere: 4 (33.3%)\\u003c/p\\u003e\\n \\u003cp\\u003eInactive: 20 (40%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003eMild: 5 (7.1%)\\u003c/p\\u003e\\n \\u003cp\\u003eModerate: 9 (15%)\\u003c/p\\u003e\\n \\u003cp\\u003eSevere: 7 (50%)\\u003c/p\\u003e\\n \\u003cp\\u003eInactive: 3 (4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt; .001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003eIBD Arthritis\\u003c/p\\u003e\\n \\u003cp\\u003e(n,%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003eYes: 21 (27.2%)\\u003c/p\\u003e\\n \\u003cp\\u003eNo: 56 (72.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003eYes: 42 (39.6%)\\u003c/p\\u003e\\n \\u003cp\\u003eNo: 64 (60.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003eYes: 12 (46.2%)\\u003c/p\\u003e\\n \\u003cp\\u003eNo: 14 (53.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003e.06\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003eConcomitant Depression or Anxiety\\u003c/p\\u003e\\n \\u003cp\\u003e(n,%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003eYes to one or both: 19 (28.4%)\\u003c/p\\u003e\\n \\u003cp\\u003eNo to both: 58 (42.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003eYes to one or both: 40 (59.7%)\\u003c/p\\u003e\\n \\u003cp\\u003eNo to both: 66 (46%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003eYes to one or both: 8 (11.9%)\\u003c/p\\u003e\\n \\u003cp\\u003eNo to both: 18(11.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003e.14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003eSurgical History\\u003c/p\\u003e\\n \\u003cp\\u003e(n,%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003eNone: 58 (75.3%)\\u003c/p\\u003e\\n \\u003cp\\u003eSmall bowel resection: 2 (2.5%)\\u003c/p\\u003e\\n \\u003cp\\u003eColonic resection: 9 (11.7%)\\u003c/p\\u003e\\n \\u003cp\\u003eIleocolonic resection: 8 (10.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003eNone: 73 (68.9%)\\u003c/p\\u003e\\n \\u003cp\\u003eSmall bowel resection: 7 (6.7%)\\u003c/p\\u003e\\n \\u003cp\\u003eColonic resection: 13 (12.2%)\\u003c/p\\u003e\\n \\u003cp\\u003eIleocolonic resection: 13 (12.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003eNone: 18 (69.2%)\\u003c/p\\u003e\\n \\u003cp\\u003eSmall bowel resection: 0\\u003c/p\\u003e\\n \\u003cp\\u003eColonic resection: 3 (11.5%)\\u003c/p\\u003e\\n \\u003cp\\u003eIleocolonic resection: 5 (19.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003e.60\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003eOsteoporosis or Osteopenia\\u003c/p\\u003e\\n \\u003cp\\u003e(n,%)\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;(*missing data for 132 patients)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003eNone: 16 (30.8%)\\u003c/p\\u003e\\n \\u003cp\\u003eOsteopenia: 8 (50%)\\u003c/p\\u003e\\n \\u003cp\\u003eOsteoporosis: 3 (33.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003eNone: 31 (59.6%)\\u003c/p\\u003e\\n \\u003cp\\u003eOsteopenia: 7 (43.8%)\\u003c/p\\u003e\\n \\u003cp\\u003eOsteoporosis: 4 (44.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003eNone: 5 (9.6%)\\u003c/p\\u003e\\n \\u003cp\\u003eOsteopenia: 1 (6.3%)\\u003c/p\\u003e\\n \\u003cp\\u003eOsteoporosis: 2 (22.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003e.47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003eVitamin D (ng/mL)\\u003c/p\\u003e\\n \\u003cp\\u003e(median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003e30.8 (8.5 \\u0026ndash; 59.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003e29 (0 \\u0026ndash; 88)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003e31 (7.1 \\u0026ndash; 55.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003e.48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003eHGB (g/dL)\\u003c/p\\u003e\\n \\u003cp\\u003e(median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003e13.4 (9.5 \\u0026ndash; 16.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003e13.2 (7.1 \\u0026ndash; 17.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003e11.2 (8.3 \\u0026ndash; 14.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt; .001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003eFerritin (ng/mL)\\u003c/p\\u003e\\n \\u003cp\\u003e(median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003e47 (4 \\u0026ndash; 1130)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003e51 (3 \\u0026ndash; 346)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003e96 (4 \\u0026ndash; 2392)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003e.07\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003eFecal Calprotectin (mcg/g)\\u003c/p\\u003e\\n \\u003cp\\u003e(median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003e171 (10 \\u0026ndash; 28151)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003e194.5 (16 \\u0026ndash; 9298)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003e402.5 (20 \\u0026ndash; 6454)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003e.43\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003eCRP (mg/L)\\u003c/p\\u003e\\n \\u003cp\\u003e(median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003e4 (.90 \\u0026ndash; 90)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003e5.75 (.50 \\u0026ndash; 122)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003e9.8 (3 \\u0026ndash; 102.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003e.07\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003eBUN (mg/dL)\\u003c/p\\u003e\\n \\u003cp\\u003e(median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003e12 (5 \\u0026ndash; 27)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003e12 (4 \\u0026ndash; 27)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003e12.5 (4 \\u0026ndash; 25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003e.99\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003eCr (mg/dL)\\u003c/p\\u003e\\n \\u003cp\\u003e(median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003e.84 (.53 \\u0026ndash; 1.87)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003e.81 (.29 \\u0026ndash; 2.34)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003e.70 (.38 \\u0026ndash; 1.17)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003e.05\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 26.6751%;\\\"\\u003e\\n \\u003cp\\u003eAlbumin (g/dL)\\u003c/p\\u003e\\n \\u003cp\\u003e(median, range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.9747%;\\\"\\u003e\\n \\u003cp\\u003e3.8 (1.3 \\u0026ndash; 4.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19.2636%;\\\"\\u003e\\n \\u003cp\\u003e3.6 (2.3 \\u0026ndash; 5.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 17.9836%;\\\"\\u003e\\n \\u003cp\\u003e3.0 (1.3 \\u0026ndash; 4.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15.9503%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e* Based on separate chi-square tests for categorical variables and one-way analysis of variance (ANOVA) or Kruskal Wallis tests for normally distributed and continuous variables, respectively\\u003c/p\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"digestive-diseases-and-sciences\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"ddsj\",\"sideBox\":\"Learn more about [Digestive Diseases and Sciences](http://link.springer.com/journal/10620)\",\"snPcode\":\"10620\",\"submissionUrl\":\"https://submission.nature.com/new-submission/10620/3\",\"title\":\"Digestive Diseases and Sciences\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false},\"keywords\":\"Frailty, Inflammatory bowel disease (IBD), FRAIL Scale (FS), Fried Frailty Index (FFI), prevalence\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-5815707/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-5815707/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eInflammatory bowel disease (IBD) predisposes individuals to frailty, linked with adverse outcomes. While the Fried Frailty Index (FFI) is a well-established phenotypic tool to assess frailty, its administration is cumbersome. The FRAIL scale, simpler but not widely used in IBD patients, presents an alternative. We aimed to assess the prevalence of frailty and compare the FRAIL scale with the FFI.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eTwo hundred and nine confirmed IBD patients underwent assessment using both the FFI and the FRAIL scale. Patients were categorized as non-frail, pre-frail, or frail. Pearson coefficients evaluated correlation, and unadjusted analyses assessed frailty risk factors. ROC curve analysis evaluated the FRAIL scale.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eAmong participants (53.5% female, median age 44), 37% were non-frail, 50% pre-frail, and 13% frail. The FRAIL scale exhibited strong correlation with the FFI for all three categories. Age showed no significant association with frailty. Frail individuals displayed higher inflammatory markers and more severe clinical disease, with frailty more prevalent in UC than CD patients. Frail individuals also exhibited lower hemoglobin, creatinine, and albumin levels.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eFrailty and pre-frailty are prevalent in the IBD population, not necessarily linked with older age. The FRAIL scale demonstrated excellent correlation with the FFI, offering a practical tool for identifying frailty in IBD without physical measurements. Future studies should explore multivariable models incorporating frailty risk factors and interventions to mitigate adverse outcomes in the IBD population.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Frailty Prevalence And Evaluation Of The FRAIL Scale Questionnaire In Patients with Inflammatory Bowel Disease\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-01-17 13:29:19\",\"doi\":\"10.21203/rs.3.rs-5815707/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-01-31T18:07:35+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-01-31T01:56:37+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-01-22T20:11:36+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"27813301378161221476305510766592018170\",\"date\":\"2025-01-21T22:19:45+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"220478966535888035242877606941621349601\",\"date\":\"2025-01-20T05:30:25+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-01-15T20:43:19+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-01-14T20:44:26+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-01-14T10:53:38+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Digestive Diseases and Sciences\",\"date\":\"2025-01-13T00:09:46+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"digestive-diseases-and-sciences\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"ddsj\",\"sideBox\":\"Learn more about [Digestive Diseases and Sciences](http://link.springer.com/journal/10620)\",\"snPcode\":\"10620\",\"submissionUrl\":\"https://submission.nature.com/new-submission/10620/3\",\"title\":\"Digestive Diseases and Sciences\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false}}],\"origin\":\"\",\"ownerIdentity\":\"6bb2b985-5d41-4c64-b4ec-1679c2ee7a4f\",\"owner\":[],\"postedDate\":\"January 17th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-05-05T15:59:41+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-5815707\",\"link\":\"https://doi.org/10.1007/s10620-025-09073-0\",\"journal\":{\"identity\":\"digestive-diseases-and-sciences\",\"isVorOnly\":false,\"title\":\"Digestive Diseases and Sciences\"},\"publishedOn\":\"2025-04-29 15:57:15\",\"publishedOnDateReadable\":\"April 29th, 2025\"},\"versionCreatedAt\":\"2025-01-17 13:29:19\",\"video\":\"\",\"vorDoi\":\"10.1007/s10620-025-09073-0\",\"vorDoiUrl\":\"https://doi.org/10.1007/s10620-025-09073-0\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-5815707\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-5815707\",\"identity\":\"rs-5815707\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}