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Boctor DL, Fenton TR, Goulet O, Lambe C. Pediatric Intestinal Failure Associated Eating Disorder: An Overview of the Importance of Oral Feeding in a Population at Risk for Feeding Difficulties. Gastroenterol Clin North Am 2024; 53:309-327. [PMID: 38719381 DOI: 10.1016/j.gtc.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Achieving feeding skills and food acceptance is a multi-layered process. In pediatric intestinal failure (PIF), oral feeding is important for feeding skills development, physiologic adaptation, quality of life and the prevention of eating disorders. In PIF, risk factors for feeding difficulties are common and early data suggests that feeding difficulties are prevalent. There is a unique paradigm for the feeding challenges in PIF. Conventional definitions of eating disorders have limited application in this context. A pediatric intestinal failure associated eating disorder (IFAED) definition that includes feeding/eating skills dysfunction, psychosocial dysfunction, and the influence on weaning nutrition support is proposed.
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Affiliation(s)
- Dana Liza Boctor
- Alberta Children's Hospital, Section of Gastroenterology, Hepatology and Nutrition, University of Calgary, Calgary, 28 Oki Drive NW, Calgary, Alberta T3B-6A8, Canada.
| | - Tanis R Fenton
- Department of Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 3rd Floor, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Olivier Goulet
- Department of Pediatric Gastroenterology-Hepatology-Nutrition, National Reference Center for Rare Digestive Diseases, Pediatric Intestinal Failure Rehabilitation Center, Hôpital Necker-Enfants Malades, Université Paris Cité, 149 Rue de Sèvres, Paris 75015, France
| | - Cecile Lambe
- Department of Pediatric Gastroenterology-Hepatology-Nutrition, National Reference Center for Rare Digestive Diseases, Pediatric Intestinal Failure Rehabilitation Center, Hôpital Necker-Enfants Malades, Université Paris Cité, 149 Rue de Sèvres, Paris 75015, France
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Simons M, Zavala S, Taft T. When dietary modification turns problematic in patients with esophageal conditions. Neurogastroenterol Motil 2024; 36:e14772. [PMID: 38380713 DOI: 10.1111/nmo.14772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Patients with chronic illness affecting the esophagus often modify their eating habits to manage symptoms. Although this begins as a protective strategy, anxiety around eating can become problematic, and lead to poor outcomes. We administered a survey to examine the factors associated with problematic eating behaviors in patients who have reflux and difficulty swallowing (esophageal dysphagia). METHODS In total, 277 adult patients aged above 18 diagnosed with achalasia, eosinophilic esophagitis, and gastroesophageal reflux completed an online survey: (1) demographic and disease information; (2) reflux and dysphagia severity (3) eating behaviors, as measured by a study-specific, modified version of the Eating Disorder Questionnaire (EDE-Q) for patients with esophageal conditions; and (4) Food related quality of life (FRQOL). Descriptive statistics, one-way ANOVA, and Pearson's correlations evaluated the sample data and a hierarchical linear regression evaluated predictors of problematic eating behaviors. KEY RESULTS Problematic eating behaviors were associated with reflux severity, dysphagia severity, symptom anxiety, and hypervigilance, and negatively associated with FRQOL. While reflux and dysphagia severity predicted greater problematic eating, symptom anxiety explained more of these behaviors. Although hypervigilance and anxiety also predicted poorer FRQOL, problematic eating was the largest predictor. CONCLUSION & INFERENCES Problematic eating behaviors are associated with increased symptom severity and symptom anxiety, and diminished FRQoL. Symptom anxiety, rather than symptom severity, appears to be a driving factor in problematic eating behaviors. Interventions aimed at diminishing symptom anxiety may be useful in reducing problematic eating behaviors in patients with gastrointestinal symptoms.
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Affiliation(s)
- Madison Simons
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sonia Zavala
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tiffany Taft
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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3
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Oliveira R, Martins V, de Sousa HT, Roseira J. Food-Related Quality of Life and Its Predictors in Inflammatory Bowel Disease. Dig Dis Sci 2024; 69:1793-1802. [PMID: 38457117 DOI: 10.1007/s10620-024-08333-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is associated with dietary restrictions and food- and drink-driven daily life limitations. Food-related quality of life (FR-QoL) is still an under-addressed issue in IBD. AIM We aimed to study determinants of FR-QoL in an IBD cohort, namely objective measures of disease activity. METHODS A cross-sectional case-control study was conducted in a Tertiary Hospital, including adult patients with IBD (cases) and blood donors or subjects referred for colorectal polypectomies (controls). Participants answered an anonymous multimodal questionnaire including sociodemographic and clinical data, the validated FR-QoL-29, and the SIBDQ tools. Patients' disease activity was previously assessed by a physician using symptom-based scores and biomarkers (Harvey-Bradshaw index, partial Mayo score, fecal calprotectin). RESULTS A total of 239 patients with IBD and 126 controls were included. Patients with active disease had poorer FR-QoL than patients in remission (80.0 [56.0-99.0] vs. 103.5 [81.0-129.9], p < 0.001). Still, patients with IBD had significantly lower FR-QoL compared with controls (99.0 [76.0-126.0] vs. 126.0 [102.8-143.0], p < 0.001), irrespective of disease activity. FR-QoL correlated with health-related quality of life, measured by SIBDQ (r = 0.490, p < 0.001), and was significantly impaired by patients' depressive humor (84.0 [61.0-112.0] vs. 108.0 [88.0-130.5], p < 0.001). Globally, FR-QoL compromise was mostly related to persistent worries about food, concerns about food-related symptoms, and life disruption due to eating and drinking. CONCLUSIONS Patients with IBD showed significant FR-QoL impairment, irrespective of disease type and activity. Related psychosocial factors, such as the patient's affective status and fear around eating, warrant a need for a multidisciplinary approach to IBD, including tailored nutritional counseling.
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Affiliation(s)
- Raquel Oliveira
- Gastroenterology Department, Algarve University Hospital Centre, Estrada do Poço Seco, 8500-338, Portimão, Portugal.
- Algarve Biomedical Centre (ABC), University of the Algarve, Faro, Portugal.
| | - Viviana Martins
- Gastroenterology Department, Algarve University Hospital Centre, Estrada do Poço Seco, 8500-338, Portimão, Portugal
- Algarve Biomedical Centre (ABC), University of the Algarve, Faro, Portugal
| | - Helena Tavares de Sousa
- Gastroenterology Department, Algarve University Hospital Centre, Estrada do Poço Seco, 8500-338, Portimão, Portugal
- Algarve Biomedical Centre (ABC), University of the Algarve, Faro, Portugal
| | - Joana Roseira
- Gastroenterology Department, Algarve University Hospital Centre, Estrada do Poço Seco, 8500-338, Portimão, Portugal
- Algarve Biomedical Centre (ABC), University of the Algarve, Faro, Portugal
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Miglioretto C, Beck E, Lambert K. A scoping review of the dietary information needs of people with inflammatory bowel disease. Nutr Diet 2024; 81:79-93. [PMID: 37806663 DOI: 10.1111/1747-0080.12843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/25/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023]
Abstract
AIMS This review aimed to explore and describe the dietary information needs of individuals with inflammatory bowel disease and sources of information. METHODS A scoping review of English language articles and grey literature, using electronic databases with a predefined search strategy was undertaken. Data were synthesised based on the identified variables (e.g. dietary information needs and sources of dietary information) corresponding to the aims of this review. RESULTS Forty-six studies were included, reporting data from 7557 people with inflammatory bowel disease, of which 58.6% had Crohn's disease and 60.1% were males. Dietary information was rated very important and appeared to be influenced by the disease course. The need to discuss it is heightened at important stages, namely diagnosis and relapse. Dietary information was described broadly and included advice about foods to avoid and dietary advice for symptoms management. No major differences were noted in the dietary information needs of people with Crohn's disease compared to ulcerative colitis. The main sources of dietary information were the gastroenterologist (36%-98%), the internet (9%-60%) and non-dietetic professionals (84.7%). CONCLUSION This review highlights limited literature describing the dietary information needs of people with inflammatory bowel disease. Importantly, the limited access to specialised dietary advice for this cohort is concerning. Future studies are required to explore not only the nuances in the needs of those with active disease and in remission, but to further understand issues of access to specialised dietary advice to provide holistic person-centred care desired by this cohort.
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Affiliation(s)
- Chiara Miglioretto
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Eleanor Beck
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
- School of Health Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
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Yin T, Ye R, Wang Q, Wang L, Xu W, Tu W, Xu G. Difficulties in eating out of home while diagnosed with inflammatory bowel disease: A qualitative interview study from China. PLoS One 2023; 18:e0288908. [PMID: 38051719 DOI: 10.1371/journal.pone.0288908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/06/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Meeting healthy dietary needs while eating out can be a challenging experience for adults with inflammatory bowel disease. This study examined the barriers experienced by adults with inflammatory bowel disease (IBD) when eating out. OBJECTIVE This study aimed to explore the perceptions of people with IBD on eating out barriers. DESIGN A qualitative study among individuals affected by IBD was conducted through semi-structured interviews. RESULTS Sixteen adults from China were diagnosed with IBD between 6 months and 20 years prior to the study. They were recruited from four tertiary care hospitals in Nanjing, China. The participants completed a semi-structured interview between April and September 2022. Self-perceived difficulties with eating and drinking when eating out were varied. After thematic analysis of the data, five main themes emerged: limited access to healthy and hygiene food; no pleasure of food enjoyment; financial strain; not feeling loved, supported or understood; and coping strategies for not meeting demand. CONCLUSIONS This study highlights the various barriers encountered by patients with inflammatory bowel disease when eating out. These findings will help people with IBD to encourage the formation of targeted health and well-being-related interventions. Knowledge of nutrition and diet should be provided in education and training programs administered to IBD.
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Affiliation(s)
- Tingting Yin
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Ran Ye
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Qiuqin Wang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Lulu Wang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenjing Xu
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenjing Tu
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Guihua Xu
- Nanjing University of Chinese Medicine, Nanjing, China
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Staudacher HM, Black CJ, Teasdale SB, Mikocka-Walus A, Keefer L. Irritable bowel syndrome and mental health comorbidity - approach to multidisciplinary management. Nat Rev Gastroenterol Hepatol 2023; 20:582-596. [PMID: 37268741 PMCID: PMC10237074 DOI: 10.1038/s41575-023-00794-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/04/2023]
Abstract
Irritable bowel syndrome (IBS) affects 5-10% of the global population. Up to one-third of people with IBS also experience anxiety or depression. Gastrointestinal and psychological symptoms both drive health-care use in people with IBS, but psychological comorbidity seems to be more important for long-term quality of life. An integrated care approach that addresses gastrointestinal symptoms with nutrition and brain-gut behaviour therapies is considered the gold standard. However, best practice for the treatment of individuals with IBS who have a comorbid psychological condition is unclear. Given the rising prevalence of mental health disorders, discussion of the challenges of implementing therapy for people with IBS and anxiety and depression is critical. In this Review, we draw upon our expertise in gastroenterology, nutrition science and psychology to highlight common challenges that arise when managing patients with IBS and co-occurring anxiety and depression, and provide recommendations for tailoring clinical assessment and treatment. We provide best practice recommendations, including dietary and behavioural interventions that could be applied by non-specialists and clinicians working outside an integrated care model.
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Affiliation(s)
- Heidi M Staudacher
- Food & Mood Centre, IMPACT Institute, Deakin University Geelong, Melbourne, Victoria, Australia.
| | - Christopher J Black
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Scott B Teasdale
- Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Laurie Keefer
- Department of Medicine and Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Weeks I, Abber SR, Thomas JJ, Calabrese S, Kuo B, Staller K, Murray HB. The Intersection of Disorders of Gut-Brain Interaction With Avoidant/Restrictive Food Intake Disorder. J Clin Gastroenterol 2023; 57:651-662. [PMID: 37079861 PMCID: PMC10623385 DOI: 10.1097/mcg.0000000000001853] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
High rates of overlap exist between disorders of gut-brain interaction (DGBI) and eating disorders, for which common interventions conceptually conflict. There is particularly increasing recognition of eating disorders not centered on shape/weight concerns, specifically avoidant/restrictive food intake disorder (ARFID) in gastroenterology treatment settings. The significant comorbidity between DGBI and ARFID highlights its importance, with 13% to 40% of DGBI patients meeting full criteria for or having clinically significant symptoms of ARFID. Notably, exclusion diets may put some patients at risk for developing ARFID and continued food avoidance may perpetuate preexisting ARFID symptoms. In this review, we introduce the provider and researcher to ARFID and describe the possible risk and maintenance pathways between ARFID and DGBI. As DGBI treatment recommendations may put some patients at risk for developing ARFID, we offer recommendations for practical treatment management including evidence-based diet treatments, treatment risk counseling, and routine diet monitoring. When implemented thoughtfully, DGBI and ARFID treatments can be complementary rather than conflicting.
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Affiliation(s)
- Imani Weeks
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
| | - Sophie R. Abber
- Department of Psychology, Florida State University, Tallahassee, FL
| | - Jennifer J. Thomas
- Harvard Medical School, Boston, MA
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Samantha Calabrese
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA
| | - Braden Kuo
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Helen Burton Murray
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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Akturk HK, Snell-Bergeon J, Karakus KE, Shah VN. Assessing the relationship between low-calorie sweetener use and quality of life measures in adults with type 1 diabetes. BMC Endocr Disord 2023; 23:147. [PMID: 37430302 PMCID: PMC10334601 DOI: 10.1186/s12902-023-01399-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND To evaluate use of low-calorie sweeteners (LCS) among adults with type 1 diabetes (T1D) and its impact on quality of life (QOL). METHODS In this single center, cross-sectional survey study with 532 adults with T1D, Food related QOL (FRQOL), LCS specific questionnaire (LCSSQ), Diabetes Self-Management Questionnaire (DSMQ), Food Frequency Questionnaire (FFQ), Audit of Diabetes-Dependent QOL (AddQOL), Type 1 Diabetes and Life (T1DAL) questionnaires were administered through RedCAP, a secure, HIPAA-compliant web-based application. Demographics and scores of adults who used LCS in last month (recent users) and others (non-users) were compared. Results were adjusted for age, sex, diabetes duration and other parameters. RESULTS Of 532 participants (mean age 36 ± 13, 69% female), 99% heard LCS before, 68% used them in the last month, 73% reported better glucose control with LCS use and 63% reported no health concerns about LCS use. Recent LCS users were older and had a longer diabetes duration and more complications (hypertension, or any complication) than non-users. However, A1c, AddQOL, T1DAL, FRQOL scores did not differ significantly between recent LCS users and non-users. DSMQ scores, DSMQ management, diet, health care scores did not differ between two groups; however, recent LCS users had lower physical activity score than non-users (p = 0.001). CONCLUSIONS Most of the adults with T1D have used LCS and perceived that LCS use improved their QOL and glycemic control; however, these were not verified with questionnaires. There was no difference in QOL questionnaires except DSMQ physical activity between recent LCS users and not users with T1D. However, more patients in need to increase their QOL may be using LCS; therefore, associations between the exposure and outcome can be bi-directional.
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Affiliation(s)
- Halis K Akturk
- Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO, USA.
| | | | - Kagan E Karakus
- Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO, USA
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO, USA
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Atkins M, Zar-Kessler C, Madva EN, Staller K, Eddy KT, Thomas JJ, Kuo B, Murray HB. History of trying exclusion diets and association with avoidant/restrictive food intake disorder in neurogastroenterology patients: A retrospective chart review. Neurogastroenterol Motil 2023; 35:e14513. [PMID: 36600490 PMCID: PMC11262773 DOI: 10.1111/nmo.14513] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/19/2022] [Accepted: 11/15/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Exclusion diets for gastrointestinal symptom management have been hypothesized to be a risk factor for avoidant/restrictive food intake disorder (ARFID; a non-body image-based eating disorder). In a retrospective study of pediatric and adult neurogastroenterology patients, we aimed to (1) identify the prevalence and characteristics of an exclusion diet history and (2) evaluate if an exclusion diet history was concurrently associated with the presence of ARFID symptoms. METHODS We conducted a chart review of 539 consecutive referrals (ages 6-90, 69% female) to adult (n = 410; January-December 2016) and pediatric (n = 129; January 2016-December 2018) neurogastroenterology clinics. Masked coders (n = 4) retrospectively applied DSM-5 criteria for ARFID and a separate coder assessed documentation of exclusion diet history. We excluded patients with no documentation of diet in the chart (n = 35) or who were not orally fed (n = 9). RESULTS Of 495 patients included, 194 (39%) had an exclusion diet history, and 118 (24%) had symptoms of ARFID. Of reported diets, dairy-free was the most frequent (45%), followed by gluten-free (36%). Where documented, exclusion diets were self-initiated by patients/parents in 66% of cases, and recommended by gastroenterology providers in 30%. Exclusion diet history was significantly associated with the presence of ARFID symptoms (OR = 3.12[95% CI 1.92-5.14], p < 0.001). CONCLUSIONS History of following an exclusion diet was common and was most often patient-initiated among pediatric and adult neurogastroenterology patients. As patients with self-reported exclusion diet history were over three times as likely to have ARFID symptoms, providers should be cognizant of this potential association when considering dietary interventions.
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Affiliation(s)
- Micaela Atkins
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA 02114
- Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115
| | - Claire Zar-Kessler
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA 02114
- Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115
| | - Elizabeth N. Madva
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA 02114
| | - Kyle Staller
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA 02114
- Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115
| | - Kamryn T. Eddy
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114
| | - Jennifer J. Thomas
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114
| | - Braden Kuo
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA 02114
- Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115
| | - Helen Burton Murray
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA 02114
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10
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Lozano A, López R, Pereira FJ, Blanco Fontao C. Impact of Cooperative Learning and Project-Based Learning through Emotional Intelligence: A Comparison of Methodologies for Implementing SDGs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16977. [PMID: 36554857 PMCID: PMC9778663 DOI: 10.3390/ijerph192416977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/27/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Education for sustainable development (ESD) is a holistic and transformative form of education that seeks action-oriented pedagogy using self-directed learning, participation, and collaboration, among other aspects, and is suitable for developing active methodologies. Since affective-emotional aspects can contribute in the teaching-learning process, this work studies, through a case study, the comparison of the influence of two active methodologies: Cooperative Learning (CL) and Project-Based Learning (PBL) in student emotions and learning processes, as well as their awareness of ESD. For that purpose, a survey was conducted at the fourth secondary level in the science laboratory, subjected to the innovation project e-WORLD, which developed the content of the 7 and 13 Sustainable Development Goals (SDGs) from the 2030 Agenda. Results of ANOVA and Tukey's tests carried out showed that both methodologies improved skills and knowledge related to climate change and energy, and triggered major positive emotions in students. Furthermore, CL allowed students to acquire more individual and group responsibility than communication skills developed with PBL. It is necessary to continue working on the involvement of students in these methodologies in order to improve their social skills and to reveal life changes towards more socio-sustainable ones.
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Affiliation(s)
- Alba Lozano
- Department of Mining, Topography and Structures, Area of Mining Prospecting and Research, University of Leon, 24007 León, Spain
- Department of Mineralogy, Petrology and Applied Geology, Faculty of Earth Sciences, University of Barcelona (UB), Martí Franquès s/n, 08028 Barcelona, Spain
| | - Roberto López
- Department of Applied Chemistry and Physics, Area of Physical Chemistry, University of Leon, 24007 León, Spain
| | - Fernando J. Pereira
- Department of Applied Chemistry and Physics, Area of Analytical Chemistry, University of Leon, 24007 León, Spain
| | - Carolina Blanco Fontao
- Department of General and Specific Didactics and Theory of Education, Area of Didactics of Experimental Sciences, University of Leon, 24007 León, Spain
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11
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Aswani-Omprakash T, Shah ND. Sociocultural Considerations for Food-Related Quality of Life in Inflammatory Bowel Disease. Gastroenterol Clin North Am 2022; 51:885-895. [PMID: 36376002 DOI: 10.1016/j.gtc.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The prevalence of inflammatory bowel disease (IBD) is increasing substantially in non-White races and ethnicities in the United States. As a part of promoting quality of life in patients with IBD, the optimization of food-related quality of life (FRQoL) is also indicated. It is known that the practices of food avoidance and restrictive eating are associated with a reduced FRQoL in IBD. Gaining insight into sociocultural influences on FRQoL will aid in the provision of culturally competent interventions to improve FRQoL in patients with IBD.
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Affiliation(s)
- Tina Aswani-Omprakash
- Mount Sinai Icahn School of Medicine, New York, NY 10029, USA; South Asian IBD Alliance, New York, NY 10021, USA. https://twitter.com/@ownyourcrohns
| | - Neha D Shah
- South Asian IBD Alliance, New York, NY 10021, USA; Colitis and Crohn's Disease Center, University of California, San Francisco, CA 94115, USA; Neha Shah Nutrition, San Francisco, CA 94105, USA.
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12
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Cox SR, Czuber-Dochan W, Wall CL, Clarke H, Drysdale C, Lomer MC, Lindsay JO, Whelan K. Improving Food-Related Quality of Life in Inflammatory Bowel Disease through a Novel Web Resource: A Feasibility Randomised Controlled Trial. Nutrients 2022; 14:nu14204292. [PMID: 36296976 PMCID: PMC9611328 DOI: 10.3390/nu14204292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/05/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
Food-related quality of life (FR-QoL) is impaired in inflammatory bowel disease (IBD) and education and support on food-related issues in IBD is needed. This feasibility trial aimed to investigate the effectiveness and acceptability of a web resource in enhancing FR-QoL in newly diagnosed IBD. Patients diagnosed with Crohn's disease or ulcerative colitis in the preceding 12 months, with an impaired FR-QoL, were recruited and randomised to either receive access to the web resource (covering IBD-specific diet concerns) or no access (control group) for 12 weeks, while receiving usual clinical care. FR-QoL, health-related quality of life, psychological outcomes, and clinical disease activity were assessed. Web resource usage was assessed, and patients' experiences of the web resource were investigated in semi-structured interviews. Of 81 patients screened, 50 participants were randomised, 30 to the web resource and 20 to control. FR-QoL increased more in the web resource (+11.7 SD 18.2) than control group (+1.4 SD 20.4) (p = 0.067), while IBD distress reduced in the web resource (-6.8 SD 26.6) and increased in the control group (+8.3 SD 25.5) (p = 0.052), albeit not statistically significantly. End of trial Crohn's disease clinical activity (PRO-2) was significantly lower in the web resource than control group (p = 0.046). Participants most frequently accessed web resource content discussing dietary management of gut symptoms and in semi-structured interviews, reported the website to contain relevant information. This feasibility study demonstrates potential effectiveness of the web resource on improving FR-QoL and psychological outcomes in IBD. An adequately powered effectiveness RCT is feasible to conduct and is now warranted. NCT03884686.
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Affiliation(s)
- Selina R. Cox
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
| | - Wladyslawa Czuber-Dochan
- Midwifery and Palliative Care, Florence Nightingale Faculty of Nursing, King’s College London, London SE1 8WA, UK
| | - Catherine L. Wall
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
| | - Hazel Clarke
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
| | - Candice Drysdale
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
| | - Miranda C. Lomer
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
- Departments of Gastroenterology and Dietetics, Guy’s & St Thomas NHS Foundation Trust, London SE1 7EH, UK
| | - James O. Lindsay
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - Kevin Whelan
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
- Correspondence:
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13
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Fitzpatrick JA, Melton SL, Yao CK, Gibson PR, Halmos EP. Dietary management of adults with IBD - the emerging role of dietary therapy. Nat Rev Gastroenterol Hepatol 2022; 19:652-669. [PMID: 35577903 DOI: 10.1038/s41575-022-00619-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 02/08/2023]
Abstract
Historically, dietitians played a minor part in the management of inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. Patients were commonly referred for consequences of uncontrolled disease, such as malnutrition and bowel obstruction risk. Today, dietitians are fundamental members of the multidisciplinary IBD team, from educating on the role of diet at diagnosis and throughout the lifespan of a patient with IBD to guiding primary induction therapy. This aspect is reflected in published guidelines for IBD management, which previously placed diet as only a minor factor, but now have diet-specific publications. This Review describes a four-step approach in a dietitian's assessment and management of diet in patients with IBD: (1) identifying and correcting nutritional gaps and dietary imbalances; (2) considering diet to treat active disease with the use of exclusive enteral nutrition (EEN) or emerging diets that could replace EEN; (3) using therapeutic diets to control existing complications of IBD, such as reduced fibre to prevent bowel obstruction in stricturing disease or a fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet to manage co-existing functional gut symptoms; and (4) considering the role of diet in preventing IBD development in high-risk populations.
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Affiliation(s)
- Jessica A Fitzpatrick
- Department of Gastroenterology, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Sarah L Melton
- Department of Gastroenterology, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Chu Kion Yao
- Department of Gastroenterology, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Peter R Gibson
- Department of Gastroenterology, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Emma P Halmos
- Department of Gastroenterology, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia.
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14
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Feeney M, Chur-Hansen A, Mikocka-Walus A. People Living with Inflammatory Bowel Disease Want Multidisciplinary Healthcare: A Qualitative Content Analysis. J Clin Psychol Med Settings 2022; 29:570-577. [PMID: 34185254 DOI: 10.1007/s10880-021-09801-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 12/20/2022]
Abstract
This study reports on the preferences of people with inflammatory bowel disease (IBD) for their healthcare. Overall, 477 people with IBD responded to an open-ended survey question within a larger study. We qualitatively content-analysed these responses with open coding using NVivo. Respondents expressed a desire for (1) better communication, (2) multidisciplinary care, (3) better treatment, services and specialist care, (4) whole person care, (5) health promotion, (6) proactive healthcare, (7) fewer administrative issues and (8) improved hospital experience. Patients with IBD want patient-centred, multidisciplinary care. Healthcare professionals should facilitate patients' access to proactive care.
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Affiliation(s)
- Meg Feeney
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, North Tce, SA, 5005, Australia
| | - Anna Chur-Hansen
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Antonina Mikocka-Walus
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, North Tce, SA, 5005, Australia.
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
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15
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Palamenghi L, Figliuc P, Leone S, Graffigna G. Food and Inflammatory Bowel Diseases: A scoping review on the impact of food on patients' psychosocial quality of life. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1695-1712. [PMID: 35174921 PMCID: PMC9542804 DOI: 10.1111/hsc.13755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/14/2022] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
Growing bodies of literature show that a controlled diet is important in controlling the symptoms of Inflammatory Bowel Diseases (IBD). This leads patients to avoid foods considered potentially harmful. However, food is not just a nutrient but entails a series of hedonistic, cultural and social values. Thus, there is the concern that having to renounce certain foods might exert an impact on patients' psychosocial quality of life, particularly in younger patients. The aim of this paper is to review the existing literature to address which aspects of the patients' quality of life are affected by food restrictions. A scoping review was carried out. Five different databases were searched in January 2021. Retrieved papers were then screened to only include the relevant studies. Data were extracted and the main results of the studies were charted. A thematic analysis was carried out on the main results to identify the areas of psychosocial quality of life more often impacted by the food restrictions. From the initially identified 1967 unique entries, 14 studies were included. Results show that the perceived importance of food in controlling symptoms is confirmed by patients' accounts. The most common strategy adopted was, thus, the avoidance of trigger foods. The thematic analysis revealed three domains that are impacted by these restrictions: psychological quality of life, social life, family sphere. This study highlights the impact that food restrictions exert on IBD patients' quality of life, and warrants further studies to fill existing gaps, in particular regarding younger patients.
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Affiliation(s)
- Lorenzo Palamenghi
- EngageMinds HUB – ConsumerFood & Health Engagement Research CenterUniversità Cattolica del Sacro CuoreMilanItaly
- Department of PsychologyUniversità Cattolica del Sacro CuoreMilanItaly
- Faculty of Agriculture, Food and Environmental SciencesUniversità Cattolica del Sacro CuoreCremonaItaly
| | - Polina Figliuc
- EngageMinds HUB – ConsumerFood & Health Engagement Research CenterUniversità Cattolica del Sacro CuoreMilanItaly
| | - Salvatore Leone
- AMICI OnlusAssociazione nazionale per le Malattie Infiammatorie Croniche dell’IntestinoMilanoItaly
| | - Guendalina Graffigna
- EngageMinds HUB – ConsumerFood & Health Engagement Research CenterUniversità Cattolica del Sacro CuoreMilanItaly
- Department of PsychologyUniversità Cattolica del Sacro CuoreMilanItaly
- Faculty of Agriculture, Food and Environmental SciencesUniversità Cattolica del Sacro CuoreCremonaItaly
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16
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Diets for inflammatory bowel disease: What do we know so far? Eur J Clin Nutr 2022; 76:1222-1233. [PMID: 35064219 DOI: 10.1038/s41430-021-01051-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 02/06/2023]
Abstract
In recent years, the role of diet in the pathogenesis of inflammatory bowel disease (IBD) has gained great interest within the scientific community. Eating habits from industrialised countries (the so-called western diet or WD) have been associated with a higher incidence of IBD in observational studies, although the dietary factors responsible for the development of the disease are still to be elucidated. Some components of the diet with proinflammatory potential may cause changes in immunity and intestinal microbiota, leading to the inflammatory reaction that causes IBD-related lesions. The quality of available evidence is low, due to methodological issues, such as the lack of intervention studies, small sample size and heterogeneity of studies. For this reason, scientific societies have offered their recommendations using clinical practice guidelines and consensus documents, in order to establish a common criterion in the nutritional treatment of patients with IBD. The objective of this review was to summarise the data published regarding diet in IBD and review the recommendations given by scientific societies.
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17
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Biesiekierski JR, Manning LP, Murray HB, Vlaeyen JWS, Ljótsson B, Van Oudenhove L. Review article: exclude or expose? The paradox of conceptually opposite treatments for irritable bowel syndrome. Aliment Pharmacol Ther 2022; 56:592-605. [PMID: 35775328 PMCID: PMC11327802 DOI: 10.1111/apt.17111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a heterogeneous disorder of gut-brain interaction (DGBI) maintained by interacting biological, psychological, and social processes. Interestingly, there are two contrasting yet evidence-based treatment approaches for reducing IBS symptoms: exclusion diets such as those low in fermentable oligo-, di-, monosaccharides and polyols (FODMAPs) and exposure-based cognitive-behavioural therapy (CBT). Exclusion diets recommend patients avoid foods thought to be symptom-inducing, whereas exposure-based CBT encourages patients to expose themselves to foods. AIMS To address the paradox of conceptually opposite exclusion diets and exposure-based CBT for IBS. METHODS In this conceptual review, we describe the rationale, practical implementation, evidence base and strengths and weaknesses of each treatment. We conducted up-to-date literature search concerning the low FODMAP diet and CBT, and performed a secondary analysis of a previously conducted trial to illustrate a key point in our review. RESULTS The low FODMAP diet has demonstrated efficacy, but problems with adherence, nutritional compromise, and heightened gastrointestinal-specific anxiety raise caution. Exposure-based CBT has demonstrated efficacy with substantial evidence for gastrointestinal-specific anxiety as a key mechanism of action. Mediation analysis also showed that increased FODMAP intake mediated decreased symptom severity in exposure-based CBT. However, there is minimal evidence supporting which treatment "works best for whom" and how these approaches could be best integrated. CONCLUSIONS Even though exclusion diets and exposure-based CBT are conceptually opposite, they each have proven efficacy. Clinicians should familiarise themselves with both treatments. Further research is needed on predictors, mechanisms and moderators of treatment outcomes.
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Affiliation(s)
- Jessica R Biesiekierski
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Australia
- Department of Food, Nutrition and Dietetics, La Trobe University, Melbourne, Australia
| | - Lauren P Manning
- Department of Food, Nutrition and Dietetics, La Trobe University, Melbourne, Australia
| | - Helen Burton Murray
- Center for Neurointestinal Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Johan W S Vlaeyen
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
- Research Group Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), University of Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Cognitive and Affective Neuroscience Lab, Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA
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18
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Schwartz NRM, McNichol SR, Devine B, Phipps AI, Roth JA, Suskind DL. Assessing Barriers to use of the Specific Carbohydrate Diet in Pediatric Inflammatory Bowel Disease: A Qualitative Study. JPGN REPORTS 2022; 3:e239. [PMID: 37168638 PMCID: PMC10158296 DOI: 10.1097/pg9.0000000000000239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/03/2022] [Indexed: 05/13/2023]
Abstract
Because of the high cost and associated toxicities of pharmacotherapy treatment for inflammatory bowel disease (IBD), there has been growing interest in dietary therapy. The objective of this study is to assess barriers to initiating or maintaining the specific carbohydrate diet (SCD) to inform strategies for improving access and adherence to the diet. Methods We conducted semistructured interviews with parents of 10 children with IBD receiving care at a single academic treatment center. Parents were eligible if their child with IBD was either currently on the SCD, previously on the SCD, or opted not to initiate the SCD. Core questions were developed in conjunction with IBD clinical experts. Interviews were transcribed and analyzed using an inductive approach. Results Parents of children diagnosed with IBD primarily chose to try the SCD because of concerns about medication safety. Three major barriers to utilizing the SCD emerged: cost, time commitment, and psychosocial impact. Many parents also expressed that following the SCD got easier over time and some parents experienced spillover effects of improved personal health and understanding of nutrition. All parents were strong proponents of the importance of diet in managing IBD and expressed desire for more research into the SCD and other forms of dietary therapy. Conclusions These findings provide important insight into factors affecting utilization of the SCD in pediatric IBD. Further research is needed to develop interventions or strategies to diminish these barriers and enable more patients to benefit from the SCD.
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Affiliation(s)
- Naomi R M Schwartz
- From the CHOICE Institute, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA
| | | | - Beth Devine
- From the CHOICE Institute, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA
| | - Amanda I Phipps
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
| | | | - David L Suskind
- Department of Gastroenterology and Hepatology, Seattle Children's Hospital, Seattle WA
- Division of Gastroenterology, Department of Pediatrics, University of Washington, Seattle, WA
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19
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Aslan Çin NN, Whelan K, Özçelik AÖ. Food-related quality of life in inflammatory bowel disease: measuring the validity and reliability of the Turkish version of FR-QOL-29. Health Qual Life Outcomes 2022; 20:103. [PMID: 35790989 PMCID: PMC9258121 DOI: 10.1186/s12955-022-02014-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose Food-related quality of life is considerably impaired in patients with inflammatory bowel disease (IBD) and should be widely measured in research and clinical practice. This study aims to translate the FR-QoL-29 instrument to the Turkish language and evaluate its validity and reliability in Turkish patients with IBD. Methods The FR-QoL-29 was forwards and backwards translated into Turkish and the validity and reliability of the FR-QoL-29-Turkish measured at two tertiary hospitals in Ankara, Turkey. Participants completed four questionnaires regarding: sociodemographic; clinical (disease type and activity), and nutritional characteristics (MUST) together with FR-QoL-29-Turkish. In addition, 30 patients repeated the questionnaires after two weeks. collected. Pearson correlation coefficients and Cronbach α were used to assess reliability and validity (p < 0.05). Results A total of 180 participants with IBD (78 Crohn’s disease, 102 ulcerative colitis), with a mean age of 45.9 ± 12.5 years, were included. Bartlett's sphericity test was statistically significant (p < 0.001), meeting the prerequisite for factor analysis, and the adequacy of the sample size for factor analysis was confirmed by a high Kaiser–Meyer–Olkin (KMO = 0.92). Validity was confirmed by factor loadings ranging from 0.310 to 0.858. Item-total score correlations ranged from 0.258 to 0.837 and Cronbach’s α coefficient was 0.96 for the whole questionnaire indicating high internal consistency. Conclusions FR-QoL-29-Turkish is a valid and reliable measure of food-related quality of life in IBD patients with Turkish language. The FR-QoL-29-Turkish gives a comprehensive overview of the main aspects of food quality of life and can be used as a useful tool in both research and clinical practice.
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20
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Burton Murray H, Staller K. When Food Moves From Friend to Foe: Why Avoidant/Restrictive Food Intake Matters in Irritable Bowel Syndrome. Clin Gastroenterol Hepatol 2022; 20:1223-1225. [PMID: 34555522 DOI: 10.1016/j.cgh.2021.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/15/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Helen Burton Murray
- Harvard Medical School, Boston, Massachusetts; Center for Neurointestinal Health, Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kyle Staller
- Harvard Medical School, Boston, Massachusetts; Center for Neurointestinal Health, Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
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21
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Psychological Considerations in the Dietary Management of Patients With DGBI. Am J Gastroenterol 2022; 117:985-994. [PMID: 35404301 PMCID: PMC9169764 DOI: 10.14309/ajg.0000000000001766] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/04/2022] [Indexed: 12/11/2022]
Abstract
In this article, an expert team of 2 gastro-psychologists, a dietician, and an academic gastroenterologist provides insights into the psychological and social implications of evidence-based and "popular" dietary interventions in disorders of gut-brain interaction (DGBI). We focus on practical approaches for evaluating a patient's appropriateness for a dietary intervention, considering the nutritional, psychological, behavioral, and social context in which a patient may find themselves managing their DGBI with dietary intervention. We also discuss how to identify risk factors for and symptoms of avoidant/restrictive food intake disorder, a growing concern in the DGBI population.
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22
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Optimal Design of Clinical Trials of Dietary Interventions in Disorders of Gut-Brain Interaction. Am J Gastroenterol 2022; 117:973-984. [PMID: 35297784 PMCID: PMC9169766 DOI: 10.14309/ajg.0000000000001732] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/11/2022] [Indexed: 12/11/2022]
Abstract
There is accumulating evidence for the fundamental role of diet in the integrated care of disorders of gut-brain interaction. Food is a complex mixture of components with individual, synergistic, and antagonistic effects, compared with the relative purity of a pharmaceutical. Food is also an inherent part of individuals' daily lives, and food choice is strongly tied to food preferences, personal beliefs, cultural and religious practices, and economic status, which can influence its ability to function as a therapeutic intervention. Hence, randomized controlled trials of dietary interventions carry unique methodological complexities that are not applicable to pharmaceutical trials that if disregarded can pose significant risk to trial quality. The challenges of designing and delivering the dietary intervention depend on the type of intervention (i.e., nutrient vs food supplementation or whole-diet intervention). Furthermore, there are multiple modes of delivery of dietary interventions, each with their own advantages (e.g., the high precision of feeding trials and the strong clinical applicability of dietary counseling trials). Randomized placebo-controlled trials of dietary interventions are possible with sufficient attention to their design and methodological nuances. Collaboration with experts in nutrition and dietetics is essential for the planning phase; however, even with expert input, not all challenges can be overcome. Researchers undertaking future dietary trials must be transparent in reporting these challenges and approaches for overcoming them. This review aims to provide guiding principles and recommendations for addressing these challenges to facilitate the conduct and reporting of high-quality trials that inform and improve clinical practice.
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Effect of Shugan Jianpi Recipe Combined with Cross Moxibustion on Biochemical Examination Indexes and Total Score of TCM Symptoms in Patients with Spleen-Stomach Damp-Heat Diarrhea Irritable Bowel Syndrome. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8286146. [PMID: 35502412 PMCID: PMC9056259 DOI: 10.1155/2022/8286146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/22/2022] [Accepted: 03/30/2022] [Indexed: 11/30/2022]
Abstract
Objective To explore the effect of Shugan Jianpi recipe combined with cross moxibustion on biochemical examination indexes and total score of TCM symptoms in patients with spleen-stomach damp-heat diarrhea irritable bowel syndrome (IBS). Methods Sixty patients with spleen-stomach damp-heat diarrhea (IBS) treated in our hospital from January 2019 to September 2021 were enrolled. The patients were randomly assigned into the control group and study group. The control group was treated with Chang Shugan Jianpi recipe, and the study group was treated with Shugan Jianpi recipe combined with cross moxibustion. The curative effect, single symptom score, total score of TCM clinical symptoms, plasma gastrointestinal hormone level, IBS-QOL score, and recurrence were compared. Results First of all, we compared the curative effects. The study group was significantly effective in 24 cases, effective in 5 cases, and ineffective in 1 case, and the effective rate was 96.67%. In the control group, 13 cases were markedly effective, 10 cases were effective, and 7 cases were ineffective, and the effective rate was 76.67%. The effective rate of the study group was higher compared to the control group (P < 0.05). Secondly, the individual symptom scores were compared. Compared between the two groups, the scores of diarrhea times, stool characteristics, abdominal pain, and abdominal distension in the study group were lower compared to the control group (P < 0.05). After treatment, the total score of TCM clinical symptoms decreased. Compared between the two groups, the total score of TCM clinical symptoms in the study group was lower compared to the control group at 1 week, 2 weeks, and 4 weeks after treatment (P < 0.05). After treatment, the levels of 5-HT and VIP decreased. The levels of 5-HT and VIP in the study group were lower compared to the control group (P < 0.05). The scores of anxieties, health worry, behavioral disorder, social reaction, somatic intention, interpersonal relationship, dietary concern, and sexual behavior in the study group were lower compared to the control group. The IBS-QOL scores were significantly lower compared to the control group (P < 0.05). Finally, we compared the recurrence. The recurrence rate in the study group was lower compared to the control group (P < 0.05). Conclusion The prescription combined with cross moxibustion has the effect of soothing the liver and invigorating the spleen, resolving dampness and stomach, and can reduce the main clinical symptoms of patients with diarrhea IBS of spleen-stomach damp-heat type, and the overall effect is significant. It can also enhance the emotional state of anxiety and depression and achieve the overall psychological and physical balance and health state, and the recurrence rate is low, which can be further applied in clinic.
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Calderon G, Patel C, Camilleri M, James-Stevenson T, Bohm M, Siwiec R, Rogers N, Wo J, Lockett C, Gupta A, Xu H, Shin A. Associations of Habitual Dietary Intake With Fecal Short-Chain Fatty Acids and Bowel Functions in Irritable Bowel Syndrome. J Clin Gastroenterol 2022; 56:234-242. [PMID: 33780215 PMCID: PMC8435047 DOI: 10.1097/mcg.0000000000001521] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/29/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND GOALS Diet may contribute to symptoms of irritable bowel syndrome (IBS) and luminal production of putative IBS biomarkers including short-chain fatty acids (SCFAs). Study aims were to to assess relationships of habitual fiber or starch intake with fecal SCFAs in patients with IBS and healthy volunteers (HVs). STUDY In 18 HVs and 30 patients with IBS (13 constipation-predominant [IBS-C] and 17 diarrhea-predominant [IBS-D]), habitual diet using a food frequency questionnaire; bowel functions using a validated bowel diary; and fecal SCFAs by HPLC-mass spectrometry were assessed. Associations of fiber and starch with SCFAs were analyzed using Spearman (rs) and Pearson (R) correlations. Relationships between other dietary endpoints, SCFAs, and bowel functions were explored. RESULTS Habitual fiber or starch intakes were not significantly correlated with SCFAs or bowel functions in all participants or HVs nor with SCFAs in IBS. Starch was negatively correlated (R=-0.53; P=0.04) with complete evacuation in IBS-D. Fiber (rs=0.65; P=0.02) and starch (rs=0.56; P=0.05) were correlated with ease of passage in IBS-C. Stool form, frequency, and ease of passage were positively correlated with total SCFAs (all P<0.05), acetate (all P<0.01), propionate (all P<0.05), and butyrate (form P=0.01; ease of passage P=0.05) among all participants, but not in IBS. Complete evacuation was negatively correlated with propionate (R=-0.34; P=0.04) in all participants. Total (P=0.04) and individual SCFAs (all P<0.05) were positively correlated with stool form in HVs. CONCLUSIONS Habitual fiber and starch intake does not influence fecal SCFAs but may influence bowel functions in IBS. Fecal SCFAs correlate with bowel functions among all participants including HVs.
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Affiliation(s)
- Gerardo Calderon
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine
| | - Chirag Patel
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine
| | - Michael Camilleri
- Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Toyia James-Stevenson
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine
| | - Matthew Bohm
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine
| | - Robert Siwiec
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine
| | - Nicholas Rogers
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine
| | - John Wo
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine
| | - Carolyn Lockett
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine
| | - Anita Gupta
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine
| | - Huiping Xu
- Department of Biostatistics; Indiana University School of Medicine, Indianapolis, IN
| | - Andrea Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine
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25
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Cox SR, Clarke H, O'Keeffe M, Dubois P, Irving PM, Lindsay JO, Whelan K. Nutrient, Fibre, and FODMAP Intakes and Food-related Quality of Life in Patients with Inflammatory Bowel Disease, and Their Relationship with Gastrointestinal Symptoms of Differing Aetiologies. J Crohns Colitis 2021; 15:2041-2053. [PMID: 34216206 PMCID: PMC8684455 DOI: 10.1093/ecco-jcc/jjab116] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Certain foods are reported as gut symptom triggers in inflammatory bowel disease [IBD], and fructans are shown to worsen non-inflammatory symptoms in inactive IBD, which may result in self-imposed dietary restrictions. The aim of this study was to investigate nutrient and FODMAP intakes, and the relationship between gut symptoms and dietary intake, in IBD. METHODS Nutrient, fibre, and FODMAP intakes were estimated using 7-day food records in patients with active IBD [Active IBD], inactive IBD with non-inflammatory gut symptoms [Inactive IBD-GI], inactive IBD without gut symptoms [Inactive IBD], and healthy controls. Nutrient intakes, numbers of participants achieving national recommendations, and food-related quality of life [FR-QoL] were compared across study groups. RESULTS Food diaries were obtained from 232 patients with IBD [65 Active IBD, 86 Inactive IBD-GI, 81 Inactive IBD] and 84 healthy controls. Patients with Active IBD had significantly lower intakes of numerous micronutrients, including iron, folate, and vitamin C, compared with controls. All IBD groups consumed less total fibre [4.5 to 5.8 g/day] than controls [p = 0.001], and total FODMAP and fructan intakes were lower in Active IBD compared with controls. Strikingly, FR-QoL was significantly lower in all IBD groups compared with controls [all p = 0.001]. CONCLUSIONS This study revealed lower intakes of fibre, FODMAPs, and micronutrients, in addition to poorer FR-QoL, in Active IBD and Inactive IBD-GI with gut symptoms compared with healthy controls. Future research should address dietary restrictions responsible for these differences.
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Affiliation(s)
- Selina R Cox
- King's College London, Faculty of Life Sciences and Medicine, Department of Nutritional Sciences, London, UK
| | - Hazel Clarke
- King's College London, Faculty of Life Sciences and Medicine, Department of Nutritional Sciences, London, UK
| | - Majella O'Keeffe
- King's College London, Faculty of Life Sciences and Medicine, Department of Nutritional Sciences, London, UK
| | - Patrick Dubois
- King's College Hospital NHS Foundation Trust, Department of Gastroenterology, London, UK
| | - Peter M Irving
- Guy's and St Thomas' NHS Foundation Trust, Department of Gastroenterology, London, UK
| | - James O Lindsay
- Barts Health NHS Trust, Department of Gastroenterology, Royal London Hospital , London, UK
| | - Kevin Whelan
- King's College London, Faculty of Life Sciences and Medicine, Department of Nutritional Sciences, London, UK
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26
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Zickgraf HF, Loftus P, Gibbons B, Cohen LC, Hunt MG. "If I could survive without eating, it would be a huge relief": Development and initial validation of the Fear of Food Questionnaire. Appetite 2021; 169:105808. [PMID: 34798226 DOI: 10.1016/j.appet.2021.105808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Fear of food and behavioral avoidance of specific foods, food groups, and food related social situations can substantially reduce health related quality of life in individuals with a wide range of conditions that affect appetite, eating behavior, and digestion, including irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), vomit and choking phobias, and food allergies/sensitivities. When this avoidance leads to weight/nutritional and/or psychosocial impairment, the diagnostic criteria for Avoidant/restrictive food intake disorder (ARFID) are met. Fear of food is an important target for interventions designed to improve psychosocial functioning and quality of life in such individuals. The purpose of this research was to develop and validate a novel measure of fear of food. METHODS Participants (n = 1138) were recruited from ongoing clinical trials for both IBD and IBS, from Amazon's Mechanical Turk, from Reddit support forums for IBS, IBD, and vomit phobia, and from an undergraduate subject pool. Exploratory and confirmatory factor analysis, Pearson's correlations, one-way ANOVA, and intraclass correlation coefficients were used to assess the validity and reliability of the Fear of Food Questionnaire. RESULTS The final 18 item questionnaire showed excellent internal consistency, test-retest reliability, convergent validity, discriminative (known groups) validity, as well as good factor structure. Fear of food was highly correlated with visceral hypersensitivity, catastrophizing, GI symptom severity and health related quality of life, as well as with self-reported Fear-ARFID symptoms. Individuals meeting study criteria for Fear-ARFID reported the highest scores relative to control and other analogue clinical groups. CONCLUSION The Fear of Food Questionnaire appears to be reliable and valid across populations and may be a valuable tool in the assessment and treatment of Fear-ARFID.
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Affiliation(s)
- Hana F Zickgraf
- University of South Alabama, Department of Psychology, USA; University of Pennsylvania, Department of Psychology, USA; Penn State Hershey Medical Center, Department of Psychiatry & Department of Surgery, USA.
| | - Patrick Loftus
- University of Pennsylvania, Department of Psychology, USA
| | | | - Lauren C Cohen
- University of Pennsylvania, Department of Psychology, USA
| | - Melissa G Hunt
- University of Pennsylvania, Department of Psychology, USA
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27
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Melchior C, Fremaux S, Jouët P, Macaigne G, Raynaud JJ, Facon S, Iglicki F, Taes Y, Sabate JM. Perceived Gastrointestinal Symptoms and Association With Meals in a French Cohort of Patients With Irritable Bowel Syndrome. J Neurogastroenterol Motil 2021; 27:574-580. [PMID: 34642277 PMCID: PMC8521472 DOI: 10.5056/jnm20201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/13/2020] [Accepted: 12/02/2020] [Indexed: 12/13/2022] Open
Abstract
Background/Aims The aim of our study is to evaluate the association between meals and perceived gastrointestinal symptoms in real life in a French cohort of irritable bowel syndrome (IBS) patients. Methods This prospective cross-sectional observational study included patients from the French association (association des patients souffrant du syndrome de l’intestin irritable [APSSII]) of IBS. Data were collected on demographics, IBS subtype, dietary food, and meal-induced gastrointestinal symptoms from patient filled self-questionnaires or questionnaires. Results Eighty-four patients with IBS were included; 82.3% female with a mean age of 46.9 ± 15.7 years. Each transit pattern subtype represented one-third of the population. Forty-five percent of patients had severe IBS according to IBS-Severity Scoring System; mean IBS Quality of Life score was 53.9 ± 18.3. Patients believed that food could trigger or exacerbate gastrointestinal symptoms in 73.3% and 93.4%, respectively. Eighty-nine percent had already tried diets, mostly lactose free diet and low fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols diet in 61.3% and 53.6% of cases. Thirty-nine percent of meals induced gastrointestinal symptoms. Meal-induced gastrointestinal symptoms were associated with severity and subtype but not with quality of life. Conclusions This study has confirmed the important link between gastrointestinal symptoms and food. Gastrointestinal symptoms induced by meals are frequent and associated with severity and IBS-diarrhea subtype. Our study also underlines patients’ interest in food and diet. More knowledge is needed on food that triggers IBS symptoms but also on diet conditions in order to improve this condition.
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Affiliation(s)
- Chloé Melchior
- INSERM UMR 1073, Institute for Research and Innovation in Biomedicine, Normandy University, Rouen, France.,Department of Gastroenterology and INSERM CIC-CRB 1404, Rouen University Hospital, Rouen, France.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Simon Fremaux
- Service de Gastroentérologie, Hôpital Avicenne AP-HP, INSERM U-987, Bobigny, France
| | - Pauline Jouët
- Service de Gastroentérologie, Hôpital Avicenne AP-HP, INSERM U-987, Bobigny, France
| | - Gilles Macaigne
- Department of Hepatogastroenterology, Marne-la-Vallee Hospital, Jossigny, France
| | - Jean-Jacques Raynaud
- Service de Gastroentérologie, Hôpital Avicenne AP-HP, INSERM U-987, Bobigny, France
| | - Suzelle Facon
- The French Association of IBS Patients (APSSII), Paris France
| | - Franck Iglicki
- Gastroenterology Unit, AP-HP, Louis Mourier Hospital and Denis Diderot University Paris 7, Paris, France
| | | | - Jean-Marc Sabate
- Service de Gastroentérologie, Hôpital Avicenne AP-HP, INSERM U-987, Bobigny, France
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28
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Day AS, Yao CK, Costello SP, Andrews JM, Bryant RV. Food avoidance, restrictive eating behaviour and association with quality of life in adults with inflammatory bowel disease: A systematic scoping review. Appetite 2021; 167:105650. [PMID: 34391842 DOI: 10.1016/j.appet.2021.105650] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/17/2021] [Accepted: 08/11/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Dietary misconceptions and behaviours may worsen outcomes of inflammatory bowel disease (IBD). This scoping review aims to examine the dietary beliefs and behaviours of individuals with IBD and identify evidence of food avoidance, dietary restriction or disordered eating and any association with quality of life (QoL). METHODOLOGY A systematic search of CINAL, EMBASE, MEDLINE was conducted. Primary, peer-reviewed studies in English examining dietary beliefs and dietary behaviours or diet and quality of life in adults with inflammatory bowel disease were included. Key dietary terminology was pre-defined. RESULTS Twenty-nine studies met inclusion criteria. A range of quantitative self-reported questionnaires (16/29), qualitative interviews (1/29) and mixed methods (7/29) were used to measure dietary beliefs and dietary behaviours. A high prevalence of food avoidance (28-89%) and restrictive dietary behaviours (41-93%) were identified. Factors associated with these behaviours included a diagnosis of CD, perceived active disease, female sex, dietary misinformation, and fears of adverse bowel symptoms. Diet and QoL remains largely unexplored in IBD beyond two recent studies demonstrating impairment of food-related quality of life in IBD. CONCLUSION A high prevalence of self-reported food avoidance and restrictive dietary behaviour exists in people with IBD. The psychosocial impact of IBD-related dietary behaviour is poorly understood. Validated tools with predefined diet terminology and objective markers of disease activity are required to measure dietary behaviour in future prospective studies, using food-related quality of life as an outcome measure.
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Affiliation(s)
- Alice S Day
- Inflammatory Bowel Disease Services, The Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, 5011, South Australia, Australia; School of Medicine, Faculty of Health Sciences, University of Adelaide, Frome Road, Adelaide, 5000, South Australia, Australia.
| | - Chu K Yao
- Translational Nutritional Sciences, Department of Gastroenterology, Monash University & Alfred Hospital, 99 Commercial Road, Melbourne, 3000, Victoria, Australia.
| | - Samuel P Costello
- Inflammatory Bowel Disease Services, The Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, 5011, South Australia, Australia; School of Medicine, Faculty of Health Sciences, University of Adelaide, Frome Road, Adelaide, 5000, South Australia, Australia.
| | - Jane M Andrews
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Frome Road, Adelaide, 5000, South Australia, Australia; Inflammatory Bowel Disease Service, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, 5000, South Australia, Australia.
| | - Robert V Bryant
- Inflammatory Bowel Disease Services, The Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, 5011, South Australia, Australia; School of Medicine, Faculty of Health Sciences, University of Adelaide, Frome Road, Adelaide, 5000, South Australia, Australia.
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Fisher K, Byham-Gray L, Rothpletz-Puglia P. Characterizing the Parental Perspective of Food-Related Quality of Life in Families After Pediatric Inflammatory Bowel Disease Diagnosis. Gastroenterol Nurs 2021; 44:E69-E77. [PMID: 34149042 DOI: 10.1097/sga.0000000000000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/30/2021] [Indexed: 11/25/2022] Open
Abstract
Food-related quality of life is defined as achieving adequate nutrition, deriving pleasure, and maintaining social activities through eating and drinking. The objective of this qualitative study was to characterize the parental perspective about eating experiences and family functioning after diagnosis of inflammatory bowel disease in their child in order to describe how these experiences may impact food-related quality of life. Semistructured interviews were completed with 10 parents of a child with inflammatory bowel disease. Conventional content analysis was conducted with steps to ensure trustworthiness. Family Systems Theory was the interpretive framework. Ambiguous nutrition information emerged as the main theme. Families experienced various and conflicting viewpoints regarding the role of diet, which presented a challenge after diagnosis. Parents reported frustration regarding the lack of uniform and personalized nutrition guidance. Our results support that families desire shared decision-making in regard to medication and diet, which is an important clinical practice implication for the entire gastroenterology medical team. Understanding the challenges faced by families after a major medical diagnosis in a child provides insight into designing medical interventions that maintain optimal quality of life in families.
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Affiliation(s)
- Kelly Fisher
- Kelly Fisher, DCN, RD, CSP, LD, is Assistant Professor of Professional Practice, Department of Nutritional Sciences, Texas Christian University, Fort Worth, Texas
- Laura Byham-Gray, PhD, RD, LD, FNKF, is Professor, Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
- Pamela Rothpletz-Puglia, EdD, RD, LD, is Associate Professor, Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
| | - Laura Byham-Gray
- Kelly Fisher, DCN, RD, CSP, LD, is Assistant Professor of Professional Practice, Department of Nutritional Sciences, Texas Christian University, Fort Worth, Texas
- Laura Byham-Gray, PhD, RD, LD, FNKF, is Professor, Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
- Pamela Rothpletz-Puglia, EdD, RD, LD, is Associate Professor, Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
| | - Pamela Rothpletz-Puglia
- Kelly Fisher, DCN, RD, CSP, LD, is Assistant Professor of Professional Practice, Department of Nutritional Sciences, Texas Christian University, Fort Worth, Texas
- Laura Byham-Gray, PhD, RD, LD, FNKF, is Professor, Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
- Pamela Rothpletz-Puglia, EdD, RD, LD, is Associate Professor, Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey
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30
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Eslampour E, Ghanadi K, Aghamohammadi V, Kazemi AM, Mohammadi R, Vahid F, Abbasnezhad A. "Association between dietary inflammatory index (DII) and risk of irritable bowel syndrome: a case-control study". Nutr J 2021; 20:60. [PMID: 34183016 PMCID: PMC8240213 DOI: 10.1186/s12937-021-00721-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Pathophysiology of IBS is not well recognized; however, several studies have shown the possible relationship between diet and risk of IBS. We assessed the ability of the dietary inflammatory index (DII) to predict the risk of IBS. Methods The subjects were 155 IBS cases and 310 age- and sex-matched healthy controls (aged ≥18 years). The participants were recruited from June, 2019 to March, 2020. IBS was recognized using the Rome IV criteria. DII score was computed based on dietary intake using a 168-item FFQ. The DII score was calculated based on energy-adjusted amounts of nutrients using residual method. Logistic regression models were used to estimate multivariable odds ratios (ORs). Results The mean DII score was significantly higher among IBS patients in comparison to healthy controls (0.78 ± 2.22 vs. − 0.39 ± 2.27). In crude model, increase in DII as continuous variable was associated with a significant increase in the risk of IBS (OR (95% CI): 1.26 (1.1–15.38)). Furthermore, the association remained significant even after adjusting for age and sex (OR (95% CI): 1.28 (1.1–17.41)) and after multivariate adjustment (OR (95% CI): 1.38 (1.2–1.56)). In crude, age and sex adjusted and multivariate-adjusted models subjects in fourth quartile of DII had higher OR in comparison to subjects in first quartile. Conclusions This study showed a possible positive association between a pro-inflammatory diet and the risk of IBS. Thus, encouraging intake of more anti-inflammatory dietary factors and reducing intake of pro-inflammatory factors may be a strategy for reducing risk of IBS. Supplementary Information The online version contains supplementary material available at 10.1186/s12937-021-00721-5.
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Affiliation(s)
- Elham Eslampour
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Koroush Ghanadi
- Department of Internal Medicine, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | | | - Alireza Moayed Kazemi
- Razi Center for Herbal Medicine Research, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Rasool Mohammadi
- Department of Epidemiology and Biostatistics, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Farhad Vahid
- Population Health Department, Nutrition and Health Research Group, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Amir Abbasnezhad
- Nutritional Health Research Center, Department of Nutrition, Lorestan University of Medical Sciences, PO Box: 6813833946, Goledasht Blvd, Khorramabad, Iran.
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31
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Day AS, Yao CK, Costello SP, Andrews JM, Bryant RV. Food-related quality of life in adults with inflammatory bowel disease is associated with restrictive eating behaviour, disease activity and surgery: A prospective multicentre observational study. J Hum Nutr Diet 2021; 35:234-244. [PMID: 34008222 DOI: 10.1111/jhn.12920] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Measuring food-related quality of life (FRQoL) quantifies the psychosocial impact of eating and drinking. FRQoL and associated factors are not well explored in people with inflammatory bowel disease (IBD), despite IBD being a chronic disease affecting the digestive tract. The present study aimed to characterise and identify any patient or disease-related predictors of FRQoL in individuals with IBD. METHODS Adults with a formal diagnosis of IBD were recruited to a prospective multicentre cross-sectional study between April 2018 and December 2019. Participants completed questionnaires measuring FRQoL (FRQoL-29), clinical disease activity (Harvey Bradshaw Index and Simple Clinical Colitis Activity Index), restrictive eating behaviour (Nine-Item Avoidant/Restrictive Food Intake Disorder Screen), mental health (Depression Anxiety Stress Scale-21) and other patient and disease-related variables. A multivariable regression was performed to identify factors associated with FRQoL. RESULTS One hundred and eight participants completed the questionnaires (n = 39, Crohn's disease; n = 69, ulcerative colitis). The mean FRQoL was 79 (95% confidence interval = 75-84) (poor, 0; superior, 145). Poorer FRQoL was observed in those with restrictive eating behaviour associated with fear of a negative consequence from eating (p < 0.0001) and reduced appetite (p < 0.030). Greater FRQoL was observed in those with lower disease activity (p < 0.0001) and previous IBD surgery (p = 0.024). FRQoL was not associated either way by IBD phenotype, duration, or gender. The majority of participants obtained their dietary information from the internet (60%) or gastroenterologist (46%). CONCLUSIONS FRQoL in people with IBD is poorer in those with restrictive eating behaviours and clinically active disease. Interestingly, it was greater in those with previous IBD surgery. Further research is required to validate these associations and explore longitudinal effects of poor FRQoL on patient outcomes and potential strategies for prevention or management of impaired FRQoL in IBD.
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Affiliation(s)
- Alice S Day
- Inflammatory Bowel Disease Services, The Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South, SA, Australia.,School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Chu K Yao
- Translational Nutritional Sciences, Department of Gastroenterology, Monash University & Alfred Hospital, Melbourne, VIC, Australia
| | - Samuel P Costello
- Inflammatory Bowel Disease Services, The Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South, SA, Australia.,School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Jane M Andrews
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia.,Inflammatory Bowel Disease Service, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Robert V Bryant
- Inflammatory Bowel Disease Services, The Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South, SA, Australia.,School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
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32
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Whelan K, Murrells T, Morgan M, Cummings F, Stansfield C, Todd A, Sebastian S, Lobo A, Lomer MCE, Lindsay JO, Czuber-Dochan W. Food-related quality of life is impaired in inflammatory bowel disease and associated with reduced intake of key nutrients. Am J Clin Nutr 2021; 113:832-844. [PMID: 33677550 DOI: 10.1093/ajcn/nqaa395] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) may impact the extent to which food, eating, and drinking bring satisfaction and enjoyment to peoples' lives, and this may impact dietary intake. The prevalence of an impaired food-related quality of life (FR-QoL), its associated factors, and its impact on diet have not been explored. OBJECTIVES To measure the prevalence and nature of the burden of impaired FR-QoL in people with IBD, the factors associated with these, and their associations with nutrient intake. METHODS We recruited 1576 outpatients with IBD (≥16 years old) in person from 7 IBD centers across the United Kingdom. Patients completed validated questionnaires to measure their FR-QoL, quality of life (QoL), distress, fatigue, anxiety, and depression. Dietary intake was recorded using the European Prospective Investigation into Cancer FFQ. A health professional recorded disease activity, Montreal classification, blood results, BMI, and malnutrition risk. FR-QoL was regressed onto explanatory variables using univariable and multivariable analyses. RESULTS Data from 1221 patients were available (77.4% response; Crohn's disease, 65%; ulcerative colitis, 35%). The FR-QoL mean (± SD) score was 80.8 ± 26.9, with wide ranges (minimum, 29; maximum, 145). Following multivariable regression, the strongest associations with FR-QoL were the number of recent disease flares (5 flares β = -12.7; P < 0.001), the IBD-specific QoL (β = 0.33; P < 0.001), and IBD-related distress (β = -0.26; P < 0.001). Patients with poorer FR-QoL had lower intakes of fiber (nonstarch polysaccharide; Q1 to Q5 difference = 2.1 g/d; 95% CI: 0.4-3.8; P = 0.048), calcium (192.6 mg/d; 95% CI: 112.5-272.6; P < 0.001), phosphorus (167 mg/d; 95% CI: 58-276; P = 0.041), and magnesium (34.4 mg/d; 95% CI: 9.3-59.4; P = 0.041). CONCLUSIONS Impaired FR-QoL is prevalent in IBD and is associated with recurrent disease flares, a reduced IBD-specific QoL, and greater IBD-related distress. A poorer FR-QoL was associated with lower intakes of key nutrients of importance to IBD, including those relating to gut health and bone mineralization.
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Affiliation(s)
- Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, United Kingdom
| | - Trevor Murrells
- Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College London, London, United Kingdom
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London, United Kingdom
| | - Fraser Cummings
- University Southampton Hospital National Health Service (NHS) Foundation Trust, Southampton, United Kingdom
| | | | - Anne Todd
- NHS Forth Valley, Forth Valley Royal Hospital, Larbert, United Kingdom
| | - Shaji Sebastian
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
- Hull York Medical School, Hull, United Kingdom
| | - Alan Lobo
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, United Kingdom
| | - Miranda C E Lomer
- Department of Nutritional Sciences, King's College London, London, United Kingdom
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - James O Lindsay
- Bart's Health NHS Trust, London, United Kingdom
- Queen Mary University of London, Blizard Institute, London, United Kingdom
| | - Wladyslawa Czuber-Dochan
- Department of Nutritional Sciences, King's College London, London, United Kingdom
- Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College London, London, United Kingdom
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Chey WD, Keefer L, Whelan K, Gibson PR. Behavioral and Diet Therapies in Integrated Care for Patients With Irritable Bowel Syndrome. Gastroenterology 2021; 160:47-62. [PMID: 33091411 DOI: 10.1053/j.gastro.2020.06.099] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/08/2020] [Accepted: 06/06/2020] [Indexed: 02/06/2023]
Abstract
Irritable bowel syndrome (IBS) is a common, symptom-based condition that has negative effects on quality of life and costs health care systems billions of dollars each year. Until recently, management of IBS has focused on over-the-counter and prescription medications that reduce symptoms in fewer than one-half of patients. Patients have increasingly sought natural solutions for their IBS symptoms. However, behavioral techniques and dietary modifications can be effective in treatment of IBS. Behavioral interventions include gastrointestinal-focused cognitive behavioral therapy and gut-directed hypnotherapy to modify interactions between the gut and the brain. In this pathway, benign sensations from the gut induce maladaptive cognitive or affective processes that amplify symptom perception. Symptoms occur in response to cognitive and affective factors that trigger fear of symptoms or lack of acceptance of disease, or from stressors in the external environment. Among the many dietary interventions used to treat patients with IBS, a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols is the most commonly recommended by health care providers and has the most evidence for efficacy. Patient with IBS who choose to follow a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols should be aware of its 3 phases: restriction, reintroduction, and personalization. Management of IBS should include an integrated care model in which behavioral interventions, dietary modification, and medications are considered as equal partners. This approach offers the greatest likelihood for success in management of patients with IBS.
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Affiliation(s)
- William D Chey
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan.
| | | | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, United Kingdom
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34
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Crooks B, McLaughlin J, Limdi J. Dietary beliefs and recommendations in inflammatory bowel disease: a national survey of healthcare professionals in the UK. Frontline Gastroenterol 2020; 13:25-31. [PMID: 34966530 PMCID: PMC8666871 DOI: 10.1136/flgastro-2020-101723] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/29/2020] [Accepted: 12/06/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The role of diet in inflammatory bowel disease (IBD) remains incompletely understood. Knowledge around the actual dietary advice healthcare professionals provide to individuals with IBD is scarce. Our objective was to describe the dietary beliefs of healthcare professionals and dietary recommendations made to people with IBD. METHODOLOGY An online survey regarding IBD-related dietary beliefs and advice provided to patients was distributed to gastroenterologists, dietitians and IBD nurses in the UK. RESULTS Two-hundred and twenty-three eligible healthcare professionals participated: 107 (48%) believed that diet was involved in IBD development. The most frequently implicated dietary components were processed foods (78%), additives/preservatives (71%), sweet/sugary foods (36%), red meat (36%) and fatty foods (31%). Views were broadly consistent across professions, however, gastroenterologists were significantly more likely to believe red meat and additives/preservatives initiated IBD. One hundred and thirteen participants (53%) believed that diet could trigger disease relapse and 128 (61%) recommended limiting specific foodstuffs to reduce this risk, most commonly high fibre foods. Forty-six (23%) considered recommending a low Fermentable Oligo-, Di- and Monosaccharides and Polyols diet to reduce relapse risk. IBD nurses and healthcare professionals with <5 years experience were most likely to recommend this. Dietitians felt most comfortable providing dietary advice for functional gastrointestinal symptoms in quiescent IBD. CONCLUSION Dietary advice in IBD is inconsistent reflecting uncertainty among healthcare professionals. While some consensus exists regarding dietary components implicated in IBD development and relapse, dietary recommendations varied. Future research is required to disentangle these complex relationships, alongside better training and education.
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Affiliation(s)
- Benjamin Crooks
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
- Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK
- Section of IBD - Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust Gastroenterology, Manchester, UK
| | - John McLaughlin
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
- Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Jimmy Limdi
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
- Section of IBD - Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust Gastroenterology, Manchester, UK
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Kim H, Son H. A Moderated-Mediation Model of the Relationship between Dietary Satisfaction and Fatigue in Older Adults with Diabetes: The Role of Meal Planning and Depressive Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8823. [PMID: 33261015 PMCID: PMC7729502 DOI: 10.3390/ijerph17238823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 01/12/2023]
Abstract
Little research has examined the pathways between psychological factors and fatigue in older adults with diabetes. This study explored the pathways between diet-related quality of life and depressive symptoms in predicting fatigue using a moderated-mediation model. A convenience sample of adults ≥65 years (n = 127) with diabetes completed a cross-sectional survey including measures of fatigue severity, diet-related quality of life, and depressive symptoms, and a moderated-mediation analysis assessed the relationships between them. Diet satisfaction was negatively related to fatigue, which was mediated by depressive symptoms. In the moderated-mediation model, diet satisfaction had a conditional effect on fatigue through the mediating effect of depressive symptoms, moderated by meal planning difficulty. At higher levels of perceived meal planning difficulty, lower diet satisfaction was indirectly associated with higher fatigue through depressive symptoms, but this pathway was non-significant at lower levels. Findings suggest that supportive care for diet therapy might improve psychological outcomes in older adults with diabetes, especially for those having difficulties with daily dietary practice. Meal planning difficulties in the dietary management of diabetes accompanied by low diet satisfaction may lead to negative psychological outcomes. Monitoring satisfaction and burdens associated with dietary practices could improve fatigue in this population.
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Affiliation(s)
- Hyerang Kim
- Department of Nursing Science, Howon University, 64 Howondae 3gil, Impi, Gunsan 54058, Jeollabuk-do, Korea;
| | - Heesook Son
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, Korea
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Abstract
PURPOSE OF REVIEW Patients with inflammatory bowel disease (IBD) are always interested in the effects of diet on their disease and are often puzzled by the apparent lack of concern in this regard expressed by their doctors. This lack of concern too often reflects the lack of knowledge but it must be recognized that the evidence base for nutritional interventions is weak and compares poorly with that underlying the use of modern biologic drugs. RECENT FINDINGS The past year has had its usual collection of personal and systematic reviews of the topic and a regrettably large number of poor quality publications on nutrition in IBD. The present contribution aims to highlight some of the more original articles of the past year and to identify areas where useful progress is being made both in cause (sugar perhaps less important than was thought) and habitual diet (where more fruit and less red meat are cautiously promoted). With regard to specific interventions, there is a swing back toward an exclusion diet in children with Crohn's disease and to dietary management of persistent symptoms in IBD patients in whom objective evidence of disease activity is absent or very low. SUMMARY The quality of articles in the field is slowly improving and it is encouraging to find several pertinent publications in the highest caliber journals. Hopefully, this will encourage improvement in clinical practice and further investment in research.
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Affiliation(s)
- Alastair Forbes
- Norwich Medical School, University of East Anglia, Norwich, UK
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Challenges of the low FODMAP diet for managing irritable bowel syndrome and approaches to their minimisation and mitigation. Proc Nutr Soc 2020; 80:19-28. [PMID: 32468985 DOI: 10.1017/s0029665120006990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Dietary restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) is clinically effective and a commonly utilised approach in the management of functional symptoms in irritable bowel syndrome. Despite this, the low FODMAP diet has a number of challenges: it can alter the gut microbiota; impact nutrient intake and diet quality; is complex to understand; requires the patient to be adequately supported to follow the diet accurately and safely; and lastly, not all patients respond to the diet. The current review highlights the evidence for the clinical effectiveness of the low FODMAP diet, but focusses on the challenges associated with the diet to the patient, health professionals and the wider healthcare service. Finally, the review discusses research findings and practical guidance for how these challenges can be minimised and mitigated. The low FODMAP diet is a useful management strategy for irritable bowel syndrome, with data from clinical trials suggesting a 50-80% response rate, and when administered appropriately, the challenges to implementing the diet can be overcome so that these outcomes can be realised effectively and safely in clinical practice.
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Han MK, Anderson R, Viennois E, Merlin D. Examination of food consumption in United States adults and the prevalence of inflammatory bowel disease using National Health Interview Survey 2015. PLoS One 2020; 15:e0232157. [PMID: 32324818 PMCID: PMC7179926 DOI: 10.1371/journal.pone.0232157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 04/09/2020] [Indexed: 12/20/2022] Open
Abstract
Various diets and food components have been implicated as one of the environmental factors associated with inflammatory bowel disease (IBD). Patients are often recommended nutritional guidelines to manage disease symptoms. However, the current food consumption pattern of US adults with IBD that are nationally representative is unclear. A secondary analysis of National Health Interview Survey 2015 was performed to characterize the estimated US adults with IBD and their food intake and consumption frequency using bivariate and multivariate logistic regression. Fries were consumed by a greater number of people with IBD. IBD population drank less 100% fruit juice and ate more cheese and cookies than non-IBD population. Intake of fries (OR 1.60, 95% CI 1.14-2.25) and sports and energy drinks (OR 1.46, 95% CI 1.07-1.97) and more frequent drinking of regular soda were significantly associated with the likelihood of having been told one have IBD, while popcorn (OR 0.73, 95% CI 0.548-0.971) and milk (OR 0.70, 95% CI 0.497-0.998) were associated with smaller odds, adjusting for covariates. Foods typically labeled as junk food were positively associated with IBD. Nonetheless, of the assessed 26 foods, we found eating patterns between IBD and non-IBD population to be mostly analogous. It is unclear whether the results reflect potential change in food intake in IBD population long before the survey interview. Understanding the role of food intake in IBD risk/prevalence would benefit from identifying other environmental factors (i.e. food desert), food processing (i.e. frying), and potential bioactive food components that can induce intestinal inflammation that can increase the individual's susceptibility to IBD.
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Affiliation(s)
- Moon K. Han
- Institute for Biomedical Sciences, Center for Diagnostics and Therapeutics, Center for Inflammation, Immunity and Infection, Digestive Disease Research Group, Georgia State University, Atlanta, Georgia, United States of America
| | - Raeda Anderson
- Department of Research and Engagement, Georgia State University, Atlanta, Georgia, United States of America
| | - Emilie Viennois
- Institute for Biomedical Sciences, Center for Diagnostics and Therapeutics, Center for Inflammation, Immunity and Infection, Digestive Disease Research Group, Georgia State University, Atlanta, Georgia, United States of America
| | - Didier Merlin
- Institute for Biomedical Sciences, Center for Diagnostics and Therapeutics, Center for Inflammation, Immunity and Infection, Digestive Disease Research Group, Georgia State University, Atlanta, Georgia, United States of America
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia, United States of America
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Chandrasekaran A, Groven S, Lewis JD, Levy SS, Diamant C, Singh E, Konijeti GG. An Autoimmune Protocol Diet Improves Patient-Reported Quality of Life in Inflammatory Bowel Disease. CROHN'S & COLITIS 360 2019; 1:otz019. [PMID: 31832627 PMCID: PMC6892563 DOI: 10.1093/crocol/otz019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Prior studies suggest dietary modification may improve clinical response or remission rates in patients with inflammatory bowel disease (IBD). Our aim was to examine whether an autoimmune protocol diet improves quality of life in patients with active Crohn disease (CD) and ulcerative colitis (UC). METHODS We conducted an uncontrolled clinical trial of the autoimmune protocol diet in adult patients with active IBD (Harvey-Bradshaw Index ≥ 5 for CD or partial Mayo score ≥ 3 for UC, and erosions/ulcers on endoscopy and/or elevated fecal calprotectin). The dietary intervention consisted of a 6-week elimination phase, followed by a 5-week maintenance phase. Short Inflammatory Bowel Disease Questionnaire (SIBDQ) was completed at baseline, and weeks 3, 6, 9, and 11. RESULTS The final cohort included 6 UC and 9 CD participants. Mean SIBDQ score improved significantly from baseline (46.5) to weeks 3 (54.0, P = 0.02), 6 (53.3, P = 0.02), 9 (62.0, P = 0.03), and 11 (60.5, P = 0.05). Among participants completing all 5 surveys, mean SIBDQ increased from 46.5 to 61.5 by week 11 (P = 0.03). By week 3, participants experienced significant improvements in bowel movement frequency (36%, P = 0.04), stress (28%, P = 0.01), and ability to perform leisure/sport activities (29%, P = 0.02). Effects were not significantly different between CD and UC participants. CONCLUSIONS Dietary modification can improve quality of life as early as week 3 in patients with active IBD. Larger randomized controlled trials are needed to examine dietary interventions in IBD.
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Affiliation(s)
| | - Shauna Groven
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA
| | - James D Lewis
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Susan S Levy
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA
| | | | - Emily Singh
- Division of Gastroenterology, Scripps Clinic, La Jolla, CA
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