{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T05:10:37Z","timestamp":1788844237976,"version":"build-2803163510"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with inflammatory bowel disease (IBD) frequently face high nutritional risk, persistent intestinal inflammation, and a high prevalence of comorbid depression. Dysregulation of the gut\u2013brain axis is hypothesized to mediate the association between nutritional status and quality of life (QOL). However, the serial mediating roles of fecal calprotectin (FC) and depression in this pathway remain unclear. This study aimed to examine this serial mediation and provide evidence for developing integrated care models centered on nutritional management to modulate inflammation, manage psychological complications, and improve patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study enrolled 327 IBD patients from four tertiary hospitals in Southwest China. Nutritional risk, depressive symptoms, and QOL were assessed using the Nutritional Risk Screening 2002 (NRS2002), the Patient Health Questionnaire-9 (PHQ-9), and the Inflammatory Bowel Disease Questionnaire (IBDQ), respectively. FC levels were measured using an enzyme-linked immunosorbent assay (ELISA). The serial mediating effects were examined using Model 6 of the SPSS PROCESS macro with 5,000 bootstrap resamples.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nutritional risk was positively correlated with FC (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f1.866,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), which in turn was positively associated with depression (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.021,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). Depression was negatively associated with QOL (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f\u22121.417,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). The total indirect effect accounted for 43.86% of the total association and consisted of contributions from three pathways. Of these three pathways, the independent mediating effect of depression alone contributed 8.55%, and the serial mediating effect of FC and depression accounted for 6.36%; both were statistically significant. The remaining portion of the total indirect effect was attributable to the non-significant pathway via FC alone.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Nutritional risk is associated with impaired QOL in IBD patients both directly and indirectly through a sequential pathway involving intestinal inflammation (FC) and depression. These findings suggest a shift in clinical practice toward an integrated care model anchored in proactive nutritional management, coupled with concurrent monitoring of inflammation and screening for depression. This model presents a targeted strategy for modulating inflammation, managing comorbidities, and ultimately improving symptoms and QOL in IBD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1891598","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T04:26:38Z","timestamp":1788841598000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The role of nutritional risk in inflammatory bowel disease: a serial mediation model through fecal calprotectin and depression leading to impaired quality of life"],"prefix":"10.3389","volume":"13","author":[{"given":"Jiamei","family":"Shen","sequence":"first","affiliation":[{"name":"Department of Nursing, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiqi","family":"Xie","sequence":"additional","affiliation":[{"name":"Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nursing, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Nursing, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huilin","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Nursing, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianrong","family":"Zhou","sequence":"additional","affiliation":[{"name":"Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1136\/gutjnl-2024-334395","article-title":"British society of gastroenterology guidelines on inflammatory bowel disease in adults: 2025","volume":"74","author":"Moran","year":"2025","journal-title":"Gut"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1053\/j.gastro.2013.04.007","article-title":"Incidence and phenotype of inflammatory bowel disease based on results from the Asia-Pacific Crohn's and colitis epidemiology study","volume":"145","author":"Siew","year":"2013","journal-title":"Gastroenterology"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1016\/j.cgh.2024.04.042","article-title":"The IBD clinic of tomorrow: holistic, patient-centric, and value-based care","volume":"23","author":"Click","year":"2025","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1016\/S2468-1253(23)00011-0","article-title":"Inflammation and malnutrition in inflammatory bowel disease","volume":"8","author":"Massironi","year":"2023","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1016\/j.clnu.2022.12.004","article-title":"ESPEN guideline on clinical nutrition in inflammatory bowel disease","volume":"42","author":"Bischoff","year":"2023","journal-title":"Clin Nutr"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"S39","DOI":"10.14309\/01.ajg.0001172988.11170.1f","article-title":"Severity-dependent impact of protein-energy malnutrition on hospital outcomes in IBD: a nationwide inpatient sample analysis","volume":"120","author":"Raju","year":"2025","journal-title":"Am J Gastroenterol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1126\/science.847460","article-title":"The need for a new medical model: a challenge for biomedicine","volume":"196","author":"Engel","year":"1977","journal-title":"Science"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"624","DOI":"10.7861\/clinmedicine.10-6-624","article-title":"Malnutrition: causes and consequences","volume":"10","author":"Saunders","year":"2010","journal-title":"Clin Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1856","DOI":"10.1002\/med.21893","article-title":"Inflammatory bowel disease biomarkers","volume":"42","author":"Liu","year":"2022","journal-title":"Med Res Rev"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1038\/s41575-022-00634-6","article-title":"Depression and anxiety in inflammatory bowel disease: epidemiology, mechanisms and treatment","volume":"19","author":"Bisgaard","year":"2022","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"108831","DOI":"10.1016\/j.pharmthera.2025.108831","article-title":"Inflammatory bowel disease and neuropsychiatric disorders: mechanisms and emerging therapeutics targeting the microbiota-gut-brain axis","volume":"269","author":"Petracco","year":"2025","journal-title":"Pharmacol Ther"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"11","DOI":"10.20524\/aog.2026.1024","article-title":"The impact of depression, anxiety and stress on self-care in inflammatory bowel disease: a systematic review","volume":"39","author":"Amato","year":"2026","journal-title":"Ann Gastroenterol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1186\/s40337-023-00936-3","article-title":"Risk of avoidant\/restrictive food intake disorder in patients with inflammatory bowel disease: predictive value of disease phenotype, disease activity and food literacy","volume":"11","author":"Yin","year":"2023","journal-title":"J Eat Disord"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"goae19","DOI":"10.1093\/gastro\/goae019","article-title":"Common gastrointestinal symptoms and their impact on psychological state and quality of life in patients with inflammatory bowel disease: a cross-sectional multicenter study in China","volume":"12","author":"Wang","year":"2024","journal-title":"Gastroenterol Rep"},{"key":"ref15","doi-asserted-by":"crossref","DOI":"10.2307\/3538355","volume-title":"The Advanced Theory of Statistics","author":"Kendall","year":"1961"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"jjaf55","DOI":"10.1093\/ecco-jcc\/jjaf055","article-title":"The mediating role of psychological inflexibility on internalized stigma and patient outcomes in a sample of adults with inflammatory bowel disease","volume":"19","author":"Reynolds","year":"2025","journal-title":"J Crohns Colitis"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1177\/00131644211003261","article-title":"Sample size requirements for simple and complex mediation models","volume":"82","author":"Sim","year":"2022","journal-title":"Educ Psychol Meas"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1007\/s00535-022-01862-y","article-title":"A review on the current status and definitions of activity indices in inflammatory bowel disease: how to use indices for precise evaluation","volume":"57","author":"Kishi","year":"2022","journal-title":"J Gastroenterol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/s0261-5614(02)00214-5","article-title":"Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials","volume":"22","author":"Kondrup","year":"2003","journal-title":"Clin Nutr"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1059191","DOI":"10.3389\/fnut.2022.1059191","article-title":"GLIM criteria using NRS-2002 and MUST as the first step adequately diagnose the malnutrition in Crohn's disease inpatients: a retrospective study","volume":"9","author":"Wang","year":"2023","journal-title":"Front Nutr"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1567","DOI":"10.1093\/ibd\/izae180","article-title":"Psychological distress is associated with inflammatory bowel disease manifestation and mucosal inflammation","volume":"31","author":"Dragasevic","year":"2025","journal-title":"Inflamm Bowel Dis"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1007318","DOI":"10.3389\/fpsyt.2022.1007318","article-title":"The impact of family function on mental health status in patient with inflammatory bowel disease: the mediating role of self-esteem","volume":"13","author":"Wu","year":"2022","journal-title":"Front Psych"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1016\/S0016-5085(89)80080-0","article-title":"A new measure of health status for clinical trials in inflammatory bowel disease","volume":"96","author":"Guyatt","year":"1989","journal-title":"Gastroenterology"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1046\/j.1365-2036.2003.01489.x","article-title":"Quality of life in Chinese patients with inflammatory bowel disease: validation of the Chinese translation of the inflammatory bowel disease questionnaire","volume":"17","author":"Leong","year":"2003","journal-title":"Aliment Pharmacol Ther"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"jjaf122","DOI":"10.1093\/ecco-jcc\/jjaf122","article-title":"European Crohn's and colitis organization consensus on dietary management of inflammatory bowel disease","volume":"19","author":"Svolos","year":"2025","journal-title":"J Crohns Colitis"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1053\/j.gastro.2025.02.036","article-title":"Perforin generated by CD8(+) T cells exacerbates inflammatory bowel disease-induced depression by promoting CXCL9 production in intestinal epithelial cells","volume":"169","author":"Huang","year":"2025","journal-title":"Gastroenterology"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"14879","DOI":"10.1021\/jacs.5c05127","article-title":"Correction to \"unusual phospholipids from Morganella morganii linked to depression\"","volume":"147","author":"Bang","year":"2025","journal-title":"J Am Chem Soc"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1093\/ecco-jcc\/jjac161","article-title":"Disease activity and health-related quality of life relationships with work productivity in patients with ulcerative colitis in OCTAVE induction 1 and 2 and OCTAVE sustain","volume":"17","author":"Targownik","year":"2023","journal-title":"J Crohns Colitis"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"2063","DOI":"10.1136\/gutjnl-2016-312307","article-title":"Discrepancies between patient-reported outcomes, and endoscopic and histological appearance in UC","volume":"66","author":"Colombel","year":"2017","journal-title":"Gut"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"2357738","DOI":"10.1080\/07853890.2024.2357738","article-title":"Inflammatory biomarkers and psychological variables to assess quality of life in patients with inflammatory bowel disease: a cross-sectional study","volume":"56","author":"Gonz\u00e1lez-Moret","year":"2024","journal-title":"Ann Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"304","DOI":"10.14309\/ajg.0000000000002063","article-title":"Characteristics and effect of anxiety and depression trajectories in inflammatory bowel disease","volume":"118","author":"Fairbrass","year":"2023","journal-title":"Am J Gastroenterol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1016\/S2468-1253(21)00014-5","article-title":"Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis lancet","volume":"6","author":"Barberio","year":"2021","journal-title":"Gastroenterol Hepatol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1780","DOI":"10.1136\/gutjnl-2021-325985","article-title":"Bidirectional brain-gut axis effects influence mood and prognosis in IBD: a systematic review and meta-analysis","volume":"71","author":"Fairbrass","year":"2022","journal-title":"Gut"},{"key":"ref34","first-page":"1581848","article-title":"Gut microbiota, nutrients, and depression","volume-title":"Front Nutr","author":"Qiao","year":"2025"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1038\/s41575-023-00890-0","article-title":"Gastrointestinal and brain barriers: unlocking gates of communication across the microbiota-gut-brain axis","volume":"21","author":"Aburto","year":"2024","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"104910","DOI":"10.1016\/j.ebiom.2023.104910","article-title":"Do interventions for mood improve inflammatory biomarkers in inflammatory bowel disease? a systematic review and meta-analysis","volume":"100","author":"Seaton","year":"2024","journal-title":"EBioMedicine"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1891598\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T04:26:39Z","timestamp":1788841599000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1891598\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,8]]},"references-count":36,"alternative-id":["10.3389\/fnut.2026.1891598"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1891598","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,8]]},"article-number":"1891598"}}