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P575 Nutrition and Inflammatory Bowel Disease – a nationwide survey of patients, gastroenterologists and dietitians

McCarthy, N.(1);Schultz, M.(2);Wall, C.(1);

(1)University of Otago- Christchurch, Department of Medicine, Christchurch, New Zealand;(2)University of Otago, Department of Medicine, Dunedin, New Zealand

Background

Literature indicates that Inflammatory Bowel Disease (IBD) patients (pts), who are at high risk of malnutrition, often adjust their diet following diagnosis and wish to receive specialised nutrition advice from their healthcare team. Dietitians (DTs) are health professionals (HPs) with specialist nutrition expertise. Our aim was to assess nutrition advice provided by different HPs.

Methods

Electronic surveys were disseminated to New Zealand IBD pts, DTs and gastroenterologists (GIs) asking about experience of, and practice providing, IBD nutrition advice. DTs and GIs were asked which nutrition interventions they recommend. DTs responded separately for Crohn’s disease (CD) and Ulcerative Colitis (UC) while GIs responded about IBD pts as a group.

Results

Surveys were completed by 407 pts, 79 DTs and 40 GIs. 

Almost all (97%) GIs report their IBD pts ask about nutrition and 95% said they provide nutrition advice. DTs and GIs commonly recommended specific diets: modified fibre, high protein/energy and low fermentable carbohydrate diets, with occasional use of some other diet regimes (Table 1). 

Half of the pts (52%) had seen a DT for advice and 31% had received nutrition advice from other HPs, commonly their GI, general practitioner or IBD nurse. Some patients (13%) received nutrition advice from other practitioners: nutritionist, naturopath, other medical doctors, counsellor, cannabis practitioner, integrated health professional, osteopath and herbalist. 

Patients frequently received general nutrition advice and specific diet advice including various strict exclusion diets and herbal, probiotic and vitamin/mineral supplements from DTs and non-DT HPs (Table 1). No DTs or GIs recommended low carb, high fat, sugar free or ketogenic diets in IBD, which were recommended to pts by other HPs.

Table 1. Nutrition interventions recommended by DTs and GIs compared with advice pts recall receiving from DTs and other HPs.
Diet advice comparisons

Conclusion

Pts with IBD often ask for nutrition advice but only half had seen a DT. The advice given by HPs (medical and non-medical) varies and it appears that this high-risk group of pts is not always offered advice with evidence of scientific benefit in pts with IBD. Pts would benefit from greater access to DTs with IBD expertise.

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