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      Impact of dietary beliefs and practices on patients with inflammatory bowel disease: An observational study from India

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          Abstract

          Background and Aim

          Patients with inflammatory bowel disease (IBD) are at a risk of nutritional deficits because of poor dietary beliefs and practices. There are no data on this aspect from Asia, which is experiencing a rise in IBD incidence. We aimed to establish dietary beliefs and practices in patients of IBD from India.

          Methods

          Patients with ulcerative colitis (UC) and Crohn's disease (CD) followed up between November 2016 and March 2017 were included. A questionnaire extracted information on the patients' sociodemographic, nutritional and disease profile, smoking and drinking habits, dietary beliefs and practices, current dietary preferences, intake and avoidance, dietary changes made after diagnosis of IBD, dietary changes made during relapse, frequency of consumption of major food groups, and the attitudes toward dietary advice.

          Results

          A total of 316 patients (218 UC and 98 CD; mean age: 38.5 ± 12.2 years) were included. Forty‐four percent patients perceived food as a risk factor for IBD, 52% felt dietary habits to have a more important role than medicines in disease control, 77% reported certain foods improve symptoms during relapse, 86% had modified their diet since the diagnosis of IBD (UC > CD, P = 0.04), 90% imposed food restrictions, and <50% had received dietary counseling. About 40% of patients could not meet their dietary requirements and 66% had decreased their dietary intake since diagnosis, which further decreased during relapse (85%).

          Conclusion

          Dietary beliefs and practices play a central role in perception of disease in IBD patients. A large majority of them make dietary changes which can lead to undernutrition. Proper dietary counseling is required in these patients to prevent malnutrition.

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          Most cited references13

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          Inflammatory bowel disease.

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            A simple clinical colitis activity index.

            The appropriate medical treatment of patients with ulcerative colitis is determined largely by the severity of symptoms. Hospital assessment of the severity of disease activity includes investigation of laboratory indices and sigmoidoscopic assessment of mucosal inflammation. To develop a simplified clinical colitis activity index to aid in the initial evaluation of exacerbations of colitis. The information for development of the simple index was initially evaluated in 63 assessments of disease activity in patients with ulcerative colitis where disease activity was evaluated using the Powell-Tuck Index (which includes symptoms, physical signs, and sigmoidoscopic appearance). The new index was then further evaluated in 113 assessments in a different group of patients, by comparison with a complex index utilising clinical and laboratory data, as well as five haematological and biochemical markers of disease severity. The newly devised Simple Clinical Colitis Activity Index, consisting of scores for five clinical criteria, showed a highly significant correlation with the Powell-Tuck Index (r = 0.959, p < 0.0001) as well as the complex index (r = 0.924, p < 0.0001) and all laboratory markers (p = 0.0003 to p < 0.0001). This new Simple Colitis Activity Index shows good correlation with existing more complex scoring systems and therefore could be useful in the initial assessment of patients with ulcerative colitis.
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              Dietary beliefs and behavior among inflammatory bowel disease patients.

              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. 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. 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). 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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                Author and article information

                Contributors
                namratasinghmohil@yahoo.com
                Journal
                JGH Open
                JGH Open
                10.1002/(ISSN)2397-9070
                JGH3
                JGH Open: An Open Access Journal of Gastroenterology and Hepatology
                Wiley Publishing Asia Pty Ltd (Melbourne )
                2397-9070
                18 September 2017
                September 2017
                : 1
                : 1 ( doiID: 10.1002/jgh3.v1.1 )
                : 15-21
                Affiliations
                [ 1 ] Department of Gastroenterology and Human Nutrition AIIMS New Delhi India
                [ 2 ] Department of Biostatistics AIIMS New Delhi India
                Author notes
                [*] [* ] Correspondence

                Dr Namrata Singh, Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Room 3068, III Floor, Teaching Block, New Delhi 110029, India.

                Email: namratasinghmohil@ 123456yahoo.com

                Author information
                http://orcid.org/0000-0002-5758-0144
                Article
                JGH312002
                10.1002/jgh3.12002
                6207045
                30483527
                90c33b19-d47c-4aad-a2dc-6bdfc40d428a
                © 2017 The Authors. JGH Open: An open access journal of gastroenterology and hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 15 July 2017
                : 29 July 2017
                : 07 August 2017
                Page count
                Figures: 0, Tables: 6, Pages: 7, Words: 5331
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                jgh312002
                September 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.5.1 mode:remove_FC converted:25.10.2018

                crohn's disease,dietary counseling,food exclusion,ulcerative colitis

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