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Maćków M, Kozioł-Kozakowska A, Szeląg M, Pytrus T, Raczkowska E, Neubauer K, Zawiślak I, Gajda R, Habánová M, Stawarski A. Use of Dietary Supplements among Polish Children with Inflammatory Bowel Disease: A Two-Center Pilot Study. Nutrients 2024; 16:2762. [PMID: 39203898 PMCID: PMC11356985 DOI: 10.3390/nu16162762] [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: 07/17/2024] [Revised: 08/17/2024] [Accepted: 08/18/2024] [Indexed: 09/03/2024] Open
Abstract
Inflammatory bowel disease (IBD) includes Crohn's disease (CD) and ulcerative colitis (UC). These diseases are characterized by inflammation, which may be a consequence of changes in the intestinal microbiota and lead to mineral and vitamin deficiencies. The aims of this study were to determine the level of dietary supplement intake in children with IBD and to determine the influence of factors such as sex, nutritional status, diet, and other comorbidities on supplement intake. The study was conducted from May 2022 to September 2023 and was a prospective study. The group of children with IBD that ultimately qualified for the study numbered 96, and the control group numbered 30. The children who participated in the study were aged 4-18 years. Most parents of children with IBD (81.4%) declared that they use supplementation for their children, while 75% of parents of children without IBD declared giving their children nutritional supplements. Vitamins in both groups were most often given to children as dietary supplements (p = 0.018), including vitamin D. Depending on the diet used, the intake of vitamin B6 (p = 0.018), vitamin E (p = 0.040) and iron (p = 0.006) was significantly different among children with IBD. Statistical significance (p = 0.021) was observed for supplementation use and disease stage among children with IBD. For 80.2% of parents of children with IBD, the main reason for using supplements was a doctor's recommendation. In the control group, 43.3% of parents indicated that the main reason for using supplements was to correct nutritional deficiencies. Supplementation was common in both groups, but attention should be paid to other current diseases in children with IBD and to nutritional status. In our opinion, educating parents about supplementation is important, especially among parents of children with IBD.
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Affiliation(s)
- Monika Maćków
- Department of Human Nutrition, Faculty of Biotechnology and Food Science, Wrocław University of Environmental and Life Sciences, Chełmońskiego 37, 51-630 Wrocław, Poland; (M.M.); (I.Z.); (R.G.)
- Regional Specialist Hospital in Wrocław, Research and Development Center, 51-124 Wrocław, Poland
| | - Agnieszka Kozioł-Kozakowska
- Department of Pediatrics, Gastroenterology and Nutrition, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Cracow, Poland;
| | - Magdalena Szeląg
- 2nd Department and Clinic of Paediatrics, Gastroenterology and Nutrition, Wrocław Medical University, 50-367 Wrocław, Poland; (M.S.); (T.P.); (A.S.)
| | - Tomasz Pytrus
- 2nd Department and Clinic of Paediatrics, Gastroenterology and Nutrition, Wrocław Medical University, 50-367 Wrocław, Poland; (M.S.); (T.P.); (A.S.)
| | - Ewa Raczkowska
- Department of Human Nutrition, Faculty of Biotechnology and Food Science, Wrocław University of Environmental and Life Sciences, Chełmońskiego 37, 51-630 Wrocław, Poland; (M.M.); (I.Z.); (R.G.)
| | - Katarzyna Neubauer
- Department and Clinic of Gastroenterology and Hepatology, Wrocław Medical University, 50-367 Wrocław, Poland;
| | - Ireneusz Zawiślak
- Department of Human Nutrition, Faculty of Biotechnology and Food Science, Wrocław University of Environmental and Life Sciences, Chełmońskiego 37, 51-630 Wrocław, Poland; (M.M.); (I.Z.); (R.G.)
| | - Robert Gajda
- Department of Human Nutrition, Faculty of Biotechnology and Food Science, Wrocław University of Environmental and Life Sciences, Chełmońskiego 37, 51-630 Wrocław, Poland; (M.M.); (I.Z.); (R.G.)
| | - Marta Habánová
- Institute of Nutrition and Genomics, Faculty of Agrobiology and Food Resources, Slovak University of Agriculture, Trieda Andreja Hlinku 2, 94976 Nitra, Slovakia;
| | - Andrzej Stawarski
- 2nd Department and Clinic of Paediatrics, Gastroenterology and Nutrition, Wrocław Medical University, 50-367 Wrocław, Poland; (M.S.); (T.P.); (A.S.)
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Gkikas K, Wan M, Svolos V, Nichols B, Hansen R, Russell RK, Gerasimidis K. YouTube as a Source of Information for Food, Diet-Related Items, and Advisory Comments for the Management of Inflammatory Bowel Disease. Inflamm Bowel Dis 2024; 30:347-356. [PMID: 37185900 PMCID: PMC10906362 DOI: 10.1093/ibd/izad076] [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: 12/21/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) often use the Internet to seek information beyond that received from healthcare professionals. This study assessed the perceptions of YouTube presenters on the role of diet in the management of IBD. METHODS Videos discussing dietary aspects (food, diet-related items, and advisory comments [FODRIACs]) in the management of IBD were included. The perceptions of presenters toward each FODRIAC were labeled as positive, negative, or neutral/intermediate, and FODRIACs were classified according to their underlying role in the management of IBD (eg, symptom management, gut inflammation). Subgroup analysis was performed by type of video presenter (patients vs healthcare professionals), type of IBD (Crohn's disease vs ulcerative colitis), and reporting of scientific evidence supporting presenters' perceptions. RESULTS We identified 122 FODRIACs within 160 videos. Patient videos received a higher number of likes (median 85 [interquartile range, 35-156]) than healthcare professional videos (median 44 [interquartile range, 16-1440]) (P = .01). Scientific evidence was cited in 2 (3%) of 76 patient videos compared with 25 (35%) of 71 healthcare professional videos (P < .001). Positive perceptions were expressed about avocadoes, salmon, bananas, white bread, and rice, whereas negative perceptions were reported for processed, high-fat and high-sugar foods and carbonated drinks. Fewer negative perceptions were expressed in videos supported by scientific evidence than in videos that lacked evidence (scientific: 4 positive, 0 negative vs nonscientific: 7 positive, 20 negative; P = .01). CONCLUSIONS We have identified FODRIACs proposed as beneficial or detrimental in the management of IBD. The effect this information has on dietary practice as patients with IBD self-manage their condition needs further exploration.
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Affiliation(s)
- Konstantinos Gkikas
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Mhairi Wan
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Vaios Svolos
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ben Nichols
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Richard Hansen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, United Kingdom
| | - Richard K Russell
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children and Young People Edinburgh, Edinburgh, United Kingdom
| | - Konstantinos Gerasimidis
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Lippert A, Renner B. Herb-Drug Interaction in Inflammatory Diseases: Review of Phytomedicine and Herbal Supplements. J Clin Med 2022; 11:1567. [PMID: 35329893 PMCID: PMC8951360 DOI: 10.3390/jcm11061567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/28/2022] [Accepted: 03/09/2022] [Indexed: 02/06/2023] Open
Abstract
Many people worldwide use plant preparations for medicinal purposes. Even in industrialized regions, such as Europe, where conventional therapies are accessible for the majority of patients, there is a growing interest in and usage of phytomedicine. Plant preparations are not only used as alternative treatment, but also combined with conventional drugs. These combinations deserve careful contemplation, as the complex mixtures of bioactive substances in plants show a potential for interactions. Induction of CYP enzymes and pGP by St John's wort may be the most famous example, but there is much more to consider. In this review, we shed light on what is known about the interactions between botanicals and drugs, in order to make practitioners aware of potential drug-related problems. The main focus of the article is the treatment of inflammatory diseases, accompanied by plant preparations used in Europe. Several of the drugs we discuss here, as basal medication in chronic inflammatory diseases (e.g., methotrexate, janus kinase inhibitors), are also used as oral tumor therapeutics.
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Affiliation(s)
- Annemarie Lippert
- Institute of Clinical Pharmacology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, 01069 Dresden, Germany;
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Steell L, Gray SR, Russell RK, MacDonald J, Seenan JP, Wong SC, Gaya DR. Pathogenesis of Musculoskeletal Deficits in Children and Adults with Inflammatory Bowel Disease. Nutrients 2021; 13:nu13082899. [PMID: 34445056 PMCID: PMC8398806 DOI: 10.3390/nu13082899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/11/2022] Open
Abstract
Musculoskeletal deficits are among the most commonly reported extra-intestinal manifestations and complications of inflammatory bowel disease (IBD), especially in those with Crohn’s disease. The adverse effects of IBD on bone and muscle are multifactorial, including the direct effects of underlying inflammatory disease processes, nutritional deficits, and therapeutic effects. These factors also indirectly impact bone and muscle by interfering with regulatory pathways. Resultantly, individuals with IBD are at increased risk of osteoporosis and sarcopenia and associated musculoskeletal morbidity. In paediatric IBD, these factors may contribute to suboptimal bone and muscle accrual. This review evaluates the main pathogenic factors associated with musculoskeletal deficits in children and adults with IBD and summarises the current literature and understanding of the musculoskeletal phenotype in these patients.
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Affiliation(s)
- Lewis Steell
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK; (L.S.); (S.R.G.)
| | - Stuart R. Gray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK; (L.S.); (S.R.G.)
| | - Richard K. Russell
- Department of Paediatric Gastroenterology, Royal Hospital for Sick Children, Edinburgh EH16 4TJ, UK;
| | - Jonathan MacDonald
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK; (J.M.); (J.P.S.)
| | - John Paul Seenan
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK; (J.M.); (J.P.S.)
| | - Sze Choong Wong
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow G51 4TF, UK;
| | - Daniel R. Gaya
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
- Correspondence:
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Gkikas K, Gerasimidis K, Milling S, Ijaz UZ, Hansen R, Russell RK. Dietary Strategies for Maintenance of Clinical Remission in Inflammatory Bowel Diseases: Are We There Yet? Nutrients 2020; 12:E2018. [PMID: 32645980 PMCID: PMC7400838 DOI: 10.3390/nu12072018] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
The etiopathogenesis of Inflammatory bowel disease (IBD) is a result of a complex interaction between host immune response, the gut microbiome and environmental factors, such as diet. Although scientific advances, with the use of biological medications, have revolutionized IBD treatment, the challenge for maintaining clinical remission and delaying clinical relapse is still present. As exclusive enteral nutrition has become a well-established treatment for the induction of remission in pediatric Crohn's disease, the scientific interest regarding diet in IBD is now focused on the development of follow-on dietary strategies, which aim to suppress colonic inflammation and delay a disease flare. The objective of this review is to present an extensive overview of the dietary strategies, which have been used in the literature to maintain clinical remission in both Crohn's disease and Ulcerative colitis, and the evidence surrounding the association of dietary components with clinical relapse. We also aim to provide study-related recommendations to be encompassed in future research studies aiming to investigate the role of diet during remission periods in IBD.
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Affiliation(s)
- Konstantinos Gkikas
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, UK; (K.G.); (K.G.)
| | - Konstantinos Gerasimidis
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, UK; (K.G.); (K.G.)
| | - Simon Milling
- Institute for Infection, Immunity and Inflammation, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Umer Z. Ijaz
- Civil Engineering, School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Richard Hansen
- Department of Paediatric Gastroenterology, Royal Hospital for Children, Glasgow G51 4TF, UK;
| | - Richard K. Russell
- Department of Paediatric Gastroenterology, Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK
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Logan M, Gkikas K, Svolos V, Nichols B, Milling S, Gaya DR, Seenan JP, Macdonald J, Hansen R, Ijaz UZ, Russell RK, Gerasimidis K. Analysis of 61 exclusive enteral nutrition formulas used in the management of active Crohn's disease-new insights into dietary disease triggers. Aliment Pharmacol Ther 2020; 51:935-947. [PMID: 32249975 PMCID: PMC8653890 DOI: 10.1111/apt.15695] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/25/2019] [Accepted: 03/01/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Exclusive enteral nutrition (EEN) is an effective treatment for Crohn's disease. AIMS To investigate the hypothesis that ingredients of EEN formulas are unlikely to initiate a disease flare and that their dietary elimination is not essential for disease amelioration. METHODS We performed compositional analysis of EEN formulas with evidence of efficacy in management of active Crohn's disease. Macronutrient content was compared against the dietary reference values (DRV), the UK National Diet and Nutrition Survey (NDNS) and intake of Crohn's disease children. Food additives were cross-referenced against the FAO/WHO database. RESULTS Sixty-one formulas were identified with variable composition (carbohydrates [22.8%-89.3%], protein [7.8%-30.1%], fat [0%-52.5%]). Maltodextrin, milk protein and vegetable/plant oils were the commonest macronutrient sources. Their n-6:n-3 fatty acid ratio varied from 0.25 to 46.5. 56 food additives were identified (median per formula: 11). All formulas were lactose-free, gluten-free, and 82% lacked fibre. The commonest food additives were emulsifiers, stabilisers, antioxidants, acidity regulators and thickeners. Food additives, implicated in Crohn's disease aetiology, were present in formulas (modified starches [100%], carrageenan [22%], carboxymethyl cellulose [13%] and polysorbate 80 [5%]). Remission rates did not differ between EEN formulas with and without those food additives. Analysis including only formulas from randomised controlled trials (RCTs) retained in the latest Cochrane meta-analysis produced similar findings. EEN formulas contained less energy from saturated fat than NDNS intake. CONCLUSION We have identified food ingredients which are present in EEN formulas that are effective in Crohn's disease and challenge perceptions that these ingredients might be harmful.
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Affiliation(s)
- Michael Logan
- Human NutritionSchool of Medicine, Dentistry and NursingUniversity of GlasgowGlasgow Royal InfirmaryGlasgowUK,Civil EngineeringSchool of EngineeringUniversity of GlasgowGlasgowUK
| | - Konstantinos Gkikas
- Human NutritionSchool of Medicine, Dentistry and NursingUniversity of GlasgowGlasgow Royal InfirmaryGlasgowUK
| | - Vaios Svolos
- Human NutritionSchool of Medicine, Dentistry and NursingUniversity of GlasgowGlasgow Royal InfirmaryGlasgowUK
| | - Ben Nichols
- Human NutritionSchool of Medicine, Dentistry and NursingUniversity of GlasgowGlasgow Royal InfirmaryGlasgowUK
| | - Simon Milling
- Institute for Infection, Immunity and InflammationUniversity of GlasgowGlasgowUK
| | - Daniel R. Gaya
- Department of GastroenterologyGlasgow Royal InfirmaryGlasgowUK
| | - John Paul Seenan
- Department of GastroenterologyQueen Elizabeth University HospitalNHS Greater Glasgow & ClydeGlasgowUK
| | - Jonathan Macdonald
- Department of GastroenterologyQueen Elizabeth University HospitalNHS Greater Glasgow & ClydeGlasgowUK
| | - Richard Hansen
- Department of Paediatric GastroenterologyRoyal Hospital for ChildrenGlasgowUK
| | - Umer Z. Ijaz
- Civil EngineeringSchool of EngineeringUniversity of GlasgowGlasgowUK
| | - Richard K. Russell
- Department of Paediatric GastroenterologyRoyal Hospital for ChildrenGlasgowUK
| | - Konstantinos Gerasimidis
- Human NutritionSchool of Medicine, Dentistry and NursingUniversity of GlasgowGlasgow Royal InfirmaryGlasgowUK
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Abstract
Complementary and alternative medicine (CAM) consists of products and practices that are not considered to be a part of conventional medicine. This article reviews pediatric studies on CAM in inflammatory bowel disease (IBD) along with relevant adult studies. Prevalence of CAM use ranges from 22% to 84% in children with IBD all over the world. CAM use in IBD includes diet changes, supplements, herbals, botanicals, and mind-body therapies. Common reasons for using CAM include severe disease and concern for adverse effects of conventional medicines. Despite widespread use, there are limited studies on efficacy and safety of CAM in children. Small studies suggest a favorable evidence for use of probiotics, fish oil, marijuana, and mind-body therapy in IBD. Adverse effects of CAM are reported but are rare. The article provides current state of knowledge on the topic and provides guidance to physicians to address CAM use in pediatric patients with IBD.
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Ong F, Seah Lee W, Lin C, Ng RT, Yee Wong S, Lim SL, Quak SH, Aw M. Complementary and alternative medicine (CAM) practices and dietary patterns in children with inflammatory bowel disease in Singapore and Malaysia. Pediatr Neonatol 2018; 59:494-500. [PMID: 29352665 DOI: 10.1016/j.pedneo.2017.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 06/06/2017] [Accepted: 12/19/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The use of complementary and alternative medicine (CAM) has been associated with adverse effects and self-imposed dietary restrictions. The prevalence of its use in Asian children with inflammatory bowel disease (IBD) is unknown. We aimed to determine the prevalence, types, and factors associated with the use of CAM among children with IBD from Singapore and Malaysia, and to ascertain if dietary restriction was prevalent in patients who used CAM. METHODS A cross-sectional study was conducted in which parents of children with IBD attending two tertiary pediatric IBD referral centres in Singapore and Malaysia were interviewed. Data about demographics, conventional treatment, complementary therapies and dietary patterns were collected in a questionnaire. RESULTS Of 64 children with IBD interviewed, 83% (n = 53) reported the use of CAM (Singapore [90%] vs. Malaysia [76%]; p = 0.152). The median number of CAM agents used was two (range 1-10). The three most common types of CAM used were probiotics (64%), vitamin and mineral supplements (55%), and food-based therapies (36%). Among individual CAM categories, the use of food-based therapies was correlated significantly with nationality (r = 0.497, p < 0.001), history of weight loss due to IBD (r = 0.340, p = 0.013) and avoidance of certain foods to prevent a relapse (r = 0.289, p = 0.036). Parents who rated their child's disease activity as more severe were less likely to use CAM (r = -0.257, p = 0.041). Fifty-nine percent of CAM users reported physician awareness of their CAM use. The overall self-perceived efficacy of CAM in improving IBD symptoms was 34%. Of the dietary patterns explored, only intake of dairy products was associated with CAM use (r = 0.306, p = 0.019). CONCLUSION Use of CAM is prevalent in children with IBD in Malaysia and Singapore. Further studies to elucidate reasons influencing CAM use, dietary patterns and efficacy of commonly used CAM would be required.
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Affiliation(s)
- Fangyi Ong
- Department of Dietetics, National University Hospital, Singapore.
| | - Way Seah Lee
- Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia; Pediatrics and Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia
| | - Charlotte Lin
- Department of Dietetics, National University Hospital, Singapore
| | - Ruey Terng Ng
- Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Shin Yee Wong
- Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Su Lin Lim
- Department of Dietetics, National University Hospital, Singapore
| | - Seng Hock Quak
- Department of Pediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Marion Aw
- Department of Pediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Cottingham P, Adams J, Vempati R, Dunn J, Sibbritt D. The Characteristics, Experiences and Perceptions of Registered Massage Therapists in New Zealand: Results from a National Survey of Practitioners. Int J Ther Massage Bodywork 2018; 11:11-24. [PMID: 29881478 PMCID: PMC5988344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Massage therapy is widely recognized as offering many health benefits, with a growing number of studies finding it has value in stress management, pain reduction, and overcoming physical limitations. However, there are few studies of massage therapists practices and perceptions in New Zealand and internationally. This paper reports the findings from the first national survey examining the characteristics, perceptions, and experiences of New Zealand-based massage therapists on a range of aspects related to their role and practices. PURPOSE This study sought to ascertain the characteristics, experiences, and perceptions of massage therapists in New Zealand, particularly in the aspects of: integration of health care; attitudes and practices related to research; and evidence and attitudes to registration. SETTING Massage practice in New Zealand (nationwide survey). PARTICIPANTS Members of Massage New Zealand (a massage practitioners association). RESEARCH DESIGN Massage practitioners were surveyed online, using a 65-part questionnaire, on a range of characteristics of their practices and their attitudes to research, integration, and registration. Statistical analysis was performed using STATA. Statistical significance was set at 0.05. MAIN OUTCOME MEASURES Four hundred massage therapists (MTs) were invited to participate and 115 responded, providing a response rate of 29%. MTs valued research (95%) and perceived that it had an impact for their practices (88%). Significant correlations were found for research value and: mean case-load (p = .009) and level of academic qualification (p = .004). The majority of MTs (79%) supported integration with conventional practitioners, and 83% referred clients to general practitioners, with 75% receiving referrals from general practitioners. Ninety-three percent of MTs supported registration, with 67% of those supporting statutory registration. CONCLUSION Massage practitioners perceive that they make a significant contribution to health care, but area of practice, such as research, and referral and integration into mainstream health care require more in-depth investigation.
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Affiliation(s)
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology, Sydney, Australia
| | - Ram Vempati
- Wellpark College of Natural Therapies, Auckland, New Zealand
| | - Jill Dunn
- Wellpark College of Natural Therapies, Auckland, New Zealand
| | - David Sibbritt
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology, Sydney, Australia
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Beliveau PJH, Wong JJ, Sutton DA, Simon NB, Bussières AE, Mior SA, French SD. The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided. Chiropr Man Therap 2017; 25:35. [PMID: 29201346 PMCID: PMC5698931 DOI: 10.1186/s12998-017-0165-8] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/31/2017] [Indexed: 12/31/2022] Open
Abstract
Background Previous research has investigated utilization rates, who sees chiropractors, for what reasons, and the type of care that chiropractors provide. However, these studies have not been comprehensively synthesized. We aimed to give a global overview by summarizing the current literature on the utilization of chiropractic services, reasons for seeking care, patient profiles, and assessment and treatment provided. Methods Systematic searches were conducted in MEDLINE, CINAHL, and Index to Chiropractic Literature using keywords and subject headings (MeSH or ChiroSH terms) from database inception to January 2016. Eligible studies: 1) were published in English or French; 2) were case series, descriptive, cross-sectional, or cohort studies; 3) described patients receiving chiropractic services; and 4) reported on the following theme(s): utilization rates of chiropractic services; reasons for attending chiropractic care; profiles of chiropractic patients; or, types of chiropractic services provided. Paired reviewers independently screened all citations and data were extracted from eligible studies. We provided descriptive numerical analysis, e.g. identifying the median rate and interquartile range (e.g., chiropractic utilization rate) stratified by study population or condition. Results The literature search retrieved 14,149 articles; 328 studies (reported in 337 articles) were relevant and reported on chiropractic utilization (245 studies), reason for attending chiropractic care (85 studies), patient demographics (130 studies), and assessment and treatment provided (34 studies). Globally, the median 12-month utilization of chiropractic services was 9.1% (interquartile range (IQR): 6.7%-13.1%) and remained stable between 1980 and 2015. Most patients consulting chiropractors were female (57.0%, IQR: 53.2%-60.0%) with a median age of 43.4 years (IQR: 39.6-48.0), and were employed (median: 77.3%, IQR: 70.3%-85.0%). The most common reported reasons for people attending chiropractic care were (median) low back pain (49.7%, IQR: 43.0%-60.2%), neck pain (22.5%, IQR: 16.3%-24.5%), and extremity problems (10.0%, IQR: 4.3%-22.0%). The most common treatment provided by chiropractors included (median) spinal manipulation (79.3%, IQR: 55.4%-91.3%), soft-tissue therapy (35.1%, IQR: 16.5%-52.0%), and formal patient education (31.3%, IQR: 22.6%-65.0%). Conclusions This comprehensive overview on the world-wide state of the chiropractic profession documented trends in the literature over the last four decades. The findings support the diverse nature of chiropractic practice, although common trends emerged.
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Affiliation(s)
| | - Jessica J. Wong
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Canada
- Department of Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON M2H 3J1 Canada
| | - Deborah A. Sutton
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Canada
| | - Nir Ben Simon
- Department of Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON M2H 3J1 Canada
| | - André E. Bussières
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
- Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
- Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, Canada
| | - Silvano A. Mior
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Canada
- Department of Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON M2H 3J1 Canada
| | - Simon D. French
- Department of Public Health Sciences, Queen’s University, Kingston, Canada
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
- Department of Chiropractic, Macquarie University, Sydney, Australia
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Svolos V, Gerasimidis K, Buchanan E, Curtis L, Garrick V, Hay J, Laird S, Munro J, Gaya DR, Russell RK, Hansen R. Dietary treatment of Crohn's disease: perceptions of families with children treated by exclusive enteral nutrition, a questionnaire survey. BMC Gastroenterol 2017; 17:14. [PMID: 28103809 PMCID: PMC5247812 DOI: 10.1186/s12876-016-0564-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/22/2016] [Indexed: 01/13/2023] Open
Abstract
Background Diet is strongly associated with the aetiology of Crohn’s Disease (CD) and exclusive enteral nutrition (EEN) is the primary induction treatment in paediatric CD. This study explored opinions around the use of EEN and alternative novel, solid food-based diets (SFDs) expressed by paediatric patients with CD, previously treated with EEN and their parents. Methods This anonymous questionnaire surveyed families of CD patients treated with EEN over 1 year. Two questionnaire forms were completed; one asking the patients’ opinions and another referring to their main carer. This questionnaire explored participants’ demographic characteristics; acceptability of a repeat EEN course to treat a future flare (EEN repeat); their opinion on how difficult EEN would be compared to an example SFD; and their intention to participate in a future clinical trial assessing the therapeutic efficacy of an SFD in CD. Results Forty-one families of CD patients were approached with 29 sending replies (71%). Most of our participants were positive on completing another EEN course, however the majority would choose an SFD alternative (Patients:66, Parents:72%). Both patients and their parents rated EEN to be more difficult to adhere to compared to an example SFD (p < 0.05), and their ratings were strongly correlated (EEN:r = 0.83, SFD:r = 0.75, p < 0.001). The majority of our respondents would agree to participate in a clinical trial assessing an SFD’s effectiveness (Patients:79, Parents:72%) for the management of active CD. Conclusions While patients with CD and their families would accept an EEN repeat, the majority would prefer an SFD alternative. CD families surveyed are supportive of the development of solid food-based dietary treatments. Electronic supplementary material The online version of this article (doi:10.1186/s12876-016-0564-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vaios Svolos
- Human Nutrition, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Konstantinos Gerasimidis
- Human Nutrition, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Elaine Buchanan
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - Lee Curtis
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - Vikki Garrick
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - Jacqueline Hay
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - Susan Laird
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Joanna Munro
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Daniel R Gaya
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Richard K Russell
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - Richard Hansen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK.
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Dietary Creatine as a Possible Novel Treatment for Crohn's Ileitis. ACG Case Rep J 2016; 3:e173. [PMID: 28008406 PMCID: PMC5171926 DOI: 10.14309/crj.2016.146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 07/07/2016] [Indexed: 12/22/2022] Open
Abstract
Creatine, a commonly used dietary supplement, plays an important role in maintaining gut barrier function. Given that dysregulation of the intestinal epithelial barrier is a hallmark of inflammatory bowel disease, it is plausible that creatine supplementation may attenuate disease severity. We present a patient with Crohn’s ileitis who responded to creatine supplementation with both symptomatic and endoscopic improvement in disease activity.
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Serpico MR, Boyle BM, Kemper KJ, Kim SC. Complementary and Alternative Medicine Use in Children With Inflammatory Bowel Diseases: A Single-Center Survey. J Pediatr Gastroenterol Nutr 2016; 63:651-657. [PMID: 26960176 DOI: 10.1097/mpg.0000000000001187] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The prevalence of inflammatory bowel diseases (IBD) and use of complementary and alternative medicine (CAM) are both common and increasing. The definition of CAM therapy among both practitioners and patients is variable. The aim of our study was to update our understanding of how pediatric IBD patients use, perceive, and define CAM therapies. METHODS We surveyed families of patients with IBD followed in the Gastroenterology Division at Nationwide Children's Hospital in summer 2014 during a routine clinic visit. The survey included questions about the following demographic and disease information; use and side effects associated with prior conventional therapies (CT); and attitudes toward, and use of CAM. RESULTS The questionnaire was completed by 104 of 118 patients approached (14 ± 3 years; 43% women). Patients had previously used an average of 3 CT. CAM therapy was used by 84% of patients surveyed, although only 24% of patients/families considered themselves to be using CAM. Common CAM therapies included vitamins/supplements, stress management techniques, and/or dietary changes. Factors associated with using specific CAM therapies included self-reported prior CT-related side effects (P < 0.01) and moderate/severe disease activity (P < 0.01). Most families (77%) desired to learn more about CAM. CONCLUSIONS Patients seen in a tertiary care center for pediatric IBD frequently integrated CAM therapies into their treatment regimen. Patients with prior side effects from CT or more severe disease were more likely to use CAM. Given the high prevalence of CAM use, pediatric gastrointestinal physicians should be knowledgeable and open to discussions about CAM therapies with their patients.
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Affiliation(s)
- Mark R Serpico
- *Division of Gastroenterology, Nationwide Children's Hospital, Columbus †Boonshoft School of Medicine, Wright State University, Dayton ‡Department of Pediatrics §Center for Integrative Health and Wellness, The Ohio State University College of Medicine, Columbus, OH
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Abstract
Crohn's disease in childhood causes linear growth retardation, which has a substantial effect on management of this disease. By contrast, growth is rarely a problem in children presenting with ulcerative colitis. Depending on how growth failure is defined, approximately one-third of children with Crohn's disease have growth retardation at diagnosis. Although corticosteroids can suppress growth, decreased height at diagnosis demonstrates that this finding is a consequence of the disease and not merely an adverse effect of treatment. Both inflammation and undernutrition contribute to decreased height velocity. Increased cytokine production acts both on the hepatic expression of insulin-like growth factor 1 (IGF-1) and at chondrocytes of the growth plates of long bones. Growth hormone insensitivity caused by deranged immune function is a major mechanism in growth retardation. Resolution of inflammation is the cornerstone of treatment, but current studies on growth hormone and IGF-1 might yield therapies for those children whose inflammation is refractory to treatment.
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Affiliation(s)
- Ian R Sanderson
- Centre for Digestive Diseases, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London. 4 Newark Street, London E1 2AT, UK
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15
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Complementary and Alternative Medicine Use at a Single Pediatric Inflammatory Bowel Disease Center. Gastroenterol Nurs 2014; 37:265-71. [DOI: 10.1097/sga.0000000000000050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Nissen N, Schunder-Tatzber S, Weidenhammer W, Johannessen H. What attitudes and needs do citizens in Europe have in relation to complementary and alternative medicine? ACTA ACUST UNITED AC 2014; 19 Suppl 2:9-17. [PMID: 23883940 DOI: 10.1159/000342710] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Surveys from several European countries suggest a European-wide increase in the use of Complementary and Alternative Medicine (CAM). To safeguard citizens' rights concerning their healthcare, it is critical to gain an overview of citizens' attitudes and to understand their expectations and needs regarding CAM. METHODS A review of literature was undertaken, based on systematic searches of the following electronic databases: PubMed, Web of Science, CINHAL, AMED, PsycINFO and PsycArticles; 189 articles met inclusion criteria. Articles were analysed thematically and their reporting quality assessed. RESULTS Despite the limited availability of research-based knowledge about citizens' attitudes and needs concerning CAM in many European countries, some trends can be noted. Many citizens hold positive attitudes to CAM and wish for increasing access to CAM provision. Citizens call for impartial, reliable and trustworthy information to support informed decision-making, and some citizens wish for greater support and involvement of biomedical healthcare professionals in facilitating their healthcare choices. While citizens value distinct aspects of CAM practice, they are also critical consumers and support clear regulatory and educational frameworks to ensure the quality and safety of CAM provision and medicinal products. CONCLUSION To gain knowledge on citizens' needs and attitudes to CAM across Europe further research is required on 3 main issues: i) how citizens across Europe obtain information about CAM and the needs they may have for trustworthy information sources, ii) the local situations for accessing CAM and iii) citizens' perspectives on the quality of care and safety of CAM provision and products.
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Affiliation(s)
- Nina Nissen
- Institute of Public Health, University of Southern Denmark, Odense, Denmark.
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Nousiainen P, Merras-Salmio L, Aalto K, Kolho KL. Complementary and alternative medicine use in adolescents with inflammatory bowel disease and juvenile idiopathic arthritis. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 14:124. [PMID: 24708564 PMCID: PMC4101821 DOI: 10.1186/1472-6882-14-124] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 03/31/2014] [Indexed: 12/26/2022]
Abstract
Background The use of complementary alternative medicine (CAM) is potentially prevalent among paediatric patients with chronic diseases but with variable rates among different age groups, diseases and countries. There are no recent reports on CAM use among paediatric patients with inflammatory bowel disease (IBD) and juvenile idiopathic arthritis (JIA) in Europe. We hypothesized that CAM use associates with a more severe disease in paediatric IBD and JIA. Methods A cross-sectional questionnaire study among adolescent outpatients with IBD and JIA addressing the frequency and type of CAM use during the past year. The patients were recruited at the Children’s Hospital, University of Helsinki, Finland. Results Of the 147 respondents, 97 had IBD (Crohn’s disease: n = 46; median age 15.5, disease duration 3.4 years) and 50 had JIA (median age 13.8, disease duration 6.9 years). During the past 12 months, 48% regularly used CAM while 81% reported occasional CAM use. Compared to patients with JIA, the use of CAM in IBD patients tended to be more frequent. The most commonly used CAM included probiotics, multivitamins, and mineral and trace element supplements. Self-imposed dietary restrictions were common, involving 27.6% of the non-CAM users but 64.8% of all CAM users. Disease activity was associated with CAM use in JIA but not in IBD. Conclusions CAM use is frequent among adolescents with IBD and JIA and associates with self-imposed dietary restrictions. Reassuringly, adherence to disease modifying drugs is good in young CAM users. In JIA, patients with active disease used more frequently CAM than patients with inactive disease. As CAM use is frequent, physicians should familiarise themselves with the basic concepts of CAM. The potential pharmacological interaction or the toxicity of certain CAM products warrants awareness and hence physicians should actively ask their patients about CAM use.
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Tsiountsioura M, Wong JE, Upton J, McIntyre K, Dimakou D, Buchanan E, Cardigan T, Flynn D, Bishop J, Russell RK, Barclay A, McGrogan P, Edwards C, Gerasimidis K. Detailed assessment of nutritional status and eating patterns in children with gastrointestinal diseases attending an outpatients clinic and contemporary healthy controls. Eur J Clin Nutr 2014; 68:700-6. [DOI: 10.1038/ejcn.2013.286] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 12/03/2013] [Accepted: 12/07/2013] [Indexed: 01/04/2023]
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Chin-Lee B, Curry WJ, Fetterman J, Graybill MA, Karpa K. Patient experience and use of probiotics in community-based health care settings. Patient Prefer Adherence 2014; 8:1513-20. [PMID: 25382972 PMCID: PMC4222242 DOI: 10.2147/ppa.s72276] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To investigate patient experience with probiotics and factors that influence probiotic use among adult patients. METHOD Patients were invited to complete a questionnaire that assessed their experiences and opinions regarding probiotics. Questionnaires were distributed to patients seeking primary health care services at a family and community medicine practice site and a community pharmacy. Patients were invited to complete the questionnaire while awaiting the physician or waiting for prescriptions to be filled. RESULTS Overall, 162 surveys were completed and returned (66% response rate) from patients aged 18 to 89 years of age (mean 49.5 years). Most patients (n=107; 65%) were familiar with the term "probiotic", and 49 patients (29.9%) had personally used the supplements in the past. Of those who had used probiotics, the majority (57%) had used the supplements to maintain "good gastrointestinal health" and most (59%) felt that the supplements had been beneficial. However, most (59%) had not informed their health care provider about their use of the supplements. CONCLUSION Use of probiotic supplements is common among consumers, but may not be reported to health care providers.
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Affiliation(s)
- Blake Chin-Lee
- Department of Family and Community Medicine, Pennsylvania State University, College of Medicine Hershey, PA, USA
| | - William J Curry
- Department of Family and Community Medicine, Pennsylvania State University, College of Medicine Hershey, PA, USA
| | - John Fetterman
- Department of Pharmacology, Pennsylvania State University, College of Medicine Hershey, PA, USA
| | - Marie A Graybill
- Department of Family and Community Medicine, Pennsylvania State University, College of Medicine Hershey, PA, USA
| | - Kelly Karpa
- Department of Pharmacology, Pennsylvania State University, College of Medicine Hershey, PA, USA
- Correspondence: Kelly Karpa, Pennsylvania State University, Department of Pharmacology, College of Medicine, 500 University Drive, Mailcode R130, Hershey, PA, USA 17033, Tel +1 717 531 1621, Fax +1 717 533 2006, Email
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Posadzki P, Watson LK, Alotaibi A, Ernst E. Prevalence of use of complementary and alternative medicine (CAM) by patients/consumers in the UK: systematic review of surveys. CLINICAL MEDICINE (LONDON, ENGLAND) 2013. [PMID: 23681857 DOI: 10.7861/clinmedicine.13-2-126.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This systematic review aimed to estimate the prevalence of use of complementary and alternative medicine (CAM) in the UK. Five databases were searched for English language, peer-reviewed surveys published between 1 January 2000 and 7 October 2011. In addition, relevant book chapters and files from our own departmental records were searched by hand. Eighty-nine surveys were included, with a total of 97,222 participants. Most studies were of poor methodological quality. Across surveys on CAM in general, the average one-year prevalence of use of CAM was 41.1% and the average lifetime prevalence was 51.8%. In methodologically sound surveys, the equivalent rates were 26.3% and 44%, respectively. In surveys with response rates >70%, average one-year prevalence was nearly threefold lower than in surveys with response rates between 21% and 50%. Herbal medicine was the most popular CAM, followed by homeopathy, aromatherapy, massage and reflexology. Many patients and consumers in the UK use CAM; healthcare professionals should therefore responsibly advise their patients about the use of CAM.
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21
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Strisciuglio C, Giannetti E, Martinelli M, Sciorio E, Staiano A, Miele E. Does cow's milk protein elimination diet have a role on induction and maintenance of remission in children with ulcerative colitis? Acta Paediatr 2013; 102:e273-8. [PMID: 23445275 DOI: 10.1111/apa.12215] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 02/11/2013] [Accepted: 02/20/2013] [Indexed: 02/06/2023]
Abstract
AIM Aims of this study were to evaluate the efficacy of a cow's milk protein (CMP) elimination diet on induction and maintenance of remission and to define association with atopy in children with ulcerative colitis (UC). METHODS Twenty-nine consecutive patients (mean age: 11.2 years; range: 4.6-17 years; F/M: 15/14) with newly diagnosed UC were randomized either to receive a CMP elimination diet (n = 14) or to continue a free diet (n = 15) associated with concomitant steroid induction and mesalazine maintenance treatment. Children were prospectively evaluated at four time points: within 1 month, 6 months and 1 year after diagnosis or at the time of relapse. RESULTS Twenty-five of the 29 enrolled patients responded to the UC induction therapy with a complete remission (86.2%), 13 belonging to CMP elimination diet group and 12 to free diet group (p = 0.59). Overall, our data showed that 7 of 13 (53.8%) patients treated with CMP elimination diet and 8 of 15 (53.3%) patients on free diet and UC therapy relapsed within 1 year of follow-up (p = 1). CONCLUSIONS In conclusion, data of this paediatric, randomized trial suggest that CMP elimination has no role in the management of UC in non-sensitized children.
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Affiliation(s)
- Caterina Strisciuglio
- Department of Translational Medical Science, Section of Pediatrics; University of Naples “Federico II”; Naples Italy
| | - Eleonora Giannetti
- Department of Translational Medical Science, Section of Pediatrics; University of Naples “Federico II”; Naples Italy
| | - Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics; University of Naples “Federico II”; Naples Italy
| | - Elisa Sciorio
- Department of Translational Medical Science, Section of Pediatrics; University of Naples “Federico II”; Naples Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics; University of Naples “Federico II”; Naples Italy
| | - Erasmo Miele
- Department of Translational Medical Science, Section of Pediatrics; University of Naples “Federico II”; Naples Italy
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Day AS. A review of the use of complementary and alternative medicines by children with inflammatory bowel disease. Front Pediatr 2013; 1:9. [PMID: 24400255 PMCID: PMC3860894 DOI: 10.3389/fped.2013.00009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 04/18/2013] [Indexed: 01/23/2023] Open
Abstract
The Inflammatory Bowel Diseases (IBDs) are diagnosed more commonly in children and adolescents. Following diagnosis, the key objectives are to achieve and then maintain remission. Although some therapies are able to effectively modify and modulate inflammatory events, none of the available interventions cure these conditions. Consequently, children and their parents face uncertainty and may look to alternative management options as ways to help their child, which may include various complementary and alternative medicines (CAMs). A number of studies have shown that many children with IBD receive or are given CAM agents. This article reviews the rates and patterns of CAM use in children with IBD, and emphasizes the increasing importance of these aspects of the management of children with IBD.
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Affiliation(s)
- Andrew S Day
- Department of Paediatrics, University of Otago Christchurch Christchurch, New Zealand
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Posadzki P, Watson LK, Alotaibi A, Ernst E. Prevalence of use of complementary and alternative medicine (CAM) by patients/consumers in the UK: systematic review of surveys. Clin Med (Lond) 2013; 13:126-31. [PMID: 23681857 PMCID: PMC4952625 DOI: 10.7861/clinmedicine.13-2-126] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This systematic review aimed to estimate the prevalence of use of complementary and alternative medicine (CAM) in the UK. Five databases were searched for English language, peer-reviewed surveys published between 1 January 2000 and 7 October 2011. In addition, relevant book chapters and files from our own departmental records were searched by hand. Eighty-nine surveys were included, with a total of 97,222 participants. Most studies were of poor methodological quality. Across surveys on CAM in general, the average one-year prevalence of use of CAM was 41.1% and the average lifetime prevalence was 51.8%. In methodologically sound surveys, the equivalent rates were 26.3% and 44%, respectively. In surveys with response rates >70%, average one-year prevalence was nearly threefold lower than in surveys with response rates between 21% and 50%. Herbal medicine was the most popular CAM, followed by homeopathy, aromatherapy, massage and reflexology. Many patients and consumers in the UK use CAM; healthcare professionals should therefore responsibly advise their patients about the use of CAM.
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Zuzak TJ, Boňková J, Careddu D, Garami M, Hadjipanayis A, Jazbec J, Merrick J, Miller J, Ozturk C, Persson IAL, Petrova G, Saz Peiró P, Schraub S, Simões-Wüst AP, Steinsbekk A, Stockert K, Stoimenova A, Styczynski J, Tzenova-Savova A, Ventegodt S, Vlieger AM, Längler A. Use of complementary and alternative medicine by children in Europe: published data and expert perspectives. Complement Ther Med 2013; 21 Suppl 1:S34-47. [PMID: 23578916 DOI: 10.1016/j.ctim.2012.01.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Revised: 12/14/2011] [Accepted: 01/03/2012] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Few data document the use of complementary and alternative medicine (CAM) in Europe, with even fewer investigating use by children. METHODS A narrative, non-systematic review of CAM use in Europe was performed by combining data from published surveys with expert perspectives. Limitations created by a lack of representative studies, varying definitions of CAM use, and what qualifies as CAM in different countries was partially overcome by integrating local experts to summarise information available only in the national language and provide their perspectives about CAM availability, quality, use and popularity in their countries using a semi-structured questionnaire. Local and international published surveys were summarised, and the prevalence of CAM use was extrapolated. RESULTS Data from 20 European countries were available, representing 69% of the European population. Some data about CAM use by the general population were available for 90% of the examined countries, whereas peer-reviewed published surveys were available for only 60%. We extrapolated that 56% (range: 10-90%, adjusted for population size) of the European population in general had used CAM at least once in the past year. Surveys in CAM use by children were available for 55% of the investigated countries. The extrapolated prevalence of CAM use by children in Europe was 52% (range: 5-90%, adjusted for population size). Paediatric CAM experts reported an increasing awareness for and use of CAM in healthcare institutions. CONCLUSION This precursor for further surveys indicates that CAM appears to be popular not only among adults in Europe, but also for children. Development of a pan-European definition of CAM use and CAM therapies are required to achieve surveys comparable between European countries. Additionally, more research investigating the efficacy and potential adverse effects of CAM therapies is needed because of increasing CAM use by children in Europe.
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Affiliation(s)
- Tycho J Zuzak
- Department of Pediatric Oncology and Hematology, University Children's Hospital Essen, Hufelandstr. 55, D-45147 Essen, Germany.
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Use and predictors of oral complementary and alternative medicine by patients with inflammatory bowel disease: a population-based, case-control study. Inflamm Bowel Dis 2013; 19:767-78. [PMID: 23429459 DOI: 10.1097/mib.0b013e31827f27c8] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of complementary and alternative medicine (CAM) in the general population and in patients with chronic diseases has increased markedly in recent decades. We aimed to determine the prevalence, type, and predictors of oral CAM use among patients with inflammatory bowel disease (IBD) compared with the general population in a large, population-based, case-control study. METHODS Overall, 1370 patients with IBD and 598 control subjects in Canterbury, New Zealand, were recruited. Environmental and phenotypic data were obtained through a questionnaire and case note review. Predictors of oral CAM use were identified using binary logistic regression. RESULTS In the previous year, 44.1% of patients with IBD and 42.3% of control subjects used oral CAM (odds ratio [OR], 1.078; 95% confidence interval [CI], 0.885-1.312). The types of oral CAM used most frequently were vitamins (Crohn's disease [CD], 25.2%; ulcerative colitis, 23.7%; control subjects, 24.9%), followed by herbs (CD 15.1%, ulcerative colitis 15.2%, control subjects 12.8%), and dietary supplements (CD, 8.5%; ulcerative colitis 12.6%, control subjects 12.1%). Female gender (OR, 1.61; 95% CI, 1.25-2.08), younger age (P = 0.005), higher education (P = 0.002), higher income (P = 0.04), being a vegetarian (OR, 3.58; 95% CI, 1.97-6.48) and a middle social class at birth (P = 0.024) were independent predictors of oral CAM use in patients with IBD. Disease phenotype was not associated with oral CAM use. In control subjects, female gender (OR, 2.67; 95% CI, 1.85-3.86), higher education (P = 0.003) and a diagnosis of asthma (P = 0.017) predicted oral CAM use. CONCLUSIONS Oral CAM use is common in, and does not differ between, patients with IBD and the general population in Canterbury, New Zealand. Socio-demographic factors, and not disease phenotype, predict oral CAM use in patients with IBD.
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Posadzki P, Watson L, Alotaibi A, Ernst E. Prevalence of complementary and alternative medicine (CAM)-use in UK paediatric patients: a systematic review of surveys. Complement Ther Med 2013; 21:224-31. [PMID: 23642955 DOI: 10.1016/j.ctim.2012.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 11/23/2012] [Accepted: 11/23/2012] [Indexed: 12/26/2022] Open
Abstract
AIM This systematic review is aimed at estimating the prevalence of complementary and alternative medicine (CAM)-use by paediatric populations in the United Kingdom (UK). METHOD AMED, CINAHL, COCHRANE, EMBASE and MEDLINE were searched for English language peer-reviewed surveys published between 01 January 2000 and September 2011. Additionally, relevant book chapters and our own departmental files were searched manually. RESULTS Eleven surveys were included with a total of 17,631 paediatric patients. The majority were of poor methodological quality. Due to significant heterogeneity of the data, a formal meta-analysis was deemed inappropriate. Ten surveys related to CAM in general, while one was specifically on homeopathy. Across all surveys on CAM in general, the average one-year prevalence rate was 34% and the average lifetime prevalence was 42%. In surveys with a sample size of more than 500, the prevalence rates were considerably lower than in surveys with the sample size of lower than 500. Herbal medicine was the most popular CAM modality, followed by homeopathy and aromatherapy. CONCLUSIONS Many paediatric patients in the UK seem to use CAM. Paediatricians should therefore have sufficient knowledge about CAM to issue responsible advice.
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Affiliation(s)
- Paul Posadzki
- Complementary Medicine, Peninsula Medical School, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SG, United Kingdom.
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Vohra S, Surette S, Mittra D, Rosen LD, Gardiner P, Kemper KJ. Pediatric integrative medicine: pediatrics' newest subspecialty? BMC Pediatr 2012; 12:123. [PMID: 22894682 PMCID: PMC3470978 DOI: 10.1186/1471-2431-12-123] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 08/02/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrative medicine is defined as relationship-centered care that focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing, including evidence-based complementary and alternative medicine. Pediatric integrative medicine (PIM) develops and promotes this approach within the field of pediatrics. We conducted a survey to identify and describe PIM programs within academic children's hospitals across North America. Key barriers and opportunities were identified for the growth and development of academic PIM initiatives in the US and Canada. METHODS Academic PIM programs were identified by email and eligible for inclusion if they had each of educational, clinical, and research activities. Program directors were interviewed by telephone regarding their clinical, research, educational, and operational aspects. RESULTS Sixteen programs were included. Most (75%) programs provided both inpatient and outpatient services. Seven programs operated with less than 1 FTE clinical personnel. Credentialing of complementary and alternative medicine (CAM) providers varied substantially across the programs and between inpatient and outpatient services. Almost all (94%) programs offered educational opportunities for residents in pediatrics and/or family medicine. One fifth (20%) of the educational programs were mandatory for medical students. Research was conducted in a range of topics, but half of the programs reported lack of research funding and/or time. Thirty-one percent of the programs relied on fee-for-service income. CONCLUSIONS Pediatric integrative medicine is emerging as a new subspecialty to better help address 21st century patient concerns.
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Affiliation(s)
- Sunita Vohra
- CARE Program for Integrative Health & Healing, Department of Pediatrics, Faculty of Medicine and School of Public Health, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada.
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Neuman MG, Nanau RM. Inflammatory bowel disease: role of diet, microbiota, life style. Transl Res 2012; 160:29-44. [PMID: 22687961 DOI: 10.1016/j.trsl.2011.09.001] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 08/27/2011] [Accepted: 09/01/2011] [Indexed: 02/08/2023]
Abstract
Inflammatory bowel disease (IBD) encompassed several chronic inflammatory disorders leading to damage of the gastrointestinal tract (GI). The 2 principal forms of these disorders are ulcerative colitis (UC) and Crohn disease (CD). Bacteria are involved in the etiology of IBD, and the genetic susceptibility, environmental factors, and lifestyle factors can affect the individual's predisposition to IBD. The review discusses the potential role of environmental factors such as diet and microbiota as well as genetics in the etiology of IBD. It is suggested that microbial ecosystem in the human bowel colonizing the gut in many different microhabitats can be influence by diet, leading to formation of metabolic processes that are essential form the bowel metabolism.
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Affiliation(s)
- Manuela G Neuman
- Department of In Vitro Drug Safety and Biotechnology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Toupin April K, Moher D, Stinson J, Byrne A, White M, Boon H, Duffy CM, Rader T, Vohra S, Tugwell P. Measurement properties of questionnaires assessing complementary and alternative medicine use in pediatrics: a systematic review. PLoS One 2012; 7:e39611. [PMID: 22768098 PMCID: PMC3387262 DOI: 10.1371/journal.pone.0039611] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Accepted: 05/23/2012] [Indexed: 11/19/2022] Open
Abstract
Objective Complementary and alternative medicine (CAM) is commonly used by children, but estimates of that use vary widely partly due to the range of questionnaires used to assess CAM use. However, no studies have attempted to appraise measurement properties of these questionnaires. The aim of this systematic review was to critically appraise and summarize measurement properties of questionnaires of CAM use in pediatrics. Study design A search strategy was implemented in major electronic databases in March 2011 and conference websites, scientific journals and experts were consulted. Studies were included if they mentioned a questionnaire assessing the prevalence of CAM use in pediatrics. Members of the team independently rated the methodological quality of the studies (using the COSMIN checklist) and measurement properties of the questionnaires (using the Terwee and Cohen criteria). Results A total of 96 CAM questionnaires were found in 104 publications. The COSMIN checklist showed that no studies reported adequate methodological quality. The Terwee criteria showed that all included CAM questionnaires had indeterminate measurement properties. According to the Cohen score, none were considered to be a well-established assessment, two approached the level of a well-established assessment, seven were promising assessments and the remainder (n = 87) did not reach the score’s minimum standards. Conclusion None of the identified CAM questionnaires have been thoroughly validated. This systematic review highlights the need for proper validation of CAM questionnaires in pediatrics, which may in turn lead to improved research and knowledge translation about CAM in clinical practice.
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Affiliation(s)
- Karine Toupin April
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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Wadhera V, Lemberg DA, Leach ST, Day AS. Complementary and alternative medicine in children attending gastroenterology clinics: usage patterns and reasons for use. J Paediatr Child Health 2011; 47:904-10. [PMID: 21658145 DOI: 10.1111/j.1440-1754.2011.02100.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The use of complementary and alternative medicines (CAM) appears to be increasing. This cross-sectional study aimed to assess the use of CAM in children, investigate factors influencing their use and attitudes towards them and to contrast to previous usage patterns. METHODS Parents of children attending gastroenterology outpatient clinics at a tertiary paediatric hospital completed a questionnaire providing details of CAM usage, awareness and attitudes. RESULTS Sixty-nine percent of the 98 respondents were using or had used CAM (n= 66). Nutritional supplements (n= 37, 56% of CAM users) and probiotics (n= 33, 50%) were most commonly used. Most CAM users sought complementary therapy to help a chronic problem (n= 43, 69.4%) and had been referred by a friend or family member (n= 33, 53.2%). Self-reported well-being was associated with CAM use (P= 0.0009) and CAM were described as partially effective by 40 parents (67.8%). Forty-six parents (75.4%) expressed that they would use CAM again. Seventy-two respondents (80%) believed that doctors should support the use of CAM. CONCLUSION Children attending this gastroenterology clinic are commonly given CAM. Awareness and acceptance of CAM by carers of children with gastroenterology conditions is high.
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Affiliation(s)
- Veena Wadhera
- Department of Gastroenterology, Sydney Children's Hospital, Randwick, Australia
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Review on efficacy and health services research studies of complementary and alternative medicine in inflammatory bowel disease. Chin J Integr Med 2011; 17:403-9. [DOI: 10.1007/s11655-011-0758-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Indexed: 01/01/2023]
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Gerasimidis K, McGrogan P, Edwards CA. The aetiology and impact of malnutrition in paediatric inflammatory bowel disease. J Hum Nutr Diet 2011; 24:313-26. [PMID: 21564345 DOI: 10.1111/j.1365-277x.2011.01171.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Disease-associated undernutrition of all types is very common in paediatric inflammatory bowel disease (IBD). Recent weight loss remains one of the triad of clinical manifestations and a cornerstone for the diagnosis of Crohn's disease (CD), although significantly fewer patients now present as being underweight. Recent evidence suggests that the introduction of medical treatment will quickly restore body weight, although this does not reflect concomitant changes in body composition. CD children present with features of nutritional cachexia with normal fat stores but depleted lean mass. Poor bone health, delayed puberty and growth failure are additional features that further complicate clinical management. Suboptimal nutritional intake is a main determinant of undernutrition, although activation of the immune system and secretion of pro-inflammatory cytokines exert additional independent effects. Biochemically low concentrations of plasma micronutrients are commonly reported in IBD patients, although their interpretation is difficult in the presence of an acute phase response and other indices of body stores adequacy are needed. Anaemia is a common extraintestinal manifestation of the IBD child. Iron-deficient anaemia is the predominant type, with anaemia of chronic disease second. Decreased dietary intake, as a result of decreased appetite and food aversion, is the major cause of undernutrition in paediatric IBD. Altered energy and nutrient requirements, malabsorption and increased gastrointestinal losses are additional factors, although their contribution to undernutrition in paediatric CD needs to be studied further.
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Affiliation(s)
- K Gerasimidis
- Human Nutrition Section, Developmental Medicine, University of Glasgow, Royal Hospital for Sick Children, UK.
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Abstract
Nutrition interventions play a central role in the treatment and management of inflammatory bowel disease in children. Malnutrition is a common presenting symptom in both pediatric ulcerative colitis and Crohn's disease and is associated with increased morbidity. Providing macronutrients can improve growth; likewise, identifying and correcting micronutrient deficiencies can improve comorbid conditions like osteopenia and anemia. Although many patients manipulate their diets to help treat their inflammatory bowel disease, only parenteral nutrition with bowel rest and exclusive enteral nutrition therapy have been shown effective for the treatment of inflammatory bowel disease.
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Affiliation(s)
- Daniel P Mallon
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
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Hilsden RJ, Verhoef MJ, Rasmussen H, Porcino A, DeBruyn JCC. Use of complementary and alternative medicine by patients with inflammatory bowel disease. Inflamm Bowel Dis 2011; 17:655-62. [PMID: 20848543 DOI: 10.1002/ibd.21360] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In this review article we provide a broad overview of complementary and alternative medicine (CAM) use in inflammatory bowel diseases (IBDs), including prevalence of use, common therapies used, and reasons for and factors associated with CAM use. CAM is commonly used by those suffering from IBD. Multiple forms of CAM are used to treat IBD, and often patients use multiple CAM therapies and continue to use conventional medical therapies. Patients using CAM report benefits that extend beyond simply improved disease control. Using CAM allows patients to exert a greater degree of control over their disease and its management than they are afforded by conventional medicine. There is limited evidence on the efficacy of CAM therapies in IBD. It is important for physicians caring for those with IBD to be familiar with common forms of CAM and to be able to provide general counseling to their patients about CAM use.
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Affiliation(s)
- Robert J Hilsden
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Abstract
The intestinal microbiota plays a key role in the initiation and perpetuation of inflammatory bowel diseases (IBD). As such, there is a strong rationale to use agents such as probiotics to modulate the gut microbiome as a treatment strategy for these disorders. Furthermore, the potential toxicities of current IBD therapies make probiotics attractive medications for patients and physicians. However, although much attention is being placed on probiotic therapy, relatively few well-designed trials have evaluated its efficacy in the management of IBD, particularly in the pediatric population. This article examines the currently available published trials studying probiotics for the treatment of IBD, with particular emphasis on their role in pediatric IBD patients.
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Affiliation(s)
- Ajay S Gulati
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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McFarland LV. State-of-the-art of irritable bowel syndrome and inflammatory bowel disease research in 2008. World J Gastroenterol 2008; 14:2625-9. [PMID: 18461647 PMCID: PMC2709056 DOI: 10.3748/wjg.14.2625] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are two of the leading causes of chronic intestinal conditions in the world. This issue of World Journal of Gastroenterology (WJG) presents a series of papers from world experts who discuss the current knowledge and opinions on these important conditions. Although great strides have been made in the diagnosis, treatment and pathology of IBS and IBD; much has yet to be explained. The etiologies and risk factors of these multifactorial conditions remain elusive. Specific diagnostic biomarkers need to be developed and safer treatments developed. The burden of IBS and IBD on the healthcare system is felt with repeated medical care visits and high costs. IBS and IBD patients can account for 30%-50% of office visits at gastroenterology services/clinics. Over one million people have IBD in the United States, with 30 000 new cases being diagnosed every year. One-quarter million people in the UK are afflicted with IBD. The cost of medical care in the United States for IBD is estimated to be $1.8 billion/year.
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