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Palamenghi L, Usta D, Leone S, Graffigna G. Food-Related Behavioral Patterns in Patients with Inflammatory Bowel Diseases: The Role of Food Involvement and Health Engagement. Nutrients 2024; 16:1185. [PMID: 38674876 PMCID: PMC11054402 DOI: 10.3390/nu16081185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Nutrition has been acknowledged as crucial in IBD and is relevant to patients' motives behind food choices, which are affected by health engagement (HE) and food involvement (FI). This study aimed to profile IBD patients according to their levels of health engagement and food involvement to identify patterns of different motives behind food choices, particularly regarding the use of food to regulate mood. A cross-sectional study was conducted with 890 Italian IBD patients who completed an online survey in April 2021. We measured health engagement, food involvement, motives behind food choices, emotional states, and food-related quality of life (Fr-QoL). K-means cluster analysis was performed to identify participants with similar levels of health engagement and food involvement. Four clusters were identified: "Health-conscious (high HE, low FI)", "Balanced (high HE, high FI)", "Hedonist (high FI, low HE)", and "Careless (low FI, low HE)". Clusters with high FI are inclined toward seeking pleasurable food, but when supported with high health engagement, individuals were less prone to use food to manage mood. Groups with higher health engagement demonstrated lower hospitalization rates and relapses and better Fr-QoL. Profiling IBD patients regarding FI and HE could aid clinicians in identifying individuals at greater risk of maladaptive food-related behaviors.
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Affiliation(s)
- Lorenzo Palamenghi
- EngageMinds HUB—Consumer, Food & Health Engagement Research Center, Faculty of Agriculture, Food and Environmental Sciences, Catholic University of Sacred Heart, 26100 Cremona, Italy; (L.P.); (G.G.)
| | - Dilara Usta
- EngageMinds HUB—Consumer, Food & Health Engagement Research Center, Faculty of Agriculture, Food and Environmental Sciences, Catholic University of Sacred Heart, 26100 Cremona, Italy; (L.P.); (G.G.)
| | - Salvo Leone
- National Association for Chronic Inflammatory Bowel Diseases (AMICI ETS), 20125 Milan, Italy;
| | - Guendalina Graffigna
- EngageMinds HUB—Consumer, Food & Health Engagement Research Center, Faculty of Agriculture, Food and Environmental Sciences, Catholic University of Sacred Heart, 26100 Cremona, Italy; (L.P.); (G.G.)
- Faculty of Psychology, Catholic University of Sacred Heart, 20123 Milan, Italy
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2
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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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3
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Godala M, Gaszyńska E, Durko Ł, Małecka-Wojciesko E. Dietary Behaviors and Beliefs in Patients with Inflammatory Bowel Disease. J Clin Med 2023; 12:jcm12103455. [PMID: 37240560 DOI: 10.3390/jcm12103455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Due to a lack of clear dietary guidelines, patients with inflammatory bowel disease (IBD) self-impose dietary restrictions based on their own nutritional experiences. The aim of this study was to investigate dietary perceptions and behavior in IBD patients. MATERIALS AND METHODS A total of 82 patients (48 with Crohn's disease and 34 with ulcerative colitis) participated in this prospective, questionnaire-based study. Based on a literature review, the questionnaire was developed to investigate dietary beliefs, behaviors and food exclusions during IBD relapses and remission. RESULTS The majority of patients (85.4%) believed that diet can be a trigger factor for IBD relapses, and 32.9% believed that diet initiates the disease. The majority of patients (81.7%) believed that they should eliminate some products from their diets. The most often-pointed-out products were spicy and fatty foods, raw fruits and vegetables, alcohol, leguminous foods, cruciferous vegetables, dairy products and milk. Most patients (75%) modified their diets after diagnosis, and 81.7% imposed food restrictions to prevent IBD relapses. CONCLUSIONS The majority of patients avoided certain foods during relapses as well as to maintain remission of IBD, basing this on their own beliefs, inconsistently with current scientific knowledge. Patient education should be a key determinant in IBD control.
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Affiliation(s)
- Małgorzata Godala
- Department of Nutrition and Epidemiology, Medical University of Lodz, 90-752 Lodz, Poland
| | - Ewelina Gaszyńska
- Department of Nutrition and Epidemiology, Medical University of Lodz, 90-752 Lodz, Poland
| | - Łukasz Durko
- Department of Digestive Tract Diseases, Medical University of Lodz, 90-153 Lodz, Poland
| | - Ewa Małecka-Wojciesko
- Department of Digestive Tract Diseases, Medical University of Lodz, 90-153 Lodz, Poland
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Brown SC, Wall CL, Gearry RB, Day AS. Exclusive Enteral Nutrition for the Treatment of Pediatric Crohn's Disease: The Patient Perspective. Pediatr Gastroenterol Hepatol Nutr 2023; 26:165-172. [PMID: 37214167 PMCID: PMC10192588 DOI: 10.5223/pghn.2023.26.3.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/16/2023] [Accepted: 02/12/2023] [Indexed: 05/24/2023] Open
Abstract
Crohn's disease (CD) is a chronic, incurable and relapsing disease involving any part of the gastrointestinal tract and exclusive enteral nutrition (EEN) is first-line therapy. Few studies have examined the patient experience of EEN. The aim of this study was to assess the child' s experiences of EEN, to identify problematic themes and understand the child's mindset. Children with CD who previously completed EEN were recruited to complete a survey. All data were analyzed using Microsoft Excel and reported as N (%). Forty-four children (mean age 11.3 years) consented to participate. Sixty-eight percent of children reported limited formula flavors as the most challenging aspect and 68% of children identified 'support' to be important. This study highlights the psychological impact of chronic disease and its therapies on children. Providing adequate support is essential to insure EEN is successful. Further studies are required to determine psychological support strategies for children taking EEN.
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Affiliation(s)
| | - Catherine L Wall
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Richard B Gearry
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Andrew S Day
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
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Özer Özlü NG, Vural F, Dökümcü ÜZ, Özcan C, Erdener HA. Nutritional Experiences of Parents of Children Who Had Gastric Transposition Surgery. Clin Nurs Res 2023; 32:138-148. [PMID: 35193414 DOI: 10.1177/10547738221078896] [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: 12/15/2022]
Abstract
This study aimed to understand the postoperative nutritional experiences of parents of children who had undergone gastric transposition surgery after corrosive esophageal injury. The study had a descriptive qualitative research design, and used a structured interview form as a result of the COVID-19 pandemic. The population of the study consisted of the parents of 12 children who had undergone gastric transposition surgery at the pediatric surgery clinic of a university hospital in an urban area in Turkey. Thematic analysis was conducted on the transcripts using the MAXQDA program. Four main themes emerged and five supporting sub-themes were identified. The main themes were what we experienced in the postoperative nutrition process, coping with how we live, what we want to know, and our recommendations to healthcare professionals. Family-centered care should be a main focus when caring children who have had gastric transposition surgery, and children and their parents should be supported by a multidisciplinary team.
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Affiliation(s)
- Nazife Gamze Özer Özlü
- Faculty of Nursing, Department of Surgery Nursing, Dokuz Eylül University Institute of Health Sciences, Inciralti, Izmir, Turkey
| | - Fatma Vural
- Faculty of Nursing, Department of Surgical Nursing, Dokuz Eylül University, Inciralti, Izmir, Turkey
| | - Ülküm Zafer Dökümcü
- Department of Pediatric Surgery, Ege University Health and Research Hospital, Bornova, Izmir, Turkey
| | - Coşkun Özcan
- Department of Pediatric Surgery, Ege University Health and Research Hospital, Bornova, Izmir, Turkey
| | - Hakkı Ata Erdener
- Department of Pediatric Surgery, Ege University Health and Research Hospital, Bornova, Izmir, Turkey
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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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7
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Dietary Nutrient Intake and Blood Micronutrient Status of Children with Crohn's Disease Compared with Their Shared-Home Environment, Healthy Siblings. Nutrients 2022; 14:nu14163425. [PMID: 36014931 PMCID: PMC9414980 DOI: 10.3390/nu14163425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
(1) The nutritional status of children with Crohn’s disease (CD) is rarely described. This study aimed to assess the dietary intake and blood micronutrient status of children with CD compared with their healthy, shared-environment siblings. (2) Methods: This observational study included children with CD (cases) and their shared-environment siblings (controls). The dietary nutrient intake was assessed with a four-day food/beverage diary and was compared with the recommended daily intakes (RDI). Blood micronutrient concentrations were measured using laboratory methods. The nutritional analyses were completed through a multivariate analysis of variance between groups. Between-group comparisons of single-nutrients were assessed using a Mann−Whitney U-test. Chi-squared analyses compared the proportion of children who did not meet the RDI for each nutrient. The results were significant at 0.05. (3) Results: The dietary intake was similar for most nutrients, except the controls had a lower intake of vitamins A and E, copper, zinc, iron, and selenium (p < 0.05). Children using partial enteral nutrition had significantly higher intakes of many micronutrients. It was common for both groups to not meet the RDI’s—more than 50% of cases for 9 nutrients and more than 50% of controls for 13 nutrients. (4) Conclusion: New Zealand children with CD and their shared-environment siblings did not meet the RDI for several micronutrients. Dietary education and/or micronutrient supplementation may be required.
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8
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Ahola Kohut S, Martincevic I, Turrell SL, Church PC, Walters TD, Weiser N, Iuliano A. Online Acceptance and Commitment Therapy and Nutrition Workshop for Parents of Children with Inflammatory Bowel Disease: Feasibility, Acceptability, and Initial Effectiveness. CHILDREN-BASEL 2021; 8:children8050396. [PMID: 34069305 PMCID: PMC8156170 DOI: 10.3390/children8050396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Abstract
Parents of children with inflammatory bowel disease (IBD) are important members of their healthcare team and influence their child’s adaptation to disease. The primary aim of this research was to test the feasibility and acceptability of a three-session online parent workshop based on acceptance and commitment therapy (ACT) and address concerns about eating well and nutrition in IBD. The secondary aim was to explore the initial effectiveness of this workshop in parent reported psychological flexibility, mindfulness, experiential avoidance, cognitive fusion, valued living, and symptoms of depression, anxiety, and stress. We used a single arm pragmatic prospective study design with parents of children attending the IBD program at a tertiary pediatric healthcare centre in Canada. Mixed methods patient reported outcomes were measured at baseline, immediate post participation, and 3 months post participation in the workshop. Thirty-seven parents enrolled in the study and feasibility and acceptability goals were largely met. Parents qualitatively described changes to their parenting, what aspects of the workshop were most helpful, and targeted feedback on how to improve workshop. Findings suggest that providing parents of children with IBD a brief online ACT workshop including nutrition guidance is feasible and leads to changes in parenting behaviours.
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Affiliation(s)
- Sara Ahola Kohut
- Department of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (P.C.C.); (T.D.W.)
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON M5G 1X8, Canada; (N.W.); (A.I.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5G 1X8, Canada
- Correspondence:
| | - Inez Martincevic
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | | | - Peter C. Church
- Department of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (P.C.C.); (T.D.W.)
- Department of Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Thomas D. Walters
- Department of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (P.C.C.); (T.D.W.)
- Department of Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Natalie Weiser
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON M5G 1X8, Canada; (N.W.); (A.I.)
| | - Armanda Iuliano
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON M5G 1X8, Canada; (N.W.); (A.I.)
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Castillo G, Mack DR, Lalu MM, Singleton R, Fergusson DA, Stintzi A, Harrison M, Presseau J. Factors contributing to fidelity in a pilot trial of individualized resistant starches for pediatric inflammatory bowel disease: a fidelity study protocol. Pilot Feasibility Stud 2021; 7:75. [PMID: 33741062 PMCID: PMC7976693 DOI: 10.1186/s40814-021-00815-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background The consumption of resistant starches is a promising adjuvant therapy for patients with inflammatory bowel disease. Rigorous evaluation of resistant starches in this setting depends on the intervention being delivered, received, and enacted as intended, that is, with fidelity. As part of a planned pilot trial, participants will be randomized to ingest resistant starches or a placebo. They will also be asked to collect stool samples and keep symptom and dose diaries to inform trial outcomes. We aim to identify potential factors impacting fidelity to the receipt and enactment of trial intervention and data collection activities from the perspective of patients and caregivers in the trial. Identifying fidelity barriers and enablers at the pilot trial phase of a clinical intervention may help to determine optimization processes when expanding to multiple sites in future trials. Methods We will conduct 15-30 semi-structured interviews with pilot trial participants (aged 8-17) and their caregivers. Trial participants will be approached for interviews approximately 6 months after the start of their trial participation. Personal projects analysis, a tool for understanding how individuals manage competing demands in their daily lives, will guide an in-depth exploration of how trial participants engage in activities related to intervention and data collection fidelity (ingesting resistant starches or placebo, collecting stool samples, keeping a symptom and dose diary) amidst the complexities of daily living. Discussion The present study will seek to explore and demonstrate how theory-informed fidelity assessments can be conducted alongside pilot trials to inform future multisite trials. Study results will clarify what factors may affect fidelity to trial intervention and data collection activities. Results may suggest what to modify to optimize the design and conduct, and ensure the integrity, of future multisite trials. Conducting process evaluations alongside clinical trials has the potential to improve our understanding of trial participant experiences. Results will provide a better understanding of how trial participants manage to engage in necessary trial activities along with other priorities. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00815-1.
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Affiliation(s)
- Gisell Castillo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - David R Mack
- Children's Hospital of Eastern Ontario Inflammatory Bowel Disease Centre, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Manoj M Lalu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - Ruth Singleton
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Alain Stintzi
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Megan Harrison
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada. .,Department of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
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Zangara MT, Bhesania N, Liu W, Cresci GAM, Kurowski JA, McDonald C. Impact of Diet on Inflammatory Bowel Disease Symptoms: An Adolescent Viewpoint. CROHN'S & COLITIS 360 2020; 2:otaa084. [PMID: 36777758 PMCID: PMC9802055 DOI: 10.1093/crocol/otaa084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Indexed: 12/19/2022] Open
Abstract
Background Dietary modification shows promise as therapy in inflammatory bowel disease (IBD); however, it is unknown whether adolescents are interested in a dietary approach. Methods Cross-sectional survey of adolescents with IBD ages 14-21 on disease knowledge, dietary habits, and perceptions of diet therapy. Results A total of 132 subjects (48.5% female), mean age of 17.8 years and median disease length of 5 years (range 0, 16), completed the survey. Diet was perceived as a symptom trigger by 59.8% of subjects, and 45.4% had tried using diet as a treatment for symptom resolution, often without physician supervision and with limited success. Subjects experiencing active disease symptoms as determined by Manitoba IBD Index were more likely to be currently modifying their diet compared to subjects without active disease symptoms (odds ratio = 4.11, confidence interval = 1.58, 10.73, P = 0.003). Conclusions Adolescents with IBD perceive a relationship between diet and disease symptoms and are interested in dietary modification as a symptom management option.
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Affiliation(s)
- Megan T Zangara
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA,Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Natalie Bhesania
- Division of Pediatric Gastroenterology and Nutrition, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Wei Liu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gail A M Cresci
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA,Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA,Department of Pediatric Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jacob A Kurowski
- Department of Pediatric Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christine McDonald
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA,Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA,Address correspondence to: Christine McDonald, PhD, Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195 ()
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11
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Mutsekwa RN, Edwards JT, Angus RL. Exclusive enteral nutrition in the management of Crohn's disease: a qualitative exploration of experiences, challenges and enablers in adult patients. J Hum Nutr Diet 2020; 34:440-449. [PMID: 33089552 DOI: 10.1111/jhn.12829] [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] [Received: 06/15/2020] [Revised: 09/04/2020] [Accepted: 09/28/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Exclusive enteral nutrition (EEN) is a first-line treatment for Crohn's disease in paediatrics with similar efficiency to corticosteroids. Benefits in adults have not been consistently observed with non-adherence cited as a limiting factor. This study aimed to gain an in depth understanding of the adult patient experience with EEN, identifying challenges and enablers to inform clinicians in the development of strategies to help increase patient adherence. METHODS This exploratory, qualitative study utilised individual semi-structured interviews with 17 adult patients who had completed EEN. Participants were purposively recruited across a range of ages, social backgrounds and clinical experience. Interviews were audio recorded, transcribed and independently thematically analysed by two researchers to provide consensus in identifying key themes. RESULTS Three major themes were identified. (i) Personal experience of EEN evolved over time, with the first few weeks the most challenging, becoming easier as symptoms improved, and participants became used to the EEN regimen. (ii) Participants developed coping strategies to manage challenges, including the impact on meal-based social participation and dietary restriction and monotony. (iii) Enabling factors for adherence to EEN included patient self-efficacy, health system support, supplement characteristics and access, and social support. CONCLUSIONS This study explored the evolving experiences of patients who completed a prescribed course of EEN. Patients described the challenges they faced, how they overcame them identifying enablers for adherence. This provides useful strategies for clinicians to integrate in their assessments and share with patients starting EEN.
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Affiliation(s)
- R N Mutsekwa
- Gold Coast Hospital and Health Service, Nutrition and Food Service Department, 1 Hospital Boulevard Southport, Southport, QLD, Australia.,Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, QLD, Australia
| | - J T Edwards
- Gold Coast Hospital and Health Service, Gastroenterology Department, 1 Hospital Boulevard Southport, Southport, QLD, Australia
| | - R L Angus
- Gold Coast Hospital and Health Service, Nutrition and Food Service Department, 1 Hospital Boulevard Southport, Southport, QLD, Australia.,School of Allied Health Sciences, Griffith University, Southport, QLD, Australia
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