1
|
Sultan N, Foyster M, Tonkovic M, Noon D, Burton-Murray H, Biesiekierski JR, Tuck CJ. Presence and characteristics of disordered eating and orthorexia in irritable bowel syndrome. Neurogastroenterol Motil 2024:e14797. [PMID: 38606723 DOI: 10.1111/nmo.14797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/07/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Orthorexia, a harmful obsession with eating healthily, may develop from illnesses characterized by dietary restriction, including irritable bowel syndrome (IBS) and eating disorders (ED). Evidence of disordered eating in IBS exists, but orthorexia has not been assessed. This cross-sectional study in adults (≥18 years) assessed presence and characteristics of disordered eating and orthorexia in IBS, compared to control subjects (CS) and ED. METHODS IBS participants met Rome IV, and ED participants met DSM-5 criteria. Disordered eating was assessed using "sick, control, one-stone, fat, food" (SCOFF, ≥2 indicating disordered eating), and orthorexia by the eating habits questionnaire (EHQ). Secondary measures included stress (PSS); anxiety (HADS-A); food-related quality of life (Fr-QoL), and dietary intake (CNAQ). KEY RESULTS In 202 IBS (192 female), 34 ED (34 female), and 109 CS (90 female), more IBS (33%) and ED (47%) scored SCOFF≥2 compared to CS (16%, p < 0.001, chi-square). IBS and ED had higher orthorexia symptom severity compared to CS (EHQ IBS 82.9 ± 18.1, ED 90.1 ± 19.6, and CS 73.5 ± 16.9, p < 0.001, one-way ANOVA). IBS and ED did not differ for SCOFF or EHQ (p > 0.05). Those with IBS and disordered eating had higher orthorexia symptom severity (EHQ 78.2 ± 16.6 vs. 92.4 ± 17.5, p < 0.001, independent t-test), worse symptoms (IBS-SSS 211.0 ± 78.4 vs. 244.4 ± 62.5, p = 0.008, Mann-Whitney U test), higher stress (p < 0.001, independent t-test), higher anxiety (p = 0.002, independent t-test), and worse FR-QoL (p < 0.001, independent t-test). CONCLUSIONS AND INFERENCES Disordered eating and orthorexia symptoms occur frequently in IBS, particularly in those with worse gastrointestinal symptoms, higher stress, and anxiety. Clinicians could consider these characteristics when prescribing dietary therapies.
Collapse
Affiliation(s)
- Nessmah Sultan
- Department of Food, Nutrition and Dietetics, La Trobe University, Bundoora, Victoria, Australia
- Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, Victoria, Australia
| | - Mandy Foyster
- Department of Food, Nutrition and Dietetics, La Trobe University, Bundoora, Victoria, Australia
| | - Matilda Tonkovic
- Department of Food, Nutrition and Dietetics, La Trobe University, Bundoora, Victoria, Australia
| | - Danielle Noon
- Department of Food, Nutrition and Dietetics, La Trobe University, Bundoora, Victoria, Australia
- Department of Nursing and Allied Health, Swinburne University, Hawthorn, Victoria, Australia
| | - Helen Burton-Murray
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jessica R Biesiekierski
- Department of Food, Nutrition and Dietetics, La Trobe University, Bundoora, Victoria, Australia
- Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, Victoria, Australia
| | - Caroline J Tuck
- Department of Food, Nutrition and Dietetics, La Trobe University, Bundoora, Victoria, Australia
- Department of Nursing and Allied Health, Swinburne University, Hawthorn, Victoria, Australia
| |
Collapse
|
2
|
Jatkowska A, White B, Jaskolski P, Nichols B, Brownson E, Clowe J, Seenan JP, Gerasimidis K, MacDonald J. Perceptions Toward Established and Novel Dietary Therapies for Crohn's Disease Management Among Adult Patients: Results From a Questionnaire Survey. Crohns Colitis 360 2024; 6:otae008. [PMID: 38464347 PMCID: PMC10924435 DOI: 10.1093/crocol/otae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Indexed: 03/12/2024] Open
Abstract
Background Exclusive enteral nutrition (EEN) and partial enteral nutrition (PEN) remain the only established dietary therapies in Crohn's disease (CD) management. We conducted a questionnaire survey to evaluate the perceptions of adults with CD toward established and emerging food-based dietary therapies. Methods A 26-question anonymous survey was mailed to 300 adults receiving biologic treatment. Two researchers independently conducted a thematic analysis of open-ended responses. Machine learning with the Random Forest-Recursive Feature Elimination algorithm identified predictors of willingness to try dietary therapies. Results One hundred and sixty patients (53% female) completed and returned the survey. Forty-two percent were following some form of exclusion diet, with low-spice and low-fiber diets being the most popular. Although only a quarter of patients believed that EEN/PEN could help with their CD, more than half believed that diet could help, with another 13% already using diet for CD management. While half of the patients were willing to try EEN, the majority were willing to try PEN instead (51% vs. 79%; P < .001). Forty-two percent of patients preferred food-based dietary plans prepared at home over EEN/PEN options. The most important predictors for willingness to try dietary therapies were age (25-65 years), recent symptoms, previous exposure to EEN/PEN, and current exclusion diet use. The top concerns about PEN were taste/palatability, satiety/hunger, and taste fatigue. Conclusions Most adults preferred to follow a food-based dietary therapy over EEN/PEN. The majority would try PEN though which allows for more flexibility to incorporate in habitual diet and may be easier to comply with than the EEN.
Collapse
Affiliation(s)
- Aleksandra Jatkowska
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Bernadette White
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Paige Jaskolski
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Ben Nichols
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Emily Brownson
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jennifer Clowe
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow, UK
| | - John Paul Seenan
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Jonathan MacDonald
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow, UK
| |
Collapse
|
3
|
Iacovou M, Lewis JD. Commentary: When applying dietary therapies for gastrointestinal conditions, family values, culture, and social challenges matter. Nutr Rev 2023; 81:1490-1494. [PMID: 36809548 DOI: 10.1093/nutrit/nuad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Some gastrointestinal conditions now have diet as a cornerstone to therapy. Three examples include the low-fermentable, oligosaccharide, disaccharide, monosaccharide, and polyol diet for irritable bowel syndrome, a gluten-free diet for celiac disease, and a hypoallergenic diet for eosinophilic esophagitis. All have been shown to be effective in Western or highly industrialized countries. However, these gastrointestinal conditions occur worldwide. Less is known regarding the effectiveness of dietary therapies in cultures and regions of dense religious and traditional practices where food is a central focus. This includes South Asia, the Mediterranean region, Africa, the Middle East, South America, and within Indigenous communities. Hence, there is a need to reproduce dietary intervention studies within cultures of dense traditional dietary practices to understand the applicability and acceptability of dietary therapy to establish generalizability. Furthermore, there is a need for nutrition experts to have a deep understanding of various cultural cuisines, practices, values, and customs. To achieve this, increasing the diversity of students in the sciences and having a diverse workforce of nutrition experts and health professionals that reflects the patient population will allow for more personalized care. In addition, there are social challenges, including a lack of medical insurance coverage, the cost of dietary interventions, and inconsistent nutrition messaging. Although there are many cultural considerations and social challenges to implementing effective dietary interventions around the world, these barriers are addressable through research methodologies that address culture and society challenges, and enhanced training of dietitians.
Collapse
Affiliation(s)
- Marina Iacovou
- is with the Centre of Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, and the Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
| | - James D Lewis
- is with the Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
4
|
Abstract
Celiac Disease (CeD) is a chronic small intestinal immune-mediated enteropathy caused by the ingestion of dietary gluten proteins in genetically susceptible individuals. CeD is one of the most common autoimmune diseases, affecting around 1.4% of the population globally. To date, the only acceptable treatment for CeD is strict, lifelong adherence to a gluten-free diet (GFD). However, in some cases, GFD does not alter gluten-induced symptoms. In addition, strict adherence to a GFD reduces patients' quality of life and is often a socio-economic burden. This narrative review offers an interdisciplinary overview of CeD pathomechanism and the limitations of GFD, focusing on current research on possible dietary interventions. It concentrates on the recent research on the degradation of gluten through enzymes, the modulation of the microbiome, and the different types of "biotics" strategies, from probiotics to the less explored "viromebiotics" as possible beneficial complementary interventions for CeD management. The final aim is to set the context for future research that may consider the role of gluten proteins and the microbiome in nutritional and non-pharmacological interventions for CeD beyond the sole use of the GFD.
Collapse
Affiliation(s)
- Sandip K Wagh
- Department of Organic and Bioorganic Chemistry, Bielefeld University, 33615 Bielefeld, Germany
- Department of Biochemistry, Dr. Babasaheb Ambedkar Marathwada University, Aurangabad 431004, India
| | | | - Manohar V Padul
- Department of Biochemistry, The Institute of Science, Dr. Homi Bhabha State University, Mumbai 400032, India
| | | | - Veronica I Dodero
- Department of Organic and Bioorganic Chemistry, Bielefeld University, 33615 Bielefeld, Germany
| |
Collapse
|
5
|
Ibrahim F, Stribling P. A 5Ad Dietary Protocol for Functional Bowel Disorders. Nutrients 2019; 11:E1938. [PMID: 31426496 DOI: 10.3390/nu11081938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/10/2019] [Accepted: 08/15/2019] [Indexed: 02/06/2023] Open
Abstract
Functional bowel disorders (FBDs) affect around 20% of the population worldwide and are associated with reduced quality of life and high healthcare costs. Dietary therapies are frequently implemented to assist with symptom relief in these individuals, however, there are concerns regarding their complexity, restrictiveness, nutritional adequacy, and effectiveness. Thus, to overcome these limitations, a novel approach, the 5Ad Dietary Protocol, was designed and tested for its efficacy in reducing the severity of a range of gastrointestinal symptoms in 22 subjects with FBDs. The protocol was evaluated in a repeated measures MANOVA design (baseline week and intervention week). Measures of stool consistency and frequency were subtyped based on the subject baseline status. Significant improvements were seen in all abdominal symptom measures (p < 0.01). The effect was independent of body mass index (BMI), age, gender, physical activity level, and whether or not the subjects were formally diagnosed with irritable bowel syndrome (IBS) prior to participation. Stool consistency and frequency also improved in the respective contrasting subtypes. The 5Ad Dietary Protocol proved to be a promising universal approach for varying forms and severities of FBDs. The present study paves the way for future research encompassing a longer study duration and the exploration of underlying physiological mechanisms.
Collapse
|