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Marsh A, Chachay V, Banks M, Okano S, Hartel G, Radford-Smith G. A pilot randomized controlled trial investigating the effects of an anti-inflammatory dietary pattern on disease activity, symptoms and microbiota profile in adults with inflammatory bowel disease. Eur J Clin Nutr 2024; 78:1072-1081. [PMID: 39122803 PMCID: PMC11611722 DOI: 10.1038/s41430-024-01487-9] [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: 01/18/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND/OBJECTIVES There is a lack of certainty in dietary prescription for individuals with inflammatory bowel disease (IBD) due to heterogeneity in studies to date. The aim of this study was to investigate the efficacy on disease activity of a modified anti-inflammatory dietary pattern purposely designed to reduce intake of food additives (IBD-MAID), compared to standard care, in adults with IBD. SUBJECT/METHODS Adults with IBD were randomised to IBD-MAID (meals provided) [n = 29] or general healthy eating (GHE) [n = 29] for 8 weeks. Disease activity, faecal calprotectin (FC), C-reactive protein (CRP), symptoms, and quality of life (S&QOL) were assessed using validated tools. RESULTS The IBD-MAID was well tolerated and adhered to (92% adherence). At week 8, there was no statistically significant difference in change from baseline in outcome measures between groups. However, baseline to week 8 analysis indicated: (1) statistically significant improvements in S (p = 0.001) & QOL (p = 0.004), FC (p = 0.007), and Crohn's disease activity (p = 0.03) but not ulcerative colitis, in individuals following the IBD-MAID and (2) statistically significant improvement in QOL in individuals receiving GHE (p = 0.015). Correlation analysis on change from baseline to week 8 revealed a greater decrease in food additives intake was associated with statistically significant improvements in FC, S & QOL and alignment of anti-inflammatory dietary principles with improvements in QOL. CONCLUSION The IBD-MAID was well tolerated. The most novel finding pertains to the correlation between reduced food additives intake and improvements in inflammatory markers, S&QOL. Further research is needed to explore the effects of food additives exposure on IBD course. TRIAL REGISTRATION 12619001500145.
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Affiliation(s)
- Abigail Marsh
- The School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia.
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
| | - Veronique Chachay
- The School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Merrilyn Banks
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Satomi Okano
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Gunter Hartel
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Graham Radford-Smith
- Gut Health Group, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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Weznaver C, Nybacka S, Simren M, Törnblom H, Jakobsson S, Störsrud S. Patients' experiences of dietary changes during a structured dietary intervention for irritable bowel syndrome. J Hum Nutr Diet 2024; 37:1336-1348. [PMID: 39138906 DOI: 10.1111/jhn.13349] [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: 10/26/2023] [Revised: 06/04/2024] [Accepted: 06/28/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Diet plays an important role in management of gastrointestinal (GI) symptoms in patients with irritable bowel syndrome (IBS). Restrictive diets have gained popularity as treatment for IBS, but no studies have examined the patients' experiences of implementing such diets. Thus, the present study aimed to explore the experience of patients with IBS undergoing a structured dietary intervention. METHODS Using inductive content analysis, semi-structured interviews were conducted in 19 patients with IBS, who were recruited from a randomised controlled trial evaluating two different restrictive diets for 4 weeks: a diet low in total carbohydrates; and a diet low in fermentable oligo-, di- and monosaccharides and polyols (i.e., FODMAP) combined with traditional IBS dietary advice. RESULTS Three main themes developed from the qualitative analysis and together they describe the dietary intervention as supportive, as well as the dietary changes as challenging and contributing to reflection. Patients found the dietary support effective in both initiating and adhering to their dietary changes. Despite the support, the implementation of the diet was perceived as challenging when it interfered with other important aspects of their lives. However, going through the dietary change process, the patients began to reflect on their eating behaviours, which enabled individual dietary adjustments. The adjustments that patients maintained were not only a result of alleviation of GI symptoms, but also based on personal preferences. CONCLUSIONS Patients with IBS undergoing restrictive diets appear to benefit from structured support. However, considering the individual patient's life situation and personal preferences, individualised dietary options should be encouraged to achieve long-term dietary changes.
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Affiliation(s)
- Cecilia Weznaver
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sanna Nybacka
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Simren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Center for Functional GI and Motility Disorders, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hans Törnblom
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sofie Jakobsson
- Institute of Health and care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stine Störsrud
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Hermsen S, Tump D, Wentink E, Duijvestein M. Investigating Patient Perspectives on Using eHealth Technologies for the Self-Management of Inflammatory Bowel Disease: Mixed Methods Study. J Med Internet Res 2024; 26:e53512. [PMID: 39240663 DOI: 10.2196/53512] [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: 10/09/2023] [Revised: 03/29/2024] [Accepted: 04/16/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) poses significant challenges for patients, requiring continuous monitoring and self-management to improve quality of life. OBJECTIVE This study aims to investigate the viewpoints of individuals living with IBD on the use of information and communication technology (ICT) for the self-management of their condition, with a particular focus on the concept of a "smart" toilet seat as an example of ICT for IBD self-management. METHODS We conducted an analysis of questionnaire responses obtained from 724 participants. They were encouraged to share their use cases and identify any perceived barriers associated with ICT adoption for managing their condition. To assess their responses, we used descriptive quantitative analysis, summative content analysis, and thematic qualitative analysis. We combined these results in an epistemic network analysis to look for meaningful patterns in the responses. RESULTS Of the 724 participants, more than half (n=405, 55.9%) were already using various forms of ICT for IBD self-management. The primary factor influencing their use of ICT was their affinity for interacting with technology. Distinct differences emerged between individuals who were using ICT and those who were not, particularly regarding their perceived use cases and concerns. CONCLUSIONS This study provides valuable insights into the perspectives of individuals with IBD on the use of ICT for self-management. To facilitate wider adoption, addressing privacy concerns, ensuring data security, and establishing reliable ICT integration will be critical.
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Affiliation(s)
- Sander Hermsen
- OnePlanet Research Centre, Precision Health and Nutrition Group, Wageningen, Netherlands
- Radboud University Medical Centre, Prevention Hub, Nijmegen, Netherlands
| | - Danielle Tump
- OnePlanet Research Centre, Precision Health and Nutrition Group, Wageningen, Netherlands
| | - Eva Wentink
- OnePlanet Research Centre, Precision Health and Nutrition Group, Wageningen, Netherlands
| | - Marjolijn Duijvestein
- Radboud University Medical Centre, Department of Gastroenterology, Nijmegen, Netherlands
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Xiong H, Zhang X, Zeng H, Xie S, Yi S. Experience of diet in patients with inflammatory bowel disease: A thematic synthesis of qualitative studies. J Clin Nurs 2024; 33:3283-3293. [PMID: 38661241 DOI: 10.1111/jocn.17186] [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: 09/19/2023] [Revised: 04/08/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
AIM To synthesise the dietary expesriences of patients with inflammatory bowel disease by reviewing relevant qualitative studies. BACKGROUND Diet plays a crucial role in the development and progression of inflammatory bowel disease (IBD). There is no specific diet that can be recommended for all patients. We conducted a synthesis of qualitative studies to gain a comprehensive understanding of the dietary management experience of patients with IBD, aiming to provide better dietary guidance in the future. DESIGN A qualitative synthesis was conducted following the Thomas and Harden method and reported following the ENTREQ statement. METHODS Qualitative studies were systematically searched in five electronic databases: PubMed, PsycINFO, Embase, CINAHL, and Web of Science. There was no time limit for publication, and all database searches were up to 10 May, 2023. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was utilised to appraise the quality of the included studies. Data for inclusion in articles were extracted and analysed using a thematic synthesis method. RESULTS Six studies involving 119 patients were eventually included. The studies were conducted in six different countries. Four major themes were identified: the diet of patients with IBD is completely different from the normal one; manage symptoms and live with the disease by modifying diet; psychological adjustment to eating (be frustrated; worried and afraid; feel ashamed; growth and resilience); barriers and challenges (barriers from perceived social support; conflicts between diet and nutrition; challenges from food hedonism and cravings). CONCLUSIONS Patients with IBD highlighted the distinction between their diet and the normal diet. Dietary modifications were used as a way to manage symptoms and live with the disease. In addition to physical symptoms, patients experienced diet-related psychological changes. Dietary modifications in patients with IBD encounters difficulties and challenges, necessitating prompt guidance and intervention. (1) The implementation of dietary modifications in patients with IBD encounters numerous obstacles and complexities, necessitating prompt guidance and intervention. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. REGISTRATION The protocol was registered with PROSPERO (CRD42023391545).
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Affiliation(s)
- Huan Xiong
- Department of Gastroenterology, The National Key Clinical Specialty, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, P.R. China
- Clinical Research Center for Gut Microbiota and Digestive Diseases of Fujian Province, Xiamen Key Laboratory of Intestinal Microbiome and Human Health, Xiamen, Fujian Province, P.R. China
- Department of Digestive Disease, Institute for Microbial Ecology, School of Medicine, Xiamen University, Xiamen, Fujian Province, P.R. China
| | - Xu Zhang
- Department of Gastroenterology, The National Key Clinical Specialty, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, P.R. China
- Clinical Research Center for Gut Microbiota and Digestive Diseases of Fujian Province, Xiamen Key Laboratory of Intestinal Microbiome and Human Health, Xiamen, Fujian Province, P.R. China
- Department of Digestive Disease, Institute for Microbial Ecology, School of Medicine, Xiamen University, Xiamen, Fujian Province, P.R. China
| | - Huiling Zeng
- Department of Gastroenterology, The National Key Clinical Specialty, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, P.R. China
| | - Shanshan Xie
- Department of Gastroenterology, The National Key Clinical Specialty, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, P.R. China
- Clinical Research Center for Gut Microbiota and Digestive Diseases of Fujian Province, Xiamen Key Laboratory of Intestinal Microbiome and Human Health, Xiamen, Fujian Province, P.R. China
- Department of Digestive Disease, Institute for Microbial Ecology, School of Medicine, Xiamen University, Xiamen, Fujian Province, P.R. China
| | - Shuanglian Yi
- Department of Gastroenterology, The National Key Clinical Specialty, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, P.R. China
- Clinical Research Center for Gut Microbiota and Digestive Diseases of Fujian Province, Xiamen Key Laboratory of Intestinal Microbiome and Human Health, Xiamen, Fujian Province, P.R. China
- Department of Digestive Disease, Institute for Microbial Ecology, School of Medicine, Xiamen University, Xiamen, Fujian Province, P.R. China
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Migdanis A, Migdanis I, Gkogkou ND, Papadopoulou SK, Giaginis C, Manouras A, Polyzou Konsta MA, Kosti RI, Oikonomou KA, Argyriou K, Potamianos S, Kapsoritakis A. The Relationship of Adherence to the Mediterranean Diet with Disease Activity and Quality of Life in Crohn's Disease Patients. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1106. [PMID: 39064535 PMCID: PMC11279084 DOI: 10.3390/medicina60071106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/27/2024] [Accepted: 06/29/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Emerging evidence is placing the Mediterranean diet (MD) in the spotlight as a potential dietary model that could benefit inflammatory bowel disease (IBD) patients in terms of prevention and progress of the disease. The main aim of the present study is to shed some light on the relationship between the adherence to the MD and the degree of disease activity, as well as the quality of life in patients with Crohn's disease (CD). Materials and Methods: An administered questionnaire was used to assess and record a number of parameters, including recent medical and weight history, anthropometric characteristics, disease activity (in remission or active disease), and quality of life of both male and female CD patients. Moreover, the level of compliance of the participants to the Mediterranean diet model was evaluated and its relationship with disease activity and quality of life was investigated. Results: Adherence to the MD was significantly higher in patients with inactive disease than in those with active disease (p = 0.019). According to the correlation analysis conducted, adherence to the MD was negatively correlated with disease activity (p = 0.039) and positively correlated with quality of life (QoL) (p = 0.046) of the participants. Intake of fruits, vegetables, and dairy products was significantly higher in remission patients (p = 0.046, p = 0.001, p = 0.041, respectively). Conclusions: We conclude, according to the findings of the study, that adherence to the MD is associated with disease activity and QoL in patients with CD. Future research should focus on MD intervention studies on IBD patients in order to assess its effect on modulating disease activity/course and related inflammatory biomarkers.
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Affiliation(s)
- Athanasios Migdanis
- Nutrition and Dietetics Department, University of Thessaly, Argonafton 1C, 42132 Trikala, Greece; (I.M.); (A.M.); (R.I.K.)
- Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece; (S.P.); (A.K.)
| | - Ioannis Migdanis
- Nutrition and Dietetics Department, University of Thessaly, Argonafton 1C, 42132 Trikala, Greece; (I.M.); (A.M.); (R.I.K.)
- Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece; (S.P.); (A.K.)
| | - Nikoleta D. Gkogkou
- MSc Program Nutrition in Health and Disease, Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece;
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Nea Moudania, 57001 Thessaloniki, Greece;
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, University of the Aegean, Myrina, 81400 Lemnos, Greece;
| | - Athanasios Manouras
- Nutrition and Dietetics Department, University of Thessaly, Argonafton 1C, 42132 Trikala, Greece; (I.M.); (A.M.); (R.I.K.)
| | | | - Rena I. Kosti
- Nutrition and Dietetics Department, University of Thessaly, Argonafton 1C, 42132 Trikala, Greece; (I.M.); (A.M.); (R.I.K.)
| | - Konstantinos A. Oikonomou
- Department of Gastroenterology, University Hospital of Larissa, Viopolis Mezourlo, 41110 Larissa, Greece; (K.A.O.); (K.A.)
| | - Konstantinos Argyriou
- Department of Gastroenterology, University Hospital of Larissa, Viopolis Mezourlo, 41110 Larissa, Greece; (K.A.O.); (K.A.)
| | - Spyridon Potamianos
- Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece; (S.P.); (A.K.)
- MSc Program Nutrition in Health and Disease, Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece;
- Department of Gastroenterology, University Hospital of Larissa, Viopolis Mezourlo, 41110 Larissa, Greece; (K.A.O.); (K.A.)
| | - Andreas Kapsoritakis
- Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece; (S.P.); (A.K.)
- MSc Program Nutrition in Health and Disease, Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece;
- Department of Gastroenterology, University Hospital of Larissa, Viopolis Mezourlo, 41110 Larissa, Greece; (K.A.O.); (K.A.)
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Sinopoulou V, Gordon M, Gregory V, Saadeh A, Akobeng AK. Prebiotics for induction and maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev 2024; 3:CD015084. [PMID: 38501688 PMCID: PMC10949417 DOI: 10.1002/14651858.cd015084.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND People affected by ulcerative colitis (UC) are interested in dietary therapies as treatments that can improve their health and quality of life. Prebiotics are a category of food ingredients theorised to have health benefits for the gastrointestinal system through their effect on the growth and activity of intestinal bacteria and probiotics. OBJECTIVES To assess the efficacy and safety of prebiotics for the induction and maintenance of remission in people with active UC. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and WHO ICTRP on 24 June 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) on people with UC. We considered any type of standalone or combination prebiotic intervention, except those prebiotics combined with probiotics (known as synbiotics), compared to any control intervention. We considered interventions of any dose and duration. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodology. MAIN RESULTS We included 9 RCTs involving a total of 445 participants. Study duration ranged from 14 days to 2 to 3 months for induction and 1 to 6 months for maintenance of remission. All studies were on adults. Five studies were on people with mild to moderate active disease, three in remission or mild activity, and one did not mention. We judged only one study as at low risk of bias in all areas. Two studies compared prebiotics with placebo for induction of remission. We cannot draw any conclusions about clinical remission (70% versus 67%; risk ratio (RR) 1.05, 95% confidence interval (CI) 0.57 to 1.94); clinical improvement (mean Rachmilewitz score on day 14 of 4.1 versus 4.5; mean difference (MD) -0.40, 95% CI -2.67 to 1.87); faecal calprotectin levels (mean faecal calprotectin on day 14 of 1211 μg/mL versus 3740 μg/mL; MD -2529.00, 95% CI -6925.38 to 1867.38); interleukin-8 (IL-8) levels (mean IL-8 on day 7 of 2.9 pg/mL versus 5.0 pg/mL; MD -2.10, 95% CI -4.93 to 0.73); prostaglandin E2 (PGE-2) levels (mean PGE-2 on day 7 of 7.1 ng/mL versus 11.5 ng/mL; MD -4.40, 95% CI -20.25 to 11.45); or withdrawals due to adverse events (21% versus 8%; RR 2.73, 95% CI 0.51 to 14.55). All evidence was of very low certainty. No other outcomes were reported. Two studies compared inulin and oligofructose 15 g with inulin and oligofructose 7.5 g for induction of remission. We cannot draw any conclusions about clinical remission (53% versus 12.5%; RR 4.27, 95% CI 1.07 to 16.96); clinical improvement (67% versus 25%; RR 2.67, 95% CI 1.06 to 6.70); total adverse events (53.5% versus 31%; RR 1.71, 95% CI 0.72 to 4.06); or withdrawals due to adverse events (13% versus 25%; RR 0.53, 95% CI 0.11 to 2.50). All evidence was of very low certainty. No other outcomes were reported. One study compared prebiotics and anti-inflammatory therapy with anti-inflammatory therapy alone for induction of remission. We cannot draw any conclusions about clinical improvement (mean Lichtiger score at 4 weeks of 6.2 versus 10.3; MD -4.10, 95% CI -8.14 to -0.06) or serum C-reactive protein (CRP) levels (mean CRP levels at 4 weeks 0.55 ng/mL versus 0.50 ng/mL; MD 0.05, 95% CI -0.37 to 0.47). All evidence was of very low certainty. No other outcomes were reported. Three studies compared prebiotics with placebo for maintenance of remission. There may be no difference between groups in rate of clinical relapse (44% versus 33%; RR 1.36, 95% CI 0.79 to 2.31), and prebiotics may lead to more total adverse events than placebo (77% versus 46%; RR 1.68, 95% CI 1.18 to 2.40). The evidence was of low certainty. We cannot draw any conclusions about clinical improvement (mean partial Mayo score at day 60 of 0.428 versus 1.625; MD -1.20, 95% CI -2.17 to -0.22); faecal calprotectin levels (mean faecal calprotectin level at day 60 of 214 μg/mL versus 304 μg/mL; MD -89.79, 95% CI -221.30 to 41.72); quality of life (mean Inflammatory Bowel Disease Questionnaire (IBDQ) score at day 60 of 193.5 versus 188.0; MD 5.50, 95% CI -8.94 to 19.94); or withdrawals due to adverse events (28.5% versus 11%; RR 2.57, 95% CI 1.15 to 5.73). The evidence for these outcomes was of very low certainty. No other outcomes were reported. One study compared prebiotics with synbiotics for maintenance of remission. We cannot draw any conclusions about quality of life (mean IBDQ score at 4 weeks 182.4 versus 176.1; MD 6.30, 95% CI -6.61 to 19.21) or withdrawals due to adverse events (23% versus 20%; RR 1.13, 95% CI 0.48 to 2.62). All evidence was of very low certainty. No other outcomes were reported. One study compared prebiotics with probiotics for maintenance of remission. We cannot draw any conclusions about quality of life (mean IBDQ score at 4 weeks 182.4 versus 168.6; MD 13.60, 95% CI 1.22 to 25.98) or withdrawals due to adverse events (22.5% versus 22.5%; RR 1.00, 95% CI 0.44 to 2.26). All evidence was of very low certainty. No other outcomes were reported. AUTHORS' CONCLUSIONS There may be no difference in occurrence of clinical relapse when adjuvant treatment with prebiotics is compared with adjuvant treatment with placebo for maintenance of remission in UC. Adjuvant treatment with prebiotics may result in more total adverse events when compared to adjuvant treatment with placebo for maintenance of remission. We could draw no conclusions for any of the other outcomes in this comparison due to the very low certainty of the evidence. The evidence for all other comparisons and outcomes was also of very low certainty, precluding any conclusions. It is difficult to make any clear recommendations for future research based on the findings of this review given the clinical and methodological heterogeneity among studies. It is recommended that a consensus is reached on these issues prior to any further research.
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Affiliation(s)
| | - Morris Gordon
- School of Medicine, University of Central Lancashire, Preston, UK
| | | | - Anas Saadeh
- School of Medicine, University of Central Lancashire, Preston, UK
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Sachar Y, Gill JS, Chande N. Impact of inflammatory bowel disease on student experience in postsecondary education. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:203-209. [PMID: 35113774 DOI: 10.1080/07448481.2021.2025382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 08/16/2021] [Accepted: 12/26/2021] [Indexed: 06/14/2023]
Abstract
Objectives: This literature review seeks to identify based on the current literature how the burden of disease for IBD patients manifests itself as this cohort transitions simultaneously from pediatric to adult care and from secondary to post-secondary education. Methods: This paper reviews the current literature regarding postsecondary students with IBD and provides a summary of research regarding key factors in their quality of experience. The research was conducted through databases including Taylor & Francis, PubMed, as well as searches via Google Scholar. Results: Over the course of this search, thirty-three relevant studies were identified. These studies addressed the themes outlined in this paper, including academic performance, social adaptation, transition of care, as well as overall transition to a postsecondary institution. Each of these is further broken down to identify specific determinants of IBD student experience. Conclusions: Although students with IBD can demonstrate resilience and adaptive behavior, the evidence suggests there are significant limitations impacting their perceived experience. The barriers IBD students face impact their ability to experience postsecondary education as they intend to, forcing them to adjust in adaptive or maladaptive manners. This review also attempts to generate possible solutions to specific barriers identified from current research, generating directions of action for students, physicians, and academic supports.
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Affiliation(s)
- Yashasavi Sachar
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jaskaran Singh Gill
- Department of Medicine, Temerty School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nilesh Chande
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Gastroenterology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Brown SC, Whelan K, Frampton C, Wall CL, Gearry RB, Day AS. Food-Related Quality of Life in Children and Adolescents With Crohn's Disease. Inflamm Bowel Dis 2022; 28:1838-1843. [PMID: 35166341 PMCID: PMC9713495 DOI: 10.1093/ibd/izac010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Food-related quality of life (FRQoL) encompasses the psychosocial elements of eating and drinking. The FRQoL of children and adolescents with inflammatory bowel disease has not yet been assessed. This study aimed to evaluate the utility of the validated FR-Qol-29 instrument in children with Crohn's disease (CD). METHODS Children diagnosed with CD, a shared home environment healthy sibling, and healthy control subjects 6 to 17 years of age were recruited to this single-center, prospective, cross-sectional study. Children or their parent or guardian completed the FR-QoL-29 instrument. Internal consistency was assessed by completing Cronbach's α. Construct validity was established by correlating the CD FR-QoL-29 sum scores with the Physician Global Assessment and Pediatric Crohn Disease Activity Index scores. The discriminant validity was analyzed using a 1-way analysis of variance, and a Spearman's correlation coefficient test was completed to identify any correlations associated with FRQoL. RESULTS Sixty children or their parent or guardian completed the FR-QoL-29 instrument (10 children in each subgroup). The internal consistency was excellent (Cronbach's α = 0.938). The mean FR-QoL-29 sum scores were 94.3 ± 27.6 for CD, 107.6 ± 20 for siblings, and 113.7 ± 13.8 for control subjects (P = .005). Those with higher disease activity had worse FRQoL (Physician Global Assessment P = .021 and Pediatric Crohn Disease Activity Index P = .004). Inflammatory bowel disease FR-QoL-29 sum scores correlated with weight (P = .027), height (P = .035), body mass index (P = .023), and age (P = .015). CONCLUSIONS FRQoL is impaired in children with CD. Healthy siblings also have poorer FRQoL than control subjects. Several clinical factors are associated with poorer FRQoL in children with CD including age and level of nutritional risk (weight, height, and body mass index). Further research is required validate these findings and to develop strategies for the prevention or treatment of impaired FRQoL in children with CD.
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Affiliation(s)
- Stephanie C Brown
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
| | - Kevin Whelan
- Department of Nutritional Sciences, King’s College London, London, United Kingdom
| | - Chris Frampton
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Catherine L Wall
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Richard B Gearry
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Andrew S Day
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
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9
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Saneie S, Aminianfar A, Shidfar F, Keshteli AH, Esmaillzadeh A, Adibi P. The association between dietary total antioxidant capacity and odds and severity of irritable bowel syndrome among Iranian adults: a cross-sectional study. BMC Gastroenterol 2022; 22:472. [PMID: 36402962 PMCID: PMC9675204 DOI: 10.1186/s12876-022-02531-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background Little evidence is available in terms of the role of dietary antioxidants in the management of irritable bowel syndrome (IBS) disease. This study aimed to examine the association between dietary total antioxidant capacity (dTAC) and odds of IBS and its severity. Methods This cross-sectional study was conducted on 3,362 Iranian adults who were referred to health centers in Isfahan province, Iran. Participants' dietary intakes were collected using a semi-quantitative validated food frequency questionnaire (DS-FFQ). The dTAC was measured by the ferric-reducing antioxidant power (FRAP) method. Multivariable binary or ordinal logistic regression analyses were performed to estimate any associations between dTAC and odds of IBS, IBS severity, and IBS subtypes. Results The average age and BMI of the participants and dTAC score were 36.3 ± 7.87 year, 24.9 ± 3.82 kg/m2. The prevalence of IBS, IBS with constipation (IBS-C), IBS with diarrhoea (IBS-D), mixed IBS (IBS-M), and un-subtyped IBS (IBS-U) were 22.2, 7.5, 4.6, 3.8, and 6.2%, respectively. In crude and adjusted models, the results did not show any significant association between dTAC and odds of IBS among whole and gender-age stratified populations. Being in the third compared with the first tertile of dTAC was not also significantly associated with odds of IBS severity. Besides, there were no significant associations between dTAC and odds of IBS-C, IBS-D, IBS-M, and IBS-U. Conclusion This study indicates that dTAC may not be associated with the odds of IBS and its severity even after stratification for gender and body mass index.
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Affiliation(s)
- Solaleh Saneie
- grid.411746.10000 0004 4911 7066Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Aminianfar
- grid.444768.d0000 0004 0612 1049Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Farzad Shidfar
- grid.411746.10000 0004 4911 7066Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ahmad Esmaillzadeh
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran ,grid.411705.60000 0001 0166 0922Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran ,grid.411036.10000 0001 1498 685XDepartment of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- grid.411036.10000 0001 1498 685XIntegrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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10
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Cox SR, Czuber-Dochan W, Wall CL, Clarke H, Drysdale C, Lomer MC, Lindsay JO, Whelan K. Improving Food-Related Quality of Life in Inflammatory Bowel Disease through a Novel Web Resource: A Feasibility Randomised Controlled Trial. Nutrients 2022; 14:nu14204292. [PMID: 36296976 PMCID: PMC9611328 DOI: 10.3390/nu14204292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/05/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
Food-related quality of life (FR-QoL) is impaired in inflammatory bowel disease (IBD) and education and support on food-related issues in IBD is needed. This feasibility trial aimed to investigate the effectiveness and acceptability of a web resource in enhancing FR-QoL in newly diagnosed IBD. Patients diagnosed with Crohn's disease or ulcerative colitis in the preceding 12 months, with an impaired FR-QoL, were recruited and randomised to either receive access to the web resource (covering IBD-specific diet concerns) or no access (control group) for 12 weeks, while receiving usual clinical care. FR-QoL, health-related quality of life, psychological outcomes, and clinical disease activity were assessed. Web resource usage was assessed, and patients' experiences of the web resource were investigated in semi-structured interviews. Of 81 patients screened, 50 participants were randomised, 30 to the web resource and 20 to control. FR-QoL increased more in the web resource (+11.7 SD 18.2) than control group (+1.4 SD 20.4) (p = 0.067), while IBD distress reduced in the web resource (-6.8 SD 26.6) and increased in the control group (+8.3 SD 25.5) (p = 0.052), albeit not statistically significantly. End of trial Crohn's disease clinical activity (PRO-2) was significantly lower in the web resource than control group (p = 0.046). Participants most frequently accessed web resource content discussing dietary management of gut symptoms and in semi-structured interviews, reported the website to contain relevant information. This feasibility study demonstrates potential effectiveness of the web resource on improving FR-QoL and psychological outcomes in IBD. An adequately powered effectiveness RCT is feasible to conduct and is now warranted. NCT03884686.
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Affiliation(s)
- Selina R. Cox
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
| | - Wladyslawa Czuber-Dochan
- Midwifery and Palliative Care, Florence Nightingale Faculty of Nursing, King’s College London, London SE1 8WA, UK
| | - Catherine L. Wall
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
| | - Hazel Clarke
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
| | - Candice Drysdale
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
| | - Miranda C. Lomer
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
- Departments of Gastroenterology and Dietetics, Guy’s & St Thomas NHS Foundation Trust, London SE1 7EH, UK
| | - James O. Lindsay
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - Kevin Whelan
- Department of Nutritional Sciences, King’s College London, London SE1 9NH, UK
- Correspondence:
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11
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Feeney M, Chur-Hansen A, Mikocka-Walus A. People Living with Inflammatory Bowel Disease Want Multidisciplinary Healthcare: A Qualitative Content Analysis. J Clin Psychol Med Settings 2022; 29:570-577. [PMID: 34185254 DOI: 10.1007/s10880-021-09801-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 12/20/2022]
Abstract
This study reports on the preferences of people with inflammatory bowel disease (IBD) for their healthcare. Overall, 477 people with IBD responded to an open-ended survey question within a larger study. We qualitatively content-analysed these responses with open coding using NVivo. Respondents expressed a desire for (1) better communication, (2) multidisciplinary care, (3) better treatment, services and specialist care, (4) whole person care, (5) health promotion, (6) proactive healthcare, (7) fewer administrative issues and (8) improved hospital experience. Patients with IBD want patient-centred, multidisciplinary care. Healthcare professionals should facilitate patients' access to proactive care.
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Affiliation(s)
- Meg Feeney
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, North Tce, SA, 5005, Australia
| | - Anna Chur-Hansen
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Antonina Mikocka-Walus
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, North Tce, SA, 5005, Australia.
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
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12
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Aslan Çin NN, Whelan K, Özçelik AÖ. Food-related quality of life in inflammatory bowel disease: measuring the validity and reliability of the Turkish version of FR-QOL-29. Health Qual Life Outcomes 2022; 20:103. [PMID: 35790989 PMCID: PMC9258121 DOI: 10.1186/s12955-022-02014-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose Food-related quality of life is considerably impaired in patients with inflammatory bowel disease (IBD) and should be widely measured in research and clinical practice. This study aims to translate the FR-QoL-29 instrument to the Turkish language and evaluate its validity and reliability in Turkish patients with IBD. Methods The FR-QoL-29 was forwards and backwards translated into Turkish and the validity and reliability of the FR-QoL-29-Turkish measured at two tertiary hospitals in Ankara, Turkey. Participants completed four questionnaires regarding: sociodemographic; clinical (disease type and activity), and nutritional characteristics (MUST) together with FR-QoL-29-Turkish. In addition, 30 patients repeated the questionnaires after two weeks. collected. Pearson correlation coefficients and Cronbach α were used to assess reliability and validity (p < 0.05). Results A total of 180 participants with IBD (78 Crohn’s disease, 102 ulcerative colitis), with a mean age of 45.9 ± 12.5 years, were included. Bartlett's sphericity test was statistically significant (p < 0.001), meeting the prerequisite for factor analysis, and the adequacy of the sample size for factor analysis was confirmed by a high Kaiser–Meyer–Olkin (KMO = 0.92). Validity was confirmed by factor loadings ranging from 0.310 to 0.858. Item-total score correlations ranged from 0.258 to 0.837 and Cronbach’s α coefficient was 0.96 for the whole questionnaire indicating high internal consistency. Conclusions FR-QoL-29-Turkish is a valid and reliable measure of food-related quality of life in IBD patients with Turkish language. The FR-QoL-29-Turkish gives a comprehensive overview of the main aspects of food quality of life and can be used as a useful tool in both research and clinical practice.
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13
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Rines J, Daley K, Loo S, Safari K, Walsh D, Gill M, Moayyedi P, Fernandes A, Marlett N, Marshall D. A patient-led, peer-to-peer qualitative study on the psychosocial relationship between young adults with inflammatory bowel disease and food. Health Expect 2022; 25:1486-1497. [PMID: 35383400 PMCID: PMC9327832 DOI: 10.1111/hex.13488] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Inflammatory bowel diseases (IBDs) are chronic gastrointestinal diseases that negatively affect the enjoyment of food and engagement in social and cultural gatherings. Such experiences may promote psychosocial challenges, an aspect of IBD often overlooked and under-supported in clinical settings and research. OBJECTIVES This study explored the psychosocial experiences that young adults with IBD have with food via a qualitative patient-led research process. METHODS Trained patient researchers conducted this study by engaging peers via semi-structured interviews and focus groups in a three-step co-design process. Participants (n = 9) identified the research topic (SET), explored the topic and identified emerging themes (COLLECT), refined themes and made recommendations for healthcare system change (REFLECT). RESULTS Themes that emerged included: 'Experimenting with Food', 'Evolution Over Time', 'Diet Changes are Emotional' and 'Role of Stigma'. Participants identified the significance and frustrations of repeated testing and experimenting with food compatibility, and noted nuances in food relationships as they gain knowledge and experience over time. They emphasized the importance of maintaining a sense of hope throughout and wished to impart this to newly diagnosed patients. CONCLUSION Participants experience numerous psychosocial challenges as they strive to manage their diet, noting gaps in support available from IBD practitioners. Participants made practical recommendations for healthcare system change to improve patient outcomes, highlighting the importance of sharing stories and collaboratively including patients in the development of new services and protocols. Authors recommend further research in this area to build a body of knowledge and support that helps IBD patients maintain hope while navigating challenges with food. PATIENT OR PUBLIC CONTRIBUTION The first four authors on this paper were the lead researchers in this study's design and analysis and identify as patients; they conducted the research with this identity at the forefront following a peer-to-peer research model. These authors were mentored by patient researchers who also contributed to the manuscript, and the research process itself was co-lead and directed by other patient participants and consultants. Results and recommendations coming from this paper came directly from patient participants.
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Affiliation(s)
- Jenna Rines
- Patient and Community Engagement Research (PaCER), Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kim Daley
- Patient and Community Engagement Research (PaCER), Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sunny Loo
- Patient and Community Engagement Research (PaCER), Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,BC Support Unit/AHSN, Vancouver, British Columbia, Canada.,Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Kwestan Safari
- Patient and Community Engagement Research (PaCER), Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Deirdre Walsh
- Patient and Community Engagement Research (PaCER), Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Marlyn Gill
- Patient and Community Engagement Research (PaCER), Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Paul Moayyedi
- IMAGINE SPOR Chronic Disease Network, Hamilton, Ontario, Canada.,Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Aida Fernandes
- IMAGINE SPOR Chronic Disease Network, Hamilton, Ontario, Canada
| | - Nancy Marlett
- Patient and Community Engagement Research (PaCER), Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Deborah Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,IMAGINE SPOR Chronic Disease Network, Hamilton, Ontario, Canada
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14
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Sinopoulou V, Gordon M, Limketkai BN, Mullin G, Aali G, Akobeng AK. Prebiotics for induction of remission in ulcerative colitis. Hippokratia 2022. [DOI: 10.1002/14651858.cd015084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Morris Gordon
- School of Medicine; University of Central Lancashire; Preston UK
| | - Berkeley N Limketkai
- Division of Digestive Diseases; University of California Los Angeles; Los Angeles California USA
| | - Gerard Mullin
- Division of Gastroenterology & Hepatology, Department of Medicine; Johns Hopkins University; Baltimore MD USA
| | - Ghazaleh Aali
- School of Medicine; University of Central Lancashire; Preston UK
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15
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Keetarut K, Kikuchi H, King B, Richards N, Lomer M, Fragkos K, Patel PS. Perceived acceptability of partial enteral nutrition (PEN) using oral nutritional supplement drinks in adolescent and adult Crohn's disease outpatients: A feasibility study. Clin Nutr ESPEN 2021; 46:276-287. [PMID: 34857209 DOI: 10.1016/j.clnesp.2021.09.742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Studies, mainly in Japanese cohorts, have shown that partial enteral nutrition (PEN) including oral nutritional supplement (ONS) drinks can prolong disease remission and increase drug effectiveness in Crohn's disease (CD). Acceptability is a key feasibility parameter to determine whether PEN is a viable treatment option in UK CD patients. We report the results of a single centre cross-sectional feasibility study carried out to investigate perceived acceptability of PEN using ONS drinks and whether ONS preference varies with sex, nutritional status or phenylthiocarbamide (PTC) sensitivity. METHODS Patients with a confirmed CD diagnosis were recruited using convenience sampling from an adult and adolescent gastroenterology outpatient clinic over 3 years. Blind taste testing of 5 polymeric ONS drinks were conducted using a validated 9-point hedonic rating scale followed by completion of an acceptability questionnaire based on the preferred ONS drink. A subset of patients took home the preferred ONS drink for a 7-day ONS study. RESULTS 105 CD patients (55 males), aged 34.9 (±15.4) years were recruited and 28 patients completed the 7-day ONS study. Overall impression scores did not significantly vary with nutritional status, sex, BMI, handgrip strength (HGS), mid-upper arm circumference (MUAC) or PTC sensitivity. Ensure plus milkshake™ rated highest for overall impression (6.5, p=<0.0001) and all other organoleptic properties (p < 0.0001). The main perceived benefits of using ONS drinks as PEN related to assurance of nutrient intake (89%), convenience (86%), and improvement of gut symptoms (85%). The main perceived barriers related to reduction in pleasure from eating and drinking (56%), struggling with drink storage (54%) having less energy and feeling more tired than if eating 3 solid meals daily (52%). 65% of patients would consider using ONS drinks as PEN as a maintenance treatment option. 81% of patients felt confident-very confident about consuming ONS drinks daily as PEN for three months but this dropped to 64% and 37% at 6 and 12 months, respectively. There was a significant drop in perceived ease of use of ONS drinks as PEN after the 7-day ONS study (P = 0.01). CONCLUSION Use of ONS drinks as PEN have high perceived benefits and appear to be a feasible option for short-term use of 3-6 months in CD patients. However, confidence in long-term use of ONS drinks as PEN is low mainly due to the perceived social impact. Future studies should assess longer trial periods and volume of ONS drinks to increase the validity of these findings.
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Affiliation(s)
- Katie Keetarut
- University College London Hospital NHS Foundation Trust, Department of Nutrition and Dietetics, 3rd Floor East, 250 Euston Road, London, NW1 2PG, UK.
| | - Harumi Kikuchi
- University College London, Institute for Liver and Digestive Health, UCL Division of Medicine, Upper Third Floor, Royal Free Campus, London, NW3 2PF, UK.
| | - Beth King
- University College London, Institute for Liver and Digestive Health, UCL Division of Medicine, Upper Third Floor, Royal Free Campus, London, NW3 2PF, UK.
| | - Nadine Richards
- University College London, Institute for Liver and Digestive Health, UCL Division of Medicine, Upper Third Floor, Royal Free Campus, London, NW3 2PF, UK.
| | - Miranda Lomer
- King's College London, Diabetes and Nutritional Sciences Division, 150 Stamford Street, London, SE1 9NH, UK.
| | - Konstantinos Fragkos
- University College London Hospital NHS Foundation Trust, GI Services, Ground Floor Central, 250 Euston Road, London, NW1 2PG, UK.
| | - Pinal S Patel
- University College London Hospital NHS Foundation Trust, Department of Nutrition and Dietetics, 3rd Floor East, 250 Euston Road, London, NW1 2PG, UK.
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16
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Marsh A, Radford-Smith G, Banks M, Lord A, Chachay V. Dietary intake of patients with inflammatory bowel disease aligns poorly with traditional Mediterranean diet principles. Nutr Diet 2021; 79:229-237. [PMID: 34806269 DOI: 10.1111/1747-0080.12715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 12/19/2022]
Abstract
AIM Previous research has shown that individuals with inflammatory bowel disease avoid specific food items, such as fibre rich foods, in order to manage symptoms. Dietary fibre and the traditional Mediterranean diet are both associated with reduced mucosal and systemic inflammation, gut barrier integrity, and microbiota diversity. There is limited data on the diet composition of individuals with inflammatory bowel disease. The aim of this study was to evaluate how it compares to the traditional Mediterranean diet and national dietary guidelines. METHODS Outpatients with inflammatory bowel disease were recruited to the study between February and August 2019. Demographic and medical information was obtained for consenting participants. All participants completed a dietary assessment of usual intake (24-h diet recall and 17-point ready reckoner) from which a Mediterranean diet adherence score was calculated. Dietary intake of core food groups was compared to the recommended number of serves outlined in the Australian Guide to Healthy Eating. RESULTS 100 participants were recruited. The mean Mediterranean diet adherence score was 5.1 ± 1.3 (maximum 14 points), 4% of participants scored ≥9 (commonly agreed criteria for Mediterranean diet adherence). Participants also consumed considerably less grains and vegetables than national dietary guidelines recommendations. CONCLUSIONS The diet of outpatients with inflammatory bowel disease did not align with Mediterranean diet characteristics. Participants consumed significantly less grains and vegetables than national guidelines, suggesting a low fibre intake. These findings suggest that dietary interventions focusing on improving the diet of individuals with inflammatory bowel disease to align with Mediterranean diet characteristics are warranted.
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Affiliation(s)
- Abigail Marsh
- The School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Graham Radford-Smith
- Gut Health Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Merrilyn Banks
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Anton Lord
- Gut Health Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Veronique Chachay
- The School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
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17
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Mehtab W, Agarwal A, Singh N, Malhotra A, Makharia GK. All that a physician should know about FODMAPs. Indian J Gastroenterol 2019; 38:378-390. [PMID: 31802437 DOI: 10.1007/s12664-019-01002-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/26/2019] [Indexed: 02/06/2023]
Abstract
A diet low in poorly absorbed, fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) is now considered as an effective strategy for symptoms control in patients with irritable bowel syndrome (IBS). The low FODMAP diet is administered in three phases, namely restriction of all dietary FODMAPs followed by rechallenge and then reintroduction of specific FODMAPs according to the tolerance of patients. A dietician should be involved in patients in whom a low FODMAP diet is planned. While restricting high FODMAPs, it is pertinent that patients are advised a well-balanced diet and suitable alternatives with low FODMAP contents in each food groups are prescribed. Strict adherence to a low FODMAP diet has been shown to improve symptoms, stool output, quality of life, and the overall well-being of patients with IBS. For those who do not respond to this dietary approach, a normal diet may be initiated and other treatment strategies (dietary or nondietary) should be considered. Interestingly, the low FODMAP diet has also been tried in other functional disorders, nonceliac gluten sensitivity, and even inflammatory bowel disease. Since the concept of FODMAP is relatively new, there is only limited data on the content of FODMAP in the Indian food items and there is a need to address this question. There is also a need for well-designed and adequately powered studies to explore the efficacy of low FODMAP diet in patients with IBS. In the present review article, we have compiled all the relevant information about FODMAPs with an objective to provide comprehensive information on FODMAPs to a physician.
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Affiliation(s)
- Wajiha Mehtab
- Department of Home Science, Lady Irwin College, University of Delhi, New Delhi, 110 001, India
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Ashish Agarwal
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Namrata Singh
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Anita Malhotra
- Department of Food Technology, Lakshmibai College, University of Delhi, New Delhi, 110 052, India
| | - Govind K Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
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18
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Skolmowska D, Głąbska D, Guzek D, Lech G. Association between Dietary Isoflavone Intake and Ulcerative Colitis Symptoms in Polish Caucasian Individuals. Nutrients 2019; 11:E1936. [PMID: 31426486 PMCID: PMC6722525 DOI: 10.3390/nu11081936] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/08/2019] [Accepted: 08/14/2019] [Indexed: 02/08/2023] Open
Abstract
Currently there are contradictory observations regarding the associations between the isoflavone intake and inflammatory bowel disease in terms of its prevention and treatment, and this may be attributed to the diversity of applied doses and influence of various isoflavones. The aim of the presented cross-sectional study is to analyze the association between intake of various isoflavones (daidzein, genistein, glicytein and total isoflavones) and ulcerative colitis symptoms (fecal blood, mucus and pus) in Polish Caucasian individuals in confirmed remission. Assessment of diet was based on self-reported data obtained from patients' three-day dietary records and their individual assessments of symptoms. A total of 56 Caucasian patients with ulcerative colitis in confirmed remission were recruited for the study (37 females and 19 males, aged 18-80). For individuals with no fecal mucus observed, higher daidzein (p = 0.035, 122 vs. 19 µg) and total isoflavone intakes (p = 0.034, 302.2 vs. 123.7 µg) were observed in comparison with individuals not declaring this symptom, while for daidzein it was confirmed for the component density of their diets. The opposite association was stated for fecal pus, as for individuals with a lack of this symptom, lower daidzein intake was stated in comparison with individuals declaring this symptom (p = 0.049, 103.3 vs. 206.7 µg), but it was not confirmed for the component density of the diets. It was stated that the high intake of isoflavones by Caucasian individuals, as in a western diet, may influence the symptoms of ulcerative colitis, with the strongest influence by daidzein. Taking this into account, isoflavones may be included into the diets of ulcerative colitis patients in remission if well-tolerated, but there is a need for further study.
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Affiliation(s)
- Dominika Skolmowska
- Chair of Dietetics, Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159c Nowoursynowska Str., 02-776 Warsaw, Poland
| | - Dominika Głąbska
- Chair of Dietetics, Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159c Nowoursynowska Str., 02-776 Warsaw, Poland.
| | - Dominika Guzek
- Chair of Consumption Research, Department of Organization and Consumption Economics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159c Nowoursynowska Str., 02-776 Warsaw, Poland
| | - Gustaw Lech
- Department of General, Gastroenterological and Oncological Surgery, Medical University of Warsaw, 1a Banacha Str., 02-097 Warsaw, Poland
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19
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Czuber-Dochan W, Morgan M, Hughes LD, Lomer MCE, Lindsay JO, Whelan K. Perceptions and psychosocial impact of food, nutrition, eating and drinking in people with inflammatory bowel disease: a qualitative investigation of food-related quality of life. J Hum Nutr Diet 2019; 33:115-127. [PMID: 31131484 DOI: 10.1111/jhn.12668] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Extensive research has provided an important understanding of the impact of inflammatory bowel disease (IBD) on nutrient intake, requirements and metabolism. By contrast, there has been limited research examining the psychosocial aspects of food, eating and drinking in IBD. The present study aimed to address this unmet need. METHODS Qualitative semi-structured interviews regarding the perceptions and psychosocial impact of food, eating and drinking were undertaken with 28 purposively selected people with IBD. Interviews were audio-recorded and transcribed verbatim. Colaizzi's framework was used to structure the data analysis. RESULTS Five major themes were identified. IBD symptoms and both surgical and medical treatments were described as having a direct impact on eating and drinking, with participants also using different food-related strategies to control IBD symptoms. These included a process of experimentation to identify trigger foods, following a severely restricted and limited diet, eating small portions, and eating more frequently. However, their limited knowledge about if, and how, food affected their symptoms, often resulted in negative coping strategies that impacted on psychosocial functioning, including a lack of enjoyment of eating, being afraid to eat and finding social occasions stressful. Managing food and drinking also made food shopping and preparation more burdensome, creating problems with families, at work and for social life, as well as the need for careful preparation and advanced planning of activities. CONCLUSIONS Inflammatory bowel disease has a profound impact on psychosocial aspects of food and nutrition, which impacts on 'food-related quality of life' (FRQoL). Further research is required to identify interventions that will improve FRQoL in patients with IBD.
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Affiliation(s)
- W Czuber-Dochan
- Department of Nutritional Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - M Morgan
- Institute of Pharmacological Sciences, King's College London, London, UK
| | - L D Hughes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M C E Lomer
- Department of Nutritional Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - J O Lindsay
- Barts Health NHS Trust, The Royal London Hospital, London, UK.,Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - K Whelan
- Department of Nutritional Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Guadagnoli L, Mutlu EA, Doerfler B, Ibrahim A, Brenner D, Taft TH. Food-related quality of life in patients with inflammatory bowel disease and irritable bowel syndrome. Qual Life Res 2019; 28:2195-2205. [PMID: 30900206 DOI: 10.1007/s11136-019-02170-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Food-related quality of life (FRQoL) evaluates the impact of diet, eating behaviors, and food-related anxiety on a person's quality of life. This is the first study to evaluate FRQoL in inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), two illnesses where food and diet are of importance. METHODS One hundred seventy-five participants (80 IBS, 95 IBD) participated in the study by completing measures evaluating FRQoL, psychological distress, and health-related quality of life. Primary analyses evaluated differences in FRQoL between IBD and IBS patients. Secondary analyses compared differences based on remission status, dietary use, and dietary consultation, as well as evaluated potential predictors of FRQoL. RESULTS IBD patients in remission report the highest FRQoL (IBD-remission: 91.2 (26.5) vs. IBD-active: 67.7 (19.6) and IBS-active: 67.6 (18.3), p < .001). Using more dietary treatments is associated with decreased FRQoL for IBS (r = - 0.23, p < .05) and IBD patients (r = - 0.31, p < .01). IBS patients are more likely to use dietary treatments than IBD (IBS = 81% vs. IBD = 64%, p < .01), with self-directed diets being the most commonly used approach. Symptom severity is the strongest predictor of FRQoL in both groups (IBD: R2 = .27, p < .01; IBS: R2 = .23, p < .001). CONCLUSION FRQoL is a unique construct for IBD and IBS patients that can be influenced by several clinical and dietary factors, including number of diets and type of diet used, depending on the diagnosis. Thus, FRQoL should be considered when working with both IBD and IBS patients.
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Affiliation(s)
- Livia Guadagnoli
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street Suite 1400, Chicago, IL, 60611, USA
| | - Ece A Mutlu
- Division of Digestive Diseases and Nutrition, Rush Medical College, Chicago, IL, USA
| | - Bethany Doerfler
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street Suite 1400, Chicago, IL, 60611, USA
| | - Ammoura Ibrahim
- Division of Digestive Diseases and Nutrition, Rush Medical College, Chicago, IL, USA
| | - Darren Brenner
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street Suite 1400, Chicago, IL, 60611, USA
| | - Tiffany H Taft
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street Suite 1400, Chicago, IL, 60611, USA.
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21
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Chung CF, Wang Q, Schroeder J, Cole A, Zia J, Fogarty J, Munson SA. Identifying and Planning for Individualized Change: Patient-Provider Collaboration Using Lightweight Food Diaries in Healthy Eating and Irritable Bowel Syndrome. PROCEEDINGS OF THE ACM ON INTERACTIVE, MOBILE, WEARABLE AND UBIQUITOUS TECHNOLOGIES 2019; 3:7. [PMID: 31080941 PMCID: PMC6504841 DOI: 10.1145/3314394] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/01/2019] [Indexed: 12/20/2022]
Abstract
Identifying and planning strategies that support a healthy lifestyle or manage a chronic disease often require patient-provider collaboration. For example, people with healthy eating goals often share everyday food, exercise, or sleep data with health coaches or nutritionists to find opportunities for change, and patients with irritable bowel syndrome (IBS) often gather food and symptom data as part of working with providers to diagnose and manage symptoms. However, a lack of effective support often prevents health experts from reviewing large amounts of data in time-constrained visits, prevents focusing on individual goals, and prevents generating correct, individualized, and actionable recommendations. To examine how to design photo-based diaries to help people and health experts exchange knowledge and focus on collaboration goals when reviewing the data together, we designed and developed Foodprint, a photo-based food diary. Foodprint includes three components: (1) A mobile app supporting lightweight data collection, (2) a web app with photo-based visualization and quantitative visualizations supporting collaborative reflection, and (3) a pre-visit note communicating an individual's expectations and questions to experts. We deployed Foodprint in two studies: (1) with 17 people with healthy eating goals and 7 health experts, and (2) with 16 IBS patients and 8 health experts. Building upon the lens of boundary negotiating artifacts and findings from two field studies, our research contributes design principles to (1) prepare individuals to collect data relevant to their health goals and for collaboration, (2) help health experts focus on an individual's eating context, experiences, and goals in collaborative review, and (3) support individuals and experts to develop individualized, actionable plans and strategies.
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Affiliation(s)
- Chia-Fang Chung
- Informatics, Indiana University Bloomington, Bloomington, IN, 47405, USA
| | - Qiaosi Wang
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Jessica Schroeder
- Paul G. Allen School of Computer Science & Engineering, DUB Group, University of Washington, Seattle, WA, 98195, USA
| | - Allison Cole
- Family Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Jasmine Zia
- Division of Gastroenterology, University of Washington, Seattle, WA, 98195, USA
| | - James Fogarty
- Paul G. Allen School of Computer Science & Engineering, DUB Group, University of Washington, Seattle, WA, 98195, USA
| | - Sean A Munson
- Human Centered Design & Engineering, DUB Group, University of Washington, Seattle, WA, 98195, USA
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22
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Nybacka S, Störsrud S, Liljebo T, Le Nevé B, Törnblom H, Simrén M, Winkvist A. Within- and Between-Subject Variation in Dietary Intake of Fermentable Oligo-, Di-, Monosaccharides, and Polyols Among Patients with Irritable Bowel Syndrome. Curr Dev Nutr 2019; 3:nzy101. [PMID: 30838348 PMCID: PMC6396026 DOI: 10.1093/cdn/nzy101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/12/2018] [Accepted: 12/17/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A diet low in fermentable carbohydrates, fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs) is a promising treatment option for patients with irritable bowel syndrome (IBS). In order to correctly estimate and study the intake of FODMAPs, information about within- and between-subject variations in intakes is needed, but is currently lacking. OBJECTIVES The aim was to characterize the variation in FODMAP intake among patients with IBS and to calculate how many days of observations are required to capture absolute intakes as well as to rank individuals. METHODS Food intake was recorded during 4 consecutive days, and intakes of energy and FODMAPs were calculated. The coefficient of variation within subjects (CVw), coefficient of variation between subjects (CVb), number of days required to estimate an individual's intake, and number of observations required to correctly rank individuals into quartiles of consumption were calculated. RESULTS Diet records were provided from 151 women and 46 men with IBS. The reported mean energy intake was 2039 ± 502 kcal among women and 2385 ± 573 kcal among men, and the median FODMAP intakes were 18.7 g (range 3.7-73.4) and 22.8 g (range 3.6-165.7), respectively. The ratio of CVw/CVb for total FODMAP intake was 0.83 for women and 0.67 for men, and below 1 for all FODMAPs. To capture intake of FODMAPs at the individual level, 19 d of observations are required. Ranking individuals within a group would require 2-6 d of observations. CONCLUSION There is more variation between subjects than within subjects regarding FODMAP intake. To correctly estimate an individual's absolute intake of FODMAPs, the number of days of diet records required exceeds what is reasonable for a participant to accomplish. However, ranking individuals into quartiles of FODMAP consumption can be achieved using a 4-d food record. This trial was registered at www.clinicaltrials.gov as NCT02107625 and NCT01252550.
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Affiliation(s)
- Sanna Nybacka
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stine Störsrud
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Hans Törnblom
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Simrén
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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23
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Effectiveness of a Dietary Support Program Based on Behavior Analysis Approach for Patients With Crohn Disease. Gastroenterol Nurs 2018; 40:229-238. [PMID: 28570423 DOI: 10.1097/sga.0000000000000171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to assess the effectiveness of a dietary support program for patients with Crohn disease based on behavior analysis and designed to maintain remission and improve satisfaction with meals. The core of the program consisted of self-monitoring by patients and evaluation by a healthcare professional. The 32-week program consisted of a 4-week baseline period, 20-week intervention period, and 8-week follow-up period. Participants filled out questionnaires measuring outcomes every 4 weeks, for a total of nine questionnaires per patient. Of the 13 patients who started the program, 11 completed the study. Of these, nine showed increased frequency of testing foods during the intervention period, with seven maintaining testing during the follow-up period. No patient experienced a worsening of health conditions. Of the 11 patients who completed the program, seven reported increased satisfaction with meals. In conclusion, this program helped increase the frequency of testing foods in patients with Crohn disease, while maintaining health conditions and improving satisfaction with meals.
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24
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Whiteley I, Gullick J. The embodied experience of pregnancy with an ileostomy. J Clin Nurs 2018; 27:3931-3944. [PMID: 29968264 DOI: 10.1111/jocn.14601] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Ian Whiteley
- Stomal Therapy; Level 1 West; Concord Repatriation General Hospital; Sydney NSW Australia
| | - Janice Gullick
- Sydney Nursing School; University of Sydney; Camperdown NSW Australia
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25
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Linedale EC, Mikocka-Walus A, Vincent AD, Gibson PR, Andrews JM. Performance of an algorithm-based approach to the diagnosis and management of functional gastrointestinal disorders: A pilot trial. Neurogastroenterol Motil 2018; 30. [PMID: 29094806 DOI: 10.1111/nmo.13243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/04/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recent advances in the development of diagnostic criteria and effective management options for functional gastrointestinal disorders (FGIDs) have not yet been integrated into clinical practice. There is a clear need for the development and validation of a simple clinical pathway for the diagnosis and management of FGIDs which can be used in primary care. METHODS In this controlled pilot study, we designed and evaluated a non-specialist-dependent, algorithm-based approach for the diagnosis and management of FGIDs (ADAM-FGID). Patients referred to 1 tertiary referral center with clinically suspected functional gastrointestinal disorders were allocated to waitlist control or algorithm group. The algorithm group was screened for organic disease, and those without clinical alarms received a written FGID diagnosis and management options. All participants were followed up for 1 year. KEY RESULTS The ADAM-FGID was found to be feasible and acceptable to both patients and primary healthcare providers. The diagnostic component identified that 39% of referrals required more urgent gastroenterological review than original triage category, with organic disease subsequently diagnosed in 31% of these. The majority of patients (82%) diagnosed with a FGID did not receive a relevant alternative diagnosis during follow-up. Patient buy-in to the model was good, with all reading the diagnostic/management letter, 80% entering management, and 61% reporting symptom improvement at 6 weeks. Moreover, 68% of patients and all referring doctors found the approach to be at least moderately acceptable. Patients reported being reassured by the approach and found the management options useful. Primary healthcare providers acknowledged the potential of this approach to reduce waiting times for endoscopic procedures and to provide reassurance to both patients and themselves. CONCLUSIONS & INFERENCES This pilot study provides preliminary evidence to support a clinical pathway for the diagnosis and management of FGIDs which does not depend upon specialist review. Further rigorous testing within primary care is needed to conclusively establish safety and efficacy. However, this approach is safer than current management and has potential to build capacity by reducing specialist burden and expediting effective care.
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Affiliation(s)
- E C Linedale
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - A Mikocka-Walus
- School of Psychology, Deakin University, Burwood, Vic., Australia
| | - A D Vincent
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,Freemasons Foundation Centre for Men's Health, Adelaide, SA, Australia
| | - P R Gibson
- Department of Gastroenterology Alfred Hospital, Monash University, Melbourne Vic, Australia
| | - J M Andrews
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,Department of Gastroenterology Alfred Hospital, Monash University, Melbourne Vic, Australia
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26
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O'Keeffe M, Jansen C, Martin L, Williams M, Seamark L, Staudacher HM, Irving PM, Whelan K, Lomer MC. Long-term impact of the low-FODMAP diet on gastrointestinal symptoms, dietary intake, patient acceptability, and healthcare utilization in irritable bowel syndrome. Neurogastroenterol Motil 2018; 30. [PMID: 28707437 DOI: 10.1111/nmo.13154] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/09/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The low-FODMAP diet is a frequently used treatment for irritable bowel syndrome (IBS). Most research has focused on short-term FODMAP restriction; however, guidelines recommend that high-FODMAP foods are reintroduced to individual tolerance. This study aimed to assess the long-term effectiveness of the low-FODMAP diet following FODMAP reintroduction in IBS patients. METHODS Patients with IBS were prospectively recruited to a questionnaire study following completion of dietitian-led low-FODMAP education. At baseline and following FODMAP restriction (short term) only, gastrointestinal symptoms were measured as part of routine clinical care. Following FODMAP reintroduction, (long term), symptoms, dietary intake, acceptability, food-related quality of life (QOL), and healthcare utilization were assessed. Data were reported for patients who continued long-term FODMAP restriction (adapted FODMAP) and/or returned to a habitual diet (habitual). KEY RESULTS Of 103 patients, satisfactory relief of symptoms was reported in 12% at baseline, 61% at short-term follow-up, and 57% at long-term follow-up. At long-term follow-up, 84 (82%) patients continued an 'adapted FODMAP' diet (total FODMAP intake mean 20.6, SD 14.9 g/d) compared with 19 (18%) of patients following a 'habitual' diet (29.4, SD 22.9 g/d, P=.039). Nutritional adequacy was not compromised for either group. The 'adapted FODMAP' group reported the diet cost significantly more than the 'habitual' group (P<.001) and affected social eating (P<.01) but there was no effect on food-related QOL. Healthcare utilization was similar between both groups. CONCLUSION AND INFERENCES Low-FODMAP education is effective for long-term IBS management, enables a nutritionally adequate diet, and is broadly acceptable to patients.
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Affiliation(s)
- M O'Keeffe
- Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, UK
| | - C Jansen
- Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, UK
| | - L Martin
- Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, UK
| | - M Williams
- Community Dietetics Service, Somerset Partnership NHS Foundation Trust, Bridgwater, Somerset, UK
| | - L Seamark
- Community Dietetics Service, Somerset Partnership NHS Foundation Trust, Bridgwater, Somerset, UK
| | - H M Staudacher
- Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, UK
| | - P M Irving
- Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, UK.,Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - K Whelan
- Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, UK.,Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M C Lomer
- Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, UK.,Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Casanova MJ, Chaparro M, Molina B, Merino O, Batanero R, Dueñas-Sadornil C, Robledo P, Garcia-Albert AM, Gómez-Sánchez MB, Calvet X, Trallero MDR, Montoro M, Vázquez I, Charro M, Barragán A, Martínez-Cerezo F, Megias-Rangil I, Huguet JM, Marti-Bonmati E, Calvo M, Campderá M, Muñoz-Vicente M, Merchante A, Ávila AD, Serrano-Aguayo P, De Francisco R, Hervías D, Bujanda L, Rodriguez GE, Castro-Laria L, Barreiro-de Acosta M, Van Domselaar M, Ramirez de la Piscina P, Santos-Fernández J, Algaba A, Torra S, Pozzati L, López-Serrano P, Arribas MDR, Rincón ML, Peláez AC, Castro E, García-Herola A, Santander C, Hernández-Alonso M, Martín-Noguerol E, Gómez-Lozano M, Monedero T, Villoria A, Figuerola A, Castaño-García A, Banales JM, Díaz-Hernández L, Argüelles-Arias F, López-Díaz J, Pérez-Martínez I, García-Talavera N, Nuevo-Siguairo OK, Riestra S, Gisbert JP. Prevalence of Malnutrition and Nutritional Characteristics of Patients With Inflammatory Bowel Disease. J Crohns Colitis 2017; 11:1430-1439. [PMID: 28981652 DOI: 10.1093/ecco-jcc/jjx102] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/20/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS This study sought to determine the prevalence of malnutrition in patients with inflammatory bowel disease, to analyse the dietary beliefs and behaviours of these patients, to study their body composition, to evaluate their muscular strength and to identify the factors associated with malnutrition in these patients. METHODS This was a prospective, multicentre study. Crohn's disease and ulcerative colitis patients from 30 Spanish centres, from the outpatient clinics, were included. A questionnaire of 11 items was applied to obtain data from patients' dietary behaviour and beliefs. Patients who accepted were evaluated to assess their nutritional status using Subjective Global Assessment and body mass index. Body composition was evaluated through bioelectrical impedance. RESULTS A total of 1271 patients were included [51% women, median age 45 years, 60% Crohn's disease]. Of these, 333 patients underwent the nutritional evaluation. A total of 77% of patients declared that they avoided some foods to prevent disease relapse. Eighty-six per cent of patients avoided some foods when they had disease activity because of fear of worsening the flare. Sixty-seven per cent of patients modified their dietary habits after disease diagnosis. The prevalence of malnutrition was 16% [95% confidence interval = 12-20%]. In the multivariate analysis, history of abdominal surgery, active disease and avoidance of some foods during flares were associated with higher risk of malnutrition. CONCLUSIONS The prevalence of malnutrition in inflammatory bowel disease patients was high. We identified some predictive factors of malnutrition. Most of the patients had self-imposed food restrictions, based on their beliefs.
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Affiliation(s)
- María José Casanova
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | - Maria Chaparro
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | - Begoña Molina
- Departments of Gastroenterology, Endocrinology and Nutrition
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | | | - Ricardo Batanero
- Departments of Gastroenterology, Endocrinology and Nutrition
- Hospital Universitario de Cruces, Spain
| | | | | | | | | | - Xavier Calvet
- Corporació Sanitària Universitària Parc Taulí, Sabadell, Universitat Autònoma de Barcelona, and CIBEREHD, Instituto de Salud Carlos III, Grupo de Investigación Consolidado (SGR01500), Spain
| | - Maria Del Roser Trallero
- Departments of Gastroenterology, Endocrinology and Nutrition
- Corporació Sanitària Universitària Parc Taulí, Sabadell, Universitat Autònoma de Barcelona, and CIBEREHD, Instituto de Salud Carlos III, Grupo de Investigación Consolidado (SGR01500), Spain
| | | | - Iria Vázquez
- Departments of Gastroenterology, Endocrinology and Nutrition
- Hospital San Jorge de Huesca, Spain
| | | | - Amaya Barragán
- Departments of Gastroenterology, Endocrinology and Nutrition
- Hospital Royo Villanova, Spain
| | | | - Isabel Megias-Rangil
- Departments of Gastroenterology, Endocrinology and Nutrition
- Hospital Universitario Sant Joan de Reus, Spain
| | | | | | - Marta Calvo
- Hospital Universitario Puerta de Hierro,Spain
| | - Mariana Campderá
- Departments of Gastroenterology, Endocrinology and Nutrition
- Hospital Universitario Puerta de Hierro,Spain
| | | | - Angel Merchante
- Departments of Gastroenterology, Endocrinology and Nutrition
- Hospital General Universitario de Castellón, Spain
| | | | - Pilar Serrano-Aguayo
- Departments of Gastroenterology, Endocrinology and Nutrition
- Hospital Universitario Virgen del Rocío, Spain
| | | | | | - Luis Bujanda
- Hospital de Donostia, Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), and CIBEREHD, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Cecilio Santander
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | | | | | | | - Tamara Monedero
- Departments of Gastroenterology, Endocrinology and Nutrition
- Hospital Universitario Reina Sofía, Spain
| | - Albert Villoria
- Corporació Sanitària Universitària Parc Taulí, Sabadell, Universitat Autònoma de Barcelona, and CIBEREHD, Instituto de Salud Carlos III, Grupo de Investigación Consolidado (SGR01500), Spain
| | | | | | - Jesús M Banales
- Hospital de Donostia, Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), and CIBEREHD, Spain
| | | | | | | | | | - Noelia García-Talavera
- Departments of Gastroenterology, Endocrinology and Nutrition
- Hospital Universitario Reina Sofía, Spain
| | | | | | - Javier P Gisbert
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
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Zia J, Chung CF, Xu K, Dong Y, Schenk JM, Cain K, Munson S, Heitkemper MM. Inter-Rater Reliability of Provider Interpretations of Irritable Bowel Syndrome Food and Symptom Journals. J Clin Med 2017; 6:jcm6110105. [PMID: 29113044 PMCID: PMC5704122 DOI: 10.3390/jcm6110105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/27/2017] [Accepted: 11/01/2017] [Indexed: 12/16/2022] Open
Abstract
There are currently no standardized methods for identifying trigger food(s) from irritable bowel syndrome (IBS) food and symptom journals. The primary aim of this study was to assess the inter-rater reliability of providers’ interpretations of IBS journals. A second aim was to describe whether these interpretations varied for each patient. Eight providers reviewed 17 IBS journals and rated how likely key food groups (fermentable oligo-di-monosaccharides and polyols, high-calorie, gluten, caffeine, high-fiber) were to trigger IBS symptoms for each patient. Agreement of trigger food ratings was calculated using Krippendorff’s α-reliability estimate. Providers were also asked to write down recommendations they would give to each patient. Estimates of agreement of trigger food likelihood ratings were poor (average α = 0.07). Most providers gave similar trigger food likelihood ratings for over half the food groups. Four providers gave the exact same written recommendation(s) (range 3–7) to over half the patients. Inter-rater reliability of provider interpretations of IBS food and symptom journals was poor. Providers favored certain trigger food likelihood ratings and written recommendations. This supports the need for a more standardized method for interpreting these journals and/or more rigorous techniques to accurately identify personalized IBS food triggers.
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Affiliation(s)
- Jasmine Zia
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, WA 98195, USA.
| | - Chia-Fang Chung
- Department of Human Centered Design and Engineering, University of Washington, Seattle, WA 98195, USA.
| | - Kaiyuan Xu
- Department of Human Centered Design and Engineering, University of Washington, Seattle, WA 98195, USA.
| | - Yi Dong
- Department of Human Centered Design and Engineering, University of Washington, Seattle, WA 98195, USA.
| | | | - Kevin Cain
- Department of Biostatistics and Office of Nursing Research, University of Washington, Seattle, WA 98195, USA.
| | - Sean Munson
- Department of Human Centered Design and Engineering, University of Washington, Seattle, WA 98195, USA.
| | - Margaret M Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA 98195, USA.
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Karkar R, Schroeder J, Epstein DA, Pina LR, Scofield J, Fogarty J, Kientz JA, Munson SA, Vilardaga R, Zia J. TummyTrials: A Feasibility Study of Using Self-Experimentation to Detect Individualized Food Triggers. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2017; 2017:6850-6863. [PMID: 28516175 PMCID: PMC5432136 DOI: 10.1145/3025453.3025480] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Diagnostic self-tracking, the recording of personal information to diagnose or manage a health condition, is a common practice, especially for people with chronic conditions. Unfortunately, many who attempt diagnostic self-tracking have trouble accomplishing their goals. People often lack knowledge and skills needed to design and conduct scientifically rigorous experiments, and current tools provide little support. To address these shortcomings and explore opportunities for diagnostic self-tracking, we designed, developed, and evaluated a mobile app that applies a self-experimentation framework to support patients suffering from irritable bowel syndrome (IBS) in identifying their personal food triggers. TummyTrials aids a person in designing, executing, and analyzing self-experiments to evaluate whether a specific food triggers their symptoms. We examined the feasibility of this approach in a field study with 15 IBS patients, finding that participants could use the tool to reliably undergo a self-experiment. However, we also discovered an underlying tension between scientific validity and the lived experience of self-experimentation. We discuss challenges of applying clinical research methods in everyday life, motivating a need for the design of self-experimentation systems to balance rigor with the uncertainties of everyday life.
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Affiliation(s)
- Ravi Karkar
- Computer Science & Engineering, DUB Group, University of Washington, Seattle, WA, United States
| | - Jessica Schroeder
- Computer Science & Engineering, DUB Group, University of Washington, Seattle, WA, United States
| | - Daniel A Epstein
- Computer Science & Engineering, DUB Group, University of Washington, Seattle, WA, United States
| | - Laura R Pina
- Computer Science & Engineering, DUB Group, University of Washington, Seattle, WA, United States
- Human Centered Design & Engineering, DUB Group, University of Washington, Seattle, WA, United States
| | - Jeffrey Scofield
- Computer Science & Engineering, DUB Group, University of Washington, Seattle, WA, United States
| | - James Fogarty
- Computer Science & Engineering, DUB Group, University of Washington, Seattle, WA, United States
| | - Julie A Kientz
- Human Centered Design & Engineering, DUB Group, University of Washington, Seattle, WA, United States
| | - Sean A Munson
- Human Centered Design & Engineering, DUB Group, University of Washington, Seattle, WA, United States
| | - Roger Vilardaga
- Center for Addiction Science and Technology, Duke University, Durham, NC, United States
| | - Jasmine Zia
- Division of Gastroenterology, DUB Group, University of Washington, Seattle, WA, United States
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30
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Schroeder J, Hoffswell J, Chung CF, Fogarty J, Munson S, Zia J. Supporting Patient-Provider Collaboration to Identify Individual Triggers using Food and Symptom Journals. CSCW : PROCEEDINGS OF THE CONFERENCE ON COMPUTER-SUPPORTED COOPERATIVE WORK. CONFERENCE ON COMPUTER-SUPPORTED COOPERATIVE WORK 2017; 2017:1726-1739. [PMID: 28516172 PMCID: PMC5432206 DOI: 10.1145/2998181.2998276] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patient-generated data can allow patients and providers to collaboratively develop accurate diagnoses and actionable treatment plans. Unfortunately, patients and providers often lack effective support to make use of such data. We examine patient-provider collaboration to interpret patient-generated data. We focus on irritable bowel syndrome (IBS), a chronic illness in which particular foods can exacerbate symptoms. IBS management often requires patient-provider collaboration using a patient's food and symptom journal to identify the patient's triggers. We contribute interactive visualizations to support exploration of such journals, as well as an examination of patient-provider collaboration in interpreting the journals. Drawing upon individual and collaborative interviews with patients and providers, we find that collaborative review helps improve data comprehension and build mutual trust. We also find a desire to use tools like our interactive visualizations within and beyond clinic appointments. We discuss these findings and present guidance for the design of future tools.
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Affiliation(s)
| | - Jane Hoffswell
- Computer Science & Engineering, DUB Group, University of Washington
| | - Chia-Fang Chung
- Human Centered Design & Engineering, DUB Group, University of Washington
| | - James Fogarty
- Computer Science & Engineering, DUB Group, University of Washington
| | - Sean Munson
- Human Centered Design & Engineering, DUB Group, University of Washington
| | - Jasmine Zia
- Division of Gastroenterology, DUB Group, University of Washington
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Pittet V, Vaucher C, Froehlich F, Burnand B, Michetti P, Maillard MH, On behalf of the Swiss IBD Cohort Study Group. Patient self-reported concerns in inflammatory bowel diseases: A gender-specific subjective quality-of-life indicator. PLoS One 2017; 12:e0171864. [PMID: 28187201 PMCID: PMC5302448 DOI: 10.1371/journal.pone.0171864] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/26/2017] [Indexed: 12/15/2022] Open
Abstract
Background Patient-reported disease perceptions are important components to be considered within a holistic model of quality of care. Gender may have an influence on these perceptions. We aimed to explore gender-specific concerns of patients included in a national bilingual inflammatory bowel disease cohort. Methods Following a qualitative study, we built a questionnaire comprising 37 items of concern. Answers were collected on a visual analog scale ranging from 0 to 100. Principal axis factor analysis was used to explore concern domains. Linear multiple regressions were conducted to assess associations with patient characteristics. Results Of 1102 patients who replied to the survey, 54% were female and 54% had Crohn’s disease. We identified six domains of concern: socialization and stigmatization, disease-related constraints and uncertainty, symptoms and their impact on body and mind, loss of body control (including sexuality), disease transmission, and long-term impact of the disease. Cancer concerns were among the highest scored by all patients (median 61.8). Severity of symptoms was the only factor associated with concerns, unrelated to dimension and gender (p<0.015). In women, being >40 years decreased disease-related constraints and uncertainty concerns, and being at home or unemployed increased them. Treatments were associated with increased socialization and stigmatization and with increased disease-related constraints and uncertainty concerns in men. Overall, psychosomatic characteristics were highly associated with concerns for both men and women. Depending on the concern dimensions, increased levels of concern were associated with the highest signs of anxiety in women or depression in men, as well as lower health-related quality of life in men. Conclusions Patients have numerous concerns related to their illness that need to be reassessed regularly. Concerns differ between men and women, suggesting that information and communication about the disease should take gender differences and subjective perceptions of quality of life into consideration.
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Affiliation(s)
- Valérie Pittet
- Institute of Social & Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
- * E-mail:
| | - Carla Vaucher
- Institute of Social & Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Florian Froehlich
- Division of Gastroenterology & Hepatology, Lausanne University Hospital, Lausanne, Switzerland
- Division of Gastroenterology & Hepatology, Basel University Hospital, Basel, Switzerland
| | - Bernard Burnand
- Institute of Social & Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Michetti
- Crohn and Colitis Center, Clinique La Source-Beaulieu, Lausanne, Switzerland
| | - Michel H. Maillard
- Division of Gastroenterology & Hepatology, Lausanne University Hospital, Lausanne, Switzerland
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Zia JK, Chung CF, Schroeder J, Munson SA, Kientz JA, Fogarty J, Bales E, Schenk JM, Heitkemper MM. The feasibility, usability, and clinical utility of traditional paper food and symptom journals for patients with irritable bowel syndrome. Neurogastroenterol Motil 2017; 29:10.1111/nmo.12935. [PMID: 27619957 PMCID: PMC11797272 DOI: 10.1111/nmo.12935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 08/06/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Paper food and gastrointestinal (GI) symptom journals are used to help irritable bowel syndrome (IBS) patients determine potential trigger foods. The primary aim of this study was to evaluate the feasibility, usability, and clinical utility of such journals as a data collection tool. A secondary aim was to explore a method for analyzing journal data to describe patterns of diet and symptoms. METHODS Participants (N=17) were asked to log three sets of 3-day food and symptom journals over a 15-day period. Feasibility was evaluated by journal completion rates, symptom logging compliance, and logging fatigability. The feasibility, usability, and clinical utility of journaling were also assessed by a customized evaluation and exit interview. For each journal, regression analyses were conducted to examine relationships between key meal nutrients and subsequent symptoms. KEY RESULTS Most participants were young (mean age 35±12) Caucasian (N=13) women (N=14). Journal completion rates were 100% for all participants with no logging fatigability. Over half perceived paper journaling of food and symptoms as feasible, usable, and clinically useful. Thirteen participants demonstrated a strong association with at least one symptom and meal nutrient. Patterns of associations differed among participants. CONCLUSIONS AND INFERENCES Paper journaling of food and GI symptoms for 9 days over a 15-day period appeared to be a feasible and usable data collection tool for IBS patients. Over half perceived journaling as at least somewhat clinically useful. Findings from this study support the anecdote that food trigger(s) and associated symptom(s) vary for each individual.
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Affiliation(s)
- J K Zia
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - C-F Chung
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA, USA
| | - J Schroeder
- Department of Computer Science & Engineering, University of Washington, Seattle, WA, USA
| | - S A Munson
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA, USA
| | - J A Kientz
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA, USA
| | - J Fogarty
- Department of Computer Science & Engineering, University of Washington, Seattle, WA, USA
| | - E Bales
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA, USA
| | - J M Schenk
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - M M Heitkemper
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
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Fermentable Carbohydrate Restriction (Low FODMAP Diet) in Clinical Practice Improves Functional Gastrointestinal Symptoms in Patients with Inflammatory Bowel Disease. Inflamm Bowel Dis 2016; 22:1129-36. [PMID: 26914438 DOI: 10.1097/mib.0000000000000708] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND A significant proportion of patients with inflammatory bowel disease (IBD) experience functional-like gastrointestinal symptoms (FGS) even during remission. Research suggests that dietary restriction of fermentable carbohydrates (low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet) can improve FGS, albeit in irritable bowel syndrome. The aim of this study was to investigate the effectiveness of the low FODMAP diet delivered in routine clinical practice in patients with IBD and coexisting FGS. METHODS Gastrointestinal symptom scores were compared in consecutive patients with IBD referred for low FODMAP dietary education for symptom management (n = 88). Symptoms were assessed using the Gastrointestinal Symptoms Rating Scale, and stool output was assessed using the Bristol Stool Form Scale at both baseline and follow-up (minimum of 6 weeks). RESULTS There was a significant and large increase in the numbers of patients reporting satisfactory relief of symptoms between baseline (14/88, 16%) and low FODMAP diet (69/88, 78%; P < 0.001). Following dietary intervention, there was also a significant decrease in severity for most symptoms and a reduction in composite symptom score (baseline mean: 1.2, SD: 0.5 versus low FODMAP diet mean: 0.7, SD: 0.5; P < 0.001). Improvements in stool consistency and frequency were observed, including an increase in "normal" stool form (P = 0.002) and "normal" stool frequency (P < 0.001). CONCLUSIONS The low FODMAP diet delivered in routine clinical practice seems effective in improving satisfaction with, and severity of, FGS in IBD. Randomized controlled trials are warranted to definitively establish effectiveness.
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Chung CF, Dew K, Cole A, Zia J, Fogarty J, Kientz JA, Munson SA. Boundary Negotiating Artifacts in Personal Informatics: Patient-Provider Collaboration with Patient-Generated Data. CSCW : PROCEEDINGS OF THE CONFERENCE ON COMPUTER-SUPPORTED COOPERATIVE WORK. CONFERENCE ON COMPUTER-SUPPORTED COOPERATIVE WORK 2016; 2016:770-786. [PMID: 28516171 DOI: 10.1145/2818048.2819926] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Patient-generated data is increasingly common in chronic disease care management. Smartphone applications and wearable sensors help patients more easily collect health information. However, current commercial tools often do not effectively support patients and providers in collaboration surrounding these data. This paper examines patient expectations and current collaboration practices around patient-generated data. We survey 211 patients, interview 18 patients, and re-analyze a dataset of 21 provider interviews. We find that collaboration occurs in every stage of self-tracking and that patients and providers create boundary negotiating artifacts to support the collaboration. Building upon current practices with patient-generated data, we use these theories of patient and provider collaboration to analyze misunderstandings and privacy concerns as well as identify opportunities to better support these collaborations. We reflect on the social nature of patient-provider collaboration to suggest future development of the stage-based model of personal informatics and the theory of boundary negotiating artifacts.
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Affiliation(s)
- Chia-Fang Chung
- Human Centered Design & Engineering, DUB Group, University of Washington
| | - Kristin Dew
- Human Centered Design & Engineering, DUB Group, University of Washington
| | - Allison Cole
- Family Medicine, DUB Group, University of Washington
| | - Jasmine Zia
- Division of Gastroenterology, DUB Group, University of Washington
| | - James Fogarty
- Computer Science & Engineering, DUB Group, University of Washington
| | - Julie A Kientz
- Human Centered Design & Engineering, DUB Group, University of Washington.,Computer Science & Engineering, DUB Group, University of Washington
| | - Sean A Munson
- Human Centered Design & Engineering, DUB Group, University of Washington.,Computer Science & Engineering, DUB Group, University of Washington
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35
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Zia JK, Barney P, Cain KC, Jarrett ME, Heitkemper MM. A Comprehensive Self-Management Irritable Bowel Syndrome Program Produces Sustainable Changes in Behavior After 1 Year. Clin Gastroenterol Hepatol 2016; 14:212-9.e1-2. [PMID: 26453951 PMCID: PMC4718771 DOI: 10.1016/j.cgh.2015.09.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/17/2015] [Accepted: 09/17/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We developed a comprehensive self-management (CSM) program that combines cognitive behavioral therapy with relaxation and dietary strategies; 9 sessions (1 hour each) over 13 weeks were shown to reduce gastrointestinal symptoms and increase quality of life in a randomized trial of patients with irritable bowel syndrome (IBS), compared with usual care. The aims of this study were to describe strategies patients with IBS selected and continued to use, 12 months after the CSM program began. METHODS We performed a cohort study to continue to follow 81 adults with IBS (87% female; mean age, 45 ± 15 years old) who received the CSM program in the previous clinical trial. During the last CSM session, participants selected strategies they intended to continue using to manage their IBS. CSM strategies were categorized into subthemes of diet (composition, trigger foods, meal size or timing, and eating behaviors), relaxation (specific relaxation strategies and lifestyle behaviors), and alternative thoughts (identifying thought distortions, challenging underlying beliefs, and other strategies). Twelve months later, participants were asked how often they used each strategy (not at all or rarely, occasionally, often, very often, or almost always). RESULTS At the last CSM session, 95% of the patients selected the subthemes of specific relaxation strategies, 90% selected diet composition, and 90% identified thought distortions for continued use. At 12 months, 94% of the participants (76 of 81) were still using at least 6 strategies, and adherence was greater than 79% for all subthemes. CONCLUSIONS We developed a CSM program to reduce symptoms and increase quality of life in patients with IBS that produced sustainable behavioral changes in almost all patients (94%) after 1 year of follow-up.
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Affiliation(s)
- Jasmine K. Zia
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Pamela Barney
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
| | - Kevin C. Cain
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
| | - Monica E. Jarrett
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
| | - Margaret M. Heitkemper
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
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Hughes LD, King L, Morgan M, Ayis S, Direkze N, Lomer MC, Lindsay JO, Whelan K. Food-related Quality of Life in Inflammatory Bowel Disease: Development and Validation of a Questionnaire. J Crohns Colitis 2016; 10:194-201. [PMID: 26507859 DOI: 10.1093/ecco-jcc/jjv192] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/08/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Psychosocial factors surrounding eating and drinking, such as enjoying food, managing restrictions, and maintaining social relationships, remain under-researched in inflammatory bowel disease [IBD]. This study aimed to develop and validate a food-related quality of life [FR-QoL] questionnaire to systematically measure these issues in the IBD population. METHODS Following semi-structured interviews with 28 IBD patients, 150 potential questionnaire items were generated. These were ranked by 100 IBD patients, and items were removed based on ceiling/floor effects and high inter-item correlations [> 0.7], with 41 items being retained. In total, 323 IBD patients, 100 asthma patients [chronic disease control], and 117 healthy controls completed the FR-QoL questionnaire, alongside generic and disease-specific QoL and food satisfaction questionnaires. Principal components analysis [PCA], construct and discriminant validity, and test-retest reliability were calculated. RESULTS Twelve items were removed following PCA. The reduced questionnaire [FR-QoL-29] explained 63.9% of the variance [Cronbach's α = 0.96]. FR-QoL-29 correlated significantly with generic QoL [r = 0.697], depression [r = -0.519], anxiety [r = -0.531], and food satisfaction [r = 0.701]. The FR-QoL-29 sumscores were significantly lower for IBD (89.5, standard deviation [SD] 28.6) than asthma [125.4, SD 24.1; p < 0.001] and healthy volunteers [123.0, SD 16.5; p<0.001]. Within IBD, worse food-related QoL was found in those with moderate/high disease activity [66.7, SD 22.1] compared with remission/low disease activity [92.5, SD 28.1]. Test-retest reliability was good (intra-class correlation [ICC] = 0.83, 95% confidence interval [CI] = 0.76:0.88). CONCLUSIONS The FR-QoL-29 shows good reliability and validity across a range of IBD characteristics. This easily administered questionnaire is a useful tool in identifying poor food-related QoL and in the future may identify areas for intervention.
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Affiliation(s)
| | - Laura King
- King's College London, Diabetes and Nutritional Sciences Division, London, UK
| | - Myfanwy Morgan
- King's College London, Health and Social Care Division, London, UK
| | - Salma Ayis
- King's College London, Health and Social Care Division, London, UK
| | - Natalie Direkze
- Frimley Park Hospital NHS Foundation Trust, Department of Gastroenterology, Frimley, UK
| | - Miranda C Lomer
- King's College London, Diabetes and Nutritional Sciences Division, London, UK Guys and St Thomas' NHS Foundation Trust, Department of Nutrition & Dietetics, London, UK Guys and St Thomas' NHS Foundation Trust, Department of Gastroenterology, London, UK
| | - James O Lindsay
- Barts and the London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK Digestive Diseases Unit, Barts Health NHS Trust, London, UK
| | - Kevin Whelan
- King's College London, Diabetes and Nutritional Sciences Division, London, UK
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Abstract
BACKGROUND An epidemiological association implicating diet in IBD risk or protection is widely accepted. Patients with IBD often make links to diet, but there is a dearth of literature exploring dietary perceptions and practices in this population. Our objective was to evaluate dietary beliefs and behaviors in IBD patients. METHODS We developed a questionnaire assessing demographics, dietary beliefs and habits in IBD patients. This was prospectively administered to 400 consecutive patients attending our IBD clinics. RESULTS Mean patient age was 48.4 years; 55% were female, 88% white, 39% had Crohn's disease and 51% had ulcerative colitis. Around 48% felt that diet could be the initiating factor in IBD and 57% felt it could trigger a flare. Worsening symptoms with certain foods was reported by 60%. About 66% deprived themselves of their favorite foods in order to prevent relapse. Three-fourth of patients believed that IBD affects appetite, more so during a relapse. Nearly half had never received any formal dietary advice, and two-thirds requested for further dietary advice. After adjusting for other predictors, the IBD subtype and ethnicity of the patients remained as significant factors for influencing beliefs held by patients. CONCLUSIONS Our study showed that patients hold beliefs pertaining to the role of diet in IBD, with a high level of consistency around key perceived triggers. Whether all the symptoms reported are due to active inflammation cannot be ascertained, but the potential exists for dietary components triggering active disease and perpetuating gut injury, impacting on quality of life and health care costs.
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Karkar R, Zia J, Vilardaga R, Mishra SR, Fogarty J, Munson SA, Kientz JA. A framework for self-experimentation in personalized health. J Am Med Inform Assoc 2015; 23:440-8. [PMID: 26644399 DOI: 10.1093/jamia/ocv150] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/29/2015] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To describe an interdisciplinary and methodological framework for applying single case study designs to self-experimentation in personalized health. The authors examine the framework's applicability to various health conditions and present an initial case study with irritable bowel syndrome (IBS). METHODS AND MATERIALS An in-depth literature review was performed to develop the framework and to identify absolute and desired health condition requirements for the application of this framework. The authors developed mobile application prototypes, storyboards, and process flows of the framework using IBS as the case study. The authors conducted three focus groups and an online survey using a human-centered design approach for assessing the framework's feasibility. RESULTS All 6 focus group participants had a positive view about our framework and volunteered to participate in future studies. Most stated they would trust the results because it was their own data being analyzed. They were most concerned about confounds, nonmeaningful measures, and erroneous assumptions on the timing of trigger effects. Survey respondents (N = 60) were more likely to be adherent to an 8- vs 12-day study length even if it meant lower confidence results. DISCUSSION Implementation of the self-experimentation framework in a mobile application appears to be feasible for people with IBS. This framework can likely be applied to other health conditions. Considerations include the learning curve for teaching self-experimentation to non-experts and the challenges involved in operationalizing and customizing study designs. CONCLUSION Using mobile technology to guide people through self-experimentation to investigate health questions is a feasible and promising approach to advancing personalized health.
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Affiliation(s)
- Ravi Karkar
- Computer Science & Engineering, University of Washington, Seattle, WA, USA
| | - Jasmine Zia
- Division of Gastroenterology, Medicine University of Washington, Seattle, WA, USA
| | - Roger Vilardaga
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Sonali R Mishra
- Information School, University of Washington, Seattle, WA, USA
| | - James Fogarty
- Computer Science & Engineering, University of Washington, Seattle, WA, USA
| | - Sean A Munson
- Human Centered Design & Engineering, University of Washington, Seattle, WA, USA
| | - Julie A Kientz
- Human Centered Design & Engineering, University of Washington, Seattle, WA, USA
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Chung CF, Cook J, Bales E, Zia J, Munson SA. More Than Telemonitoring: Health Provider Use and Nonuse of Life-Log Data in Irritable Bowel Syndrome and Weight Management. J Med Internet Res 2015; 17:e203. [PMID: 26297627 PMCID: PMC4642406 DOI: 10.2196/jmir.4364] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 07/24/2015] [Accepted: 07/27/2015] [Indexed: 12/16/2022] Open
Abstract
Background The quantified self, self-monitoring or life-logging movement is a trend to incorporate technology into data acquisition on aspects of a person's daily life in terms of inputs (eg food consumed), states (eg mood), and performance (mental and physical). Consumer self-monitoring mobile phone apps have been widely studied and used to promote healthy behavior changes. Data collected through life-logging apps also have the potential to support clinical care. Objective We sought to develop an in-depth understanding of providers’ facilitators and barriers to successfully integrating life-log data into their practices and creating better experiences. We specifically investigated three research questions: How do providers currently use patient-collected life-log data in clinical practice? What are provider concerns and needs with respect to this data? What are the constraints for providers to integrate this type of data into their workflows? Methods We interviewed 21 health care providers—physicians, dietitians, a nurse practitioner, and a behavioral psychologist—who work with obese and irritable bowel syndrome patients. We transcribed and analyzed interviews according to thematic analysis and an affinity diagramming process. Results Providers reported using self-monitoring data to enhance provider-patient communication, develop personalized treatment plans, and to motivate and educate patients, in addition to using them as diagnostic and adherence tools. However, limitations associated with current systems and workflows create barriers to regular and effective review of this data. These barriers include a lack of time to review detailed records, questions about providers' expertise to review it, and skepticism about additional benefits offered by reviewing data. Current self-monitoring tools also often lack flexibility, standardized formats, and mechanisms to share data with providers. Conclusions Variations in provider needs affect tracking and reviewing needs. Systems to support diagnosis might require better reliability and resolution, while systems to support interaction should support collaborative reflection and communication. Automatic synthesis of data logs could help providers focus on educational goals while communication of contextual information might help providers better understand patient values. We also discuss how current mobile apps and provider systems do, and do not, support these goals, and future design opportunities to realize the potential benefits of using life-logging tools in clinical care.
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Affiliation(s)
- Chia-Fang Chung
- Department of Human Centered Design & Engineering, Dub Group, University of Washington, Seattle, WA, United States.
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Palant A, Koschack J, Rassmann S, Lucius-Hoene G, Karaus M, Himmel W. "And then you start to loose it because you think about Nutella": The significance of food for people with inflammatory bowel disease - a qualitative study. BMC Gastroenterol 2015; 15:93. [PMID: 26219642 PMCID: PMC4518859 DOI: 10.1186/s12876-015-0322-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/16/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many patients with inflammatory bowel disease strongly believe that food or certain food products heavily influence the symptoms or even trigger acute flare-ups. Unfortunately, there is no generalizable information for these patients, and therefore no effective diet has been identified to date. METHODS The narrative interviews we used for this study provide the basis for the German website www.krankheitserfahrungen.de . Maximum-variation sampling was used to include a broad range of experiences and a variety of different factors that might influence people's experiences. The sample included men and women of different age groups and social and ethnic backgrounds from across Germany. The interviews were analyzed using grounded theory. RESULTS Four interrelated categories emerged: managing uncertainty, eating: between craving and aversion, being different and professional help as a further source of uncertainty. The most important issue for our responders was the handling of uncertainty and to find a way between desire for, and aversion against, eating. Many participants described difficulties during formal social occasions such as weddings, birthdays, or when going out to a restaurant. CONCLUSIONS Many of the experiences the participants reported in their daily struggle with food and their illness, such as cravings for and abstaining from certain foods, were rather unusual and often stressful. Because they decided not to go out in public any longer, some of the interviewees experienced even more social isolation than they did before. Health professionals need to become more involved and not only advice about food and eating, but also help their patients find strategies for avoiding social isolation.
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Affiliation(s)
- Alexander Palant
- Department for General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany.
| | - Janka Koschack
- Department for General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany.
| | - Simone Rassmann
- Department for General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany.
| | | | - Michael Karaus
- Evangelic Hospital Göttingen-Weende, Göttingen, Germany.
| | - Wolfgang Himmel
- Department for General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany.
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Gibson PR, Varney J, Malakar S, Muir JG. Food components and irritable bowel syndrome. Gastroenterology 2015; 148:1158-74.e4. [PMID: 25680668 DOI: 10.1053/j.gastro.2015.02.005] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/03/2015] [Accepted: 02/05/2015] [Indexed: 12/15/2022]
Abstract
Ingestion of food has long been linked with gut symptoms, and there is increasing interest in using diet in the management of patients with irritable bowel syndrome (IBS). The West has developed an intense interest in specialized, restrictive diets, such as those that target multiple food groups, avoid gluten, or reduce fermentable oligo-, di-, and mono-saccharides and polyols. However, most gastroenterologists are not well educated about diets or their effects on the gut. It is important to understand the various dietary approaches, their putative mechanisms, the evidence that supports their use, and the benefits or harm they might produce. The concepts behind, and delivery of, specialized diets differ from those of pharmacologic agents. High-quality research is needed to determine the efficacy of different dietary approaches and the place of specific strategies.
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Affiliation(s)
- Peter R Gibson
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia.
| | - Jane Varney
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Sreepurna Malakar
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Jane G Muir
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
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Abstract
The current general interest in the use of food choice or diet in maintaining good health and in preventing and treating disease also applies to patients with IBD, who often follow poor or nutritionally challenging dietary plans. Unfortunately, dietary advice plays only a minor part in published guidelines for management of IBD, which sends a message that diet is not of great importance. However, a considerable evidence base supports a focused and serious attention to nutrition and diet in patients with IBD. In this Review, a step-wise approach in the evaluation and management of these patients is proposed. First, dietary intake and eating habits as well as current nutritional state should be documented, and corrective measures instituted. Secondly, dietary strategies as primary or adjunctive therapy for the reduction of inflammation and/or prevention of relapse of IBD should be seriously contemplated. Thirdly, use of diet to improve symptoms or lessen the effects of complications should be considered. Finally, dietary advice regarding disease prevention should be discussed when relevant. An increasing need exists for applying improved methodologies into establishing the value of current and new ways of using food choice as a therapeutic and preventive tool in IBD.
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Sykes DN, Fletcher PC, Schneider MA. Balancing my disease: women's perspectives of living with inflammatory bowel disease. J Clin Nurs 2015; 24:2133-42. [DOI: 10.1111/jocn.12785] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2014] [Indexed: 01/18/2023]
Affiliation(s)
- Dorothy N Sykes
- Department of Physical Education and Kinesiology; Wilfrid Laurier University; Waterloo ON Canada
| | - Paula C Fletcher
- Department of Physical Education and Kinesiology; Wilfrid Laurier University; Waterloo ON Canada
| | - Margaret A Schneider
- Department of Physical Education and Kinesiology; Wilfrid Laurier University; Waterloo ON Canada
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Lindberg A, Fossum B, Karlen P, Oxelmark L. Experiences of complementary and alternative medicine in patients with inflammatory bowel disease - a qualitative study. Altern Ther Health Med 2014; 14:407. [PMID: 25338541 PMCID: PMC4210588 DOI: 10.1186/1472-6882-14-407] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 10/16/2014] [Indexed: 12/16/2022]
Abstract
Background The use of Complementary and Alternative Medicine (CAM) in Inflammatory Bowel Disease (IBD) is increasing. Although CAM often improves patients’ well-being, it can also lead to side-effects and interactions with conventional medications. Research on patients with IBD in Sweden who have experiences of CAM is sparse. More studies are needed to enhance awareness of and improve communication about CAM. The aim of this study was to describe experiences of CAM in the healthcare context reported by patients with IBD. Methods Fifteen patients with IBD, eight with Crohn’s disease (CD) and seven with ulcerative colitis (UC), were recruited. Semi-structured qualitative interviews were conducted and qualitative content analysis was performed. Results The analysis revealed the theme Knowledge and communication lead to participation in the area of CAM based on three categories; CAM use, Communication and Self-care. Patients with IBD wanted to be asked about CAM to be able to start a dialogue, as some perceived being treated in a disparaging manner and not taken seriously when raising the subject. Healthcare professionals (HCPs) need to be aware of this in order to meet and understand patient needs. Patients with IBD found it easier to communicate about CAM with the IBD nurses than physicians and dietary changes was one important CAM treatment. Conclusions The finding that it was easier to discuss CAM with nurses than physicians emphasizes the important role of the IBD nurse in communication and monitoring patients’ CAM use. Patients wanted to be asked about CAM to be able to start a dialogue, as some perceived not taken seriously when raising the subject. Furthermore, HCPs need to understand that many patients with IBD regard dietary changes as an important part of CAM treatment. Further research in these areas is needed.
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Dietary fiber information for individuals with Crohn disease: reports of gastrointestinal effects. Gastroenterol Nurs 2014; 36:320-7. [PMID: 24084130 DOI: 10.1097/sga.0b013e3182a67a9a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The experiences of individuals with Crohn disease before and after receiving dietary fiber information have not been described in the literature. This article offers findings from a study that used four semistructured audiorecorded interviews during a 4-week time period for the purpose of exploring the experiences of 11 individuals before and after receiving dietary fiber information from a healthcare professional. The first and second interviews occurred immediately before and after the presentation of information. Follow-up interviews occurred at 2-week intervals. Thematic analysis of the baseline interviews revealed 2 themes: (a) accepting a redefined (lower expectations) definition of normal quality of life and (b) continuing to look for answers. Three themes emerged from the follow-up interviews at Week 4: (a) reevaluating old diet-related concepts, (b) enjoying a healthier lifestyle at a self-set pace, and (c) enjoying positive physical effects of wheat bran consumption. This article examines the 3rd postintervention theme, "enjoying physical effects of wheat bran consumption." The relevance of this research is that nurses equipped with dietary fiber information may be better able to help some individuals with Crohn disease to explore the potential benefits of a well-rounded nutritious pattern of eating that includes wheat bran cereal.
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Everyday Life, Healthcare, and Self-Care Management Among People With Irritable Bowel Syndrome. Gastroenterol Nurs 2014; 37:217-25. [DOI: 10.1097/sga.0000000000000048] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Zallot C, Quilliot D, Chevaux JB, Peyrin-Biroulet C, Guéant-Rodriguez RM, Freling E, Collet-Fenetrier B, Williet N, Ziegler O, Bigard MA, Guéant JL, Peyrin-Biroulet L. Dietary beliefs and behavior among inflammatory bowel disease patients. Inflamm Bowel Dis 2013; 19:66-72. [PMID: 22467242 DOI: 10.1002/ibd.22965] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND We investigated dietary beliefs and behavior in a large population of adult inflammatory bowel disease (IBD) patients and evaluated their impact on patients' social life. METHODS A questionnaire of 14 items was administered to all consecutive IBD patients followed at the Nancy University Hospital Department of Gastroenterology from February to July 2011. RESULTS A total of 244 patients participated in the survey; 15.6% (n = 38) of patients believed that diet could initiate the disease, while 57.8% (n = 141) believed that food can play a role in causing a relapse. Forty percent (107/244) of patients identified food as a risk factor for relapse. Seventy-three percent of respondents reported having already received nutritional advice. The majority of respondents (47.5%, n = 116) reported that the disease had changed the pleasure of eating. Only one-quarter of patients had a normal diet in case of relapse. Almost two out of three patients (66.8%, n = 163) reported not eating certain foods they usually like to eat in order to prevent a relapse. Dietary beliefs and behavior had an impact on their social life for one-fifth of patients. Excluding food was associated with refusing outdoor dining for fear of causing relapse (P = 0.006) and not sharing the same menu as the other members of the family living under the same roof (P = 0.002). CONCLUSIONS The majority of IBD patients are avoiding certain foods. Dietary beliefs and behavior have a strong impact on their social life.
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Affiliation(s)
- Camille Zallot
- Inserm, U954 and Department of Hepato-Gastroenterology, Nancy University Hospital, France
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Böhn L, Störsrud S, Simrén M. Nutrient intake in patients with irritable bowel syndrome compared with the general population. Neurogastroenterol Motil 2013; 25:23-30.e1. [PMID: 22937900 DOI: 10.1111/nmo.12001] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Food and diet are central issues that concern patients with irritable bowel syndrome (IBS). Few studies have thoroughly analyzed dietary intake in IBS. Our aims were to determine the nutrient intake in IBS patients in comparison to the general population, assess nutritional differences between IBS subgroups based on the predominant bowel habit or symptom severity, as well as to evaluate if their nutrient intake meet nutrition recommendations. METHODS We included 187 IBS patients (mean 40.2 years; 139 women). They completed a 4-days food registration record, which was compared with an age-, and gender-matched control group (n = 374; 278 women) from a nation-wide dietary survey and with Nordic Nutrient Recommendations. KEY RESULTS Daily nutrient intake in IBS patients was similar to the general population and met national nutrients recommendations. Irritable bowel syndrome patients had similar energy distribution from macronutrients compared to the control group, but the protein percentage tended to be higher. Irritable bowel syndrome patients also had significantly higher daily intake of vitamin E, folate, iron, vitamin C, and dietary fibers, as well as lower intake of vitamin A, riboflavin, calcium, and potassium. There was no association between nutrient intake and IBS subtypes or symptom severity. CONCLUSIONS & INFERENCES Although many IBS patients state that they avoid food items, this does not seem to influence their intake of nutrients to any large extent. The observed minor differences in nutrient intake indicate a tendency toward higher intake of fruit and vegetables and a lower intake of meat and dairy products in IBS patients.
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Affiliation(s)
- L Böhn
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Kemp K, Griffiths J, Lovell K. Understanding the health and social care needs of people living with IBD: a meta-synthesis of the evidence. World J Gastroenterol 2012; 18:6240-9. [PMID: 23180944 PMCID: PMC3501772 DOI: 10.3748/wjg.v18.i43.6240] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 06/25/2012] [Accepted: 09/19/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To undertake a metasynthesis of qualitative studies to understand the health and social needs of people living with inflammatory bowel disease (IBD). METHODS A systematic search strategy identified qualitative studies exploring the phenomenon of living with inflammatory bowel disease. Databases included MEDLINE, PsychInfo, EMBASE, CINAHL and the British Nursing Index via the OVID platform. Qualitative search filters were adapted from Hedges database (http://www.urmc.rochester.edu/hslt/miner/digital_library/tip_sheets/Cinahl_eb_filters.pdf). Qualitative empirical studies exploring the health and social needs of people living with inflammatory bowel disease were selected. Study eligibility and data extraction were independently completed using the Critical Appraisal Skills Programme for qualitative studies. The studies were analysed and synthesised using metasynthesis methodology. The themes from the studies allowed for common translations into a new interpretation of the impact of living with inflammatory bowel disease. RESULTS Of 1395 studies, six published studies and one unpublished thesis fulfilled the inclusion criteria. First iteration of synthesis identified 16 themes, 2nd iteration synthesised these into three main 2nd order constructs: "detained by the disease"; "living in a world of disease" and "wrestling with life". "Detained by the disease" is the fear of incontinence, the behaviour the patients display due to the fear, and the impact this has on the individual, such as social isolation and missing out on life events. All of these serve to "pull" the patient back from normal living. "Living in a world of disease" is the long term effects of living with a long term condition and the fear of these effects. "Wrestling with life" is the continued fight to thrive, the "push" to continue normal living. CONCLUSION The metasynthesis provides a comprehensive representation of living with IBD. The unmistakeable burden of incontinence is exposed and its ongoing effects are demonstrated. The combined overall impact of living with IBD is the tension these patients live with: "Pushed and pulled: a compromised life", people living with IBD experience a constant conflict throughout their lives, they push to be normal but IBD pulls them back. The impact of the fear of incontinence and behaviour of the individual as a result, requires further qualitative enquiry.
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