Objective: To investigate the status quo of dietary behavior of patients with inflammatory bowel disease (IBD) and analyze its influence factors. Methods: All patients (n = 104) who went to the department of gastroenterology of Hua Dong Hospital were recruited. Dietary behavior of patients was investigated by a questionnaire self-designed while the nutritional status was evaluated using the Patient-generated Subjective Global Assessment (PG-SGA). Results: Among 104 cases with IBD, the numbers of well dietary belief were 58 cases (55.8%) and the poor were 46 cases (45.2%). The good eating habits were 33 cases (31.7%), the general were 25 cases (24.0%) and the poor were 46 (44.2%). The adequate intakes of carbohydrate, protein and fat were separately 36 cases (34.6%), 25 cases (24.0%) and 33 cases (31.7%) while the inadequate intakes were separately 68 cases (65.4%), 79 cases (76.0%) and 71 cases (68.3%). Sex, culture degree and duration were influence factors of the dietary belief (P < 0.05). Conclusion: The problems in dietary behavior are not optimistic. Most patients with IBD are with poor dietary belief and eating habits while the intake of carbohydrate, protein and fat is insufficient although the choice of food is reasonable. And majority of patients were combined with malnutrition. Education of the dietary knowledge about IBD should be strengthened, especially for patients who are female, short-term duration and lower culture degree.
Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’ disease (CD), are chronic relapsing intestinal inflammatory diseases, listed as the world refractory disease by World Health Organization (WHO). According to a report in China, the number of patients with IBD in recent 5 years was eight times as that in the same period in the 1990s, among which, the incidences of UC and CD were 11.6/100,000 and 1.4/100,000 [
Participants in this study were recruited from a random of patients diagnosed with IBD between January and December 2015 and presented to the department of gastroenterology of Hua Dong Hospital Affiliated to Fudan University at Shanghai, China. The inclusion criteria were patients with UC or CD diagnosed according to IBD diagnostic criteria recommended by Chinese Society of Gastroenterology in 2008 and the duration was above 1 year.
Approval for this study was obtained from Fudan University ethics and all patients provided their signed informed consent of participation. A total of 104 patients matched the inclusion criteria.
The questionnaire mainly included the patients’ general information such as age, sex, disease type, duration and so on.
This questionnaire was self-designed divided into 3 aspects, as following: 1) Dietary belief which includes the relationship between dietary and IBD, tie-in diet and importance of diet therapy proposed by doctors. Every item was scored by Likert Scale. The total scores were between 3 and 15 points. The more the scores were, the better the dietary belief was. It could be divided into three groups bases on the value of 70%, 80% and 90% of the highest score, as following: 3 - 12, weak dietary belief; 13, the general; and 14 or above, the well. 2) Eating habits consisting of eating times per day, regularity, eating outside, food flavor, cooking methods, oil, nutrition supplement and selections of snacks, seafood, spicy food, pickled food, cold food, coffee, beverage, strong tea, drinking and smoking. Total scores were between 17 and 85 points. It was divided into three groups depending on the value of 70%, 80% and 90% of the highest score, as: 17 - 68, the poor eating habits; 69 - 76, the general; and 77 or above, the good. 3) Dietary pattern including the intake of carbohydrate food, protein food, fat food, fiber food and nutritional supplements. It was assessed by 24h Dietary Recall. According to Chinese expert consensus on nutrition support treatment about IBD, daily intake of total energy should be up to 25 - 30 kcal/kg every day, the intake of protein every day should be 1.0 - 1.5 g/kg and the energy from fat should be account for 30% - 50% of total energy. If the daily actual intake of the carbohydrate, protein and fat is equal to or beyond that recommended, it separately suggests that the intake is enough. If not, it suggests the intake is inadequate.
The content validity of the questionnaire was 0.85 and the retest reliability was 0.90.
The tool was simple and effective with high sensitivity and specificity. It could be not only used for gastrointestinal cancer patients, but also applied in chronic diseases. The tool consisted of two parts: 1) patients’ self-as- sessment including weight change, symptoms, dietary intake and activity ability; 2) evaluation of medical personnel including disease diagnosis, age, metabolic stress and physical examination. Total scores were from 0 to 35 points which could be categorized into the following triage ranges: 0 - 3, well nutrition (Grade A); 4 - 8, moderate malnutrition (Grade B); and 9 or above, severely malnutrition (Grade C). Among them, Grad B and Grade C were combined as malnutrition. The too was with good reliability and validity, of which, Cronbach’s α was 0.64, the sensitivity 98% and the specificity 82% [
All questionnaires were filled in face to face manner. During the survey, participants answered and recorded in the request according to their actual diet after explaining the content of the questionnaires. 110 questionnaires were allocated to patients with IBD. Among them, 6 cases withdrew from the study because of the aggravation of illness. The rate of recovery was 94.5%.
All data were processed using SPSS statistics version 19.0. The count data was described as proportion. The measure data was described as mean ± standard deviation or the maximum, minimum and the median depended on the feature of data. Univariate analysis was analyzed by chi-square test and Fisher exact test, and the multiple-factor analysis was dealt with the logistic regression analysis. In addition, the relationship between dietary belief and eating habits was analyzed by bivariate correlation analysis.
Among 104 cases with IBD, the age was between 18 and 85 years old, the median was 56 years old. 31 cases (29.8%) were 44 years old or below, 34 cases (31.7%) were between 45 and 59 years old and 39 cases (38.5%) were 60 years old or above. 39 (37.5%) cases were junior school or below and 65 cases (62.5%) were high school or above. Patients with ulcerative colitis (UC) were 77 cases (74.0%) and those with Crohn’s disease were 27 cases (26.0%). The duration of 66 cases (51.0%) was 3 years or below and 38 cases (49.0%) was 4 years or above. In addition, the IBD of 46 cases (44.2%) were at remission and 58cases (55.8%) were at active stage (
Categories | Frequency (n) | Proportion (%) | |
---|---|---|---|
Sex | Male | 62 | 59.6 |
Female | 42 | 40.4 | |
Age | 18 - 44 | 31 | 29.8 |
45 - 59 | 33 | 31.7 | |
≥60 | 40 | 38.5 | |
Culture degree | Junior school or below | 39 | 37.5 |
High school or above | 65 | 62.5 | |
Duration | ≤3 | 53 | 51.0 |
≥4 | 51 | 49.0 | |
Type of disease | UC | 77 | 74.0 |
CD | 27 | 26.0 | |
Disease activity index | Remission | 46 | 44.2 |
Activity | 58 | 55.8 |
Among 104 cases, well dietary belief were 58 cases (55.8%), the poor were 46 cases (44.2%)) among which the general were 5 cases (4.8%) and the weak were 41 cases (39.4%).
In participants, good eating habits were 33 cases (31.7%), the general were 25 cases (24.0%) and the poor were 46 (44.2%).
The adequate intake of carbohydrate, protein and fat were separately36 cases (34.6%), 25 cases (24.0%) and 33 cases (31.7%) while the deficiency intake were 68 cases (65.4%), 79 cases (76.0%) and 71 cases (68.3%). The definite situation of dietary intake was shown in
According to Pearson chi-square test and Fisher’s exact test, dietary belief had something with eating habits while eating habits could affect dietary pattern(P < 0.05) (
Categories | Contents | Dietary intake frequency | |||||
---|---|---|---|---|---|---|---|
Always | Often | Sometime | Occasionally | Never | |||
Carbohydrate | Rice | 46 (44.2) | 44 (42.3) | 12 (11.5) | 2 (1.9) | 0 (0.0) | |
Wheat | 6 (5.8) | 34 (32.7) | 35 (33.7) | 26 (25.0) | 3 (2.9) | ||
Corn | 0 (0.0) | 5 (4.8) | 12 (11.5) | 60 (57.7) | 27 (26.0) | ||
Starchy | 1 1.0) | 18 (17.3) | 35 (33.7) | 26 (25.0) | 24 (23.1) | ||
Protein | Milk and products | 3 (2.9) | 10 (9.6) | 12 (11.5) | 15 (14.4) | 64 (61.5) | |
Beans and products | 14 (13.5) | 36 (34.6) | 17 (16.3) | 25 (24.0) | 12 (11.5) | ||
Eggs | 21 (20.2) | 47 (45.2) | 17 (16.3) | 18 (17.3) | 1 (1.0) | ||
Red meat | 13 (12.5) | 33 (31.7) | 22 (21.2) | 28 (26.9) | 8 (7.7) | ||
Poultry meat | 12 (11.5) | 42 (40.4) | 26 (25.0) | 14 (13.5) | 10 (9.6) | ||
Fish | 14 (13.5) | 50 (48.1) | 17 (16.3) | 10 (9.6) | 13 (12.5) | ||
River shrimp and crab | 1 (1.0) | 19 (18.3) | 21 (20.2) | 28 (26.9) | 35 (33.7) | ||
Fat | Visceral food | 0 (0.0) | 9 (8.7) | 24 (23.1) | 45 (43.3) | 26 (25.0) | |
Greasiness | 0 (0.0) | 4 (3.8) | 17 (16.3) | 58 (55.8) | 25 (24.0) | ||
Fiber | Coarse grain | 4 (3.8) | 12 (11.5) | 23 (22.1) | 31 (29.8) | 34 (32.7) | |
Fruit and vegetables | 4 (3.8) | 25 (24.0) | 18 (17.3) | 29 (27.9) | 28 (26.9) | ||
Supplement | Vitamins and trace elements | 0 (0.0) | 13 (12.5) | 16 (15.4) | 4 (3.8) | 71 (68.3) | |
Categories | Total | Eating habits | χ2 | P | |||
---|---|---|---|---|---|---|---|
Good | General | Poor | |||||
Dietary belief | Well | 58 | 26 | 14 | 18 | 12.252 | 0.002** |
Poor | 46 | 7 | 11 | 28 | |||
Total | 104 | 33 | 25 | 46 |
**P < 0.01.
Categories | Carbohydrate | Protein | Fat | |||
---|---|---|---|---|---|---|
Adequate | Deficiency | Adequate | Deficiency | Adequate | Deficiency | |
Eating habits | ||||||
Poor | 16 | 30 | 15 | 31 | 27 | 19 |
General | 12 | 13 | 9 | 16 | 5 | 20 |
Good | 8 | 25 | 1 | 32 | 1 | 32 |
χ2 | 3.548 | 11.785 | 29.577 | |||
P | 0.170 | 0.003** | 0.000** |
**P < 0.01.
Variable | r | p |
---|---|---|
Dietary belief | 0.341 | 0.000** |
**P < 0.01.
According to Pearson chi-square test and Fisher’s exact test, the difference of dietary belief in patients in different duration of IBD was significant (P < 0.05) (
According to Pearson chi-square test and Fisher’s exact test, the culture degree and duration of IBD were related to eating habits (P < 0.05) (
According to Pearson chi-square test and Fisher’s exact test, the dietary pattern distributed in the different sex, culture degree and duration of IBD was significantly different (P < 0.05) (
According to logistic regression analysis, the duration of IBD is the independent factor of dietary belief (
The results suggest that the culture degree and duration are independent factors of eating habits (
According to the logistic regression analysis, duration of IBD can influence the intake of protein while the sex and the duration affect the intake of fat (
Based on PG-SGA, there were 25 cases with Grade A accounted for 24.1%, 56 cases with Grade B for 53.8% and 23 cases with Grade C for 22.1%.
Whether you own correct dietary belief decides the efforts and persistence of behabior during diet management.
Categories | Dietary belief | χ2 | P | |||
---|---|---|---|---|---|---|
Poor | Well | |||||
Sex | Male | 26 | 36 | 0.328 | 0.688 | |
Female | 20 | 22 | ||||
Age | 18 - 44 | 18 | 13 | 3.453 | 0.178 | |
45 - 59 | 13 | 20 | ||||
≥60 | 15 | 25 | ||||
Culture degree | Junior school or below | 14 | 25 | 1.757 | 0.223 | |
High school or above | 32 | 33 | ||||
Type of disease | UC | 32 | 45 | 0.859 | 0.377 | |
CD | 14 | 13 | ||||
Duration | ≤3 | 30 | 23 | 6.708 | 0.010* | |
≥4 | 16 | 35 | ||||
Disease activity index | Remission | 22 | 23 | 0.698 | 0.404 | |
Activity | 24 | 35 | ||||
*P < 0.05.
Categories | Eating habits | χ2 | P | |||
---|---|---|---|---|---|---|
Poor | General | Good | ||||
Sex | Male | 30 | 15 | 17 | 1.501 | 0.472 |
Female | 16 | 10 | 16 | |||
Age | 18 - 44 | 16 | 9 | 6 | 3.547 | 0.471 |
45 - 59 | 14 | 8 | 11 | |||
≥60 | 16 | 8 | 16 | |||
Culture degree | Junior school or below | 11 | 8 | 20 | 11.463 | 0.003** |
High school or above | 35 | 17 | 13 | |||
Type of disease | UC | 32 | 20 | 25 | 0.992 | 0.609 |
CD | 14 | 5 | 8 | |||
Duration | ≤3 | 35 | 11 | 7 | 29.791 | 0.000** |
≥4 | 11 | 14 | 26 | |||
Disease activity index | Remission | 22 | 10 | 13 | 0.700 | 0.705 |
Activity | 24 | 15 | 20 |
**P < 0.01.
In this study, 44.2% of participants were with weak dietary belief, mainly reflected in that they thought it had nothing between diet and IBD, ignored the collocation of dietary nutrition or thought there was no necessary to obey doctors’ dietary therapy. This reflected that patients could not understand the relationship between diet and IBD. Ying Zhu [
Categories | Carbohydrate | Protein | Fat | |||
---|---|---|---|---|---|---|
Deficiency | Adequate | Deficiency | Adequate | Deficiency | Adequate | |
Sex | ||||||
Male | 41 | 21 | 46 | 16 | 37 | 25* |
Female | 27 | 15 | 33 | 9 | 34 | 8 |
Age | ||||||
18 - 44 | 18 | 13* | 22 | 9 | 22 | 9 |
45 - 59 | 18 | 15 | 26 | 7 | 20 | 13 |
≥60 | 32 | 8 | 31 | 9 | 29 | 11 |
Culture degree | ||||||
junior school or below | 31 | 8* | 32 | 7 | 30 | 9 |
high school or above | 37 | 28 | 47 | 18 | 41 | 24 |
Type of disease | ||||||
UC | 50 | 27 | 58 | 19 | 52 | 25 |
CD | 18 | 9 | 21 | 6 | 19 | 8 |
Duration | ||||||
≤3 | 35 | 18 | 34 | 19** | 31 | 22* |
≥4 | 33 | 18 | 45 | 6 | 40 | 11 |
Disease activity index | ||||||
Remission | 28 | 17 | 37 | 8 | 30 | 15 |
Activity | 40 | 19 | 42 | 17 | 41 | 18 |
*P < 0.05, **P < 0.01.
Variable | B | S.E | Wals | P | Exp (B) | 95% CI |
---|---|---|---|---|---|---|
Duration | 1.048 | 0.410 | 6.548 | 0.011* | 2.853 | [1.278, 6.370] |
*P < 0.05.
Variables | B | S.E | Wals | P | 95% CI |
---|---|---|---|---|---|
Culture degree | 1.263 | 0.416 | 9.234 | 0.002** | [0.448, 2.078] |
Duration | 1.947 | 0.418 | 21.670 | 0.000** | [2.767,1.127] |
**P < 0.01.
Dietary pattern | Variables | B | S.E | Wals | P | Exp (B) | 95% CI |
---|---|---|---|---|---|---|---|
Carbohydrate | Age | −0.351 | 0.272 | 1.665 | 0.197 | 0.704 | [0.413, 1.200] |
Culture degree | 0.873 | 0.496 | 3.102 | 0.078 | 2.394 | [0.906, 6.325] | |
Protein | Duration | −1.433 | 0.521 | 7.579 | 0.006** | 0.239 | [0.086, 0.662] |
Fat | Sex | −1.089 | 0.482 | 5.108 | 0.024* | 0.336 | [0.131, 0.865] |
Duration | -0.983 | 0.453 | 4.719 | 0.030* | 0.374 | [0.154, 0.908] |
*P < 0.05, **P < 0.01.
Eating habits refers to the preference for food built for a long time in daily life. This study suggested that there were only 31.7% of participants with good eating habits. Because majority of participants ate irregularly or outside, drunk, smoked or ate snacks, seafood and so on. These may be related to the lack of knowledge about diet or poor ability of self-management on the disease [
Reasonable dietary pattern, mainly including the intake of food and the proportion of dietary nutrients, is one of four cornerstones to guarantee health. This study showed that even if the selection of food containing carbohydrate, protein and fat was reasonable, the amount of dietary intake was inadequate. In 104 cases, the proportion of the deficient intake of carbohydrate, protein and fat were separately 65.4%, 76.0% and 68.3%, among which the insufficient intake of protein was rather obvious. These may be caused by excessive limitation of eating in case of the recurrence of IBD. Patients with IBD easily developed malnutrition due to unreasonable dietary pattern together with intestinal inflammation. This study suggested that patients should pay more attention on the intake of diet and adjust dietary therapy properly. If necessary, nutritional supplements or intestinal nutrition can be selected to improve nutrition status and promote the recovery of the disease.
This study suggested that scores of dietary belief and eating habits had positive correlation (P < 0.05). Xianhong Han [
IBD is a recurrent chronic disease. This study suggested duration was an independent factor of dietary behavior affecting dietary belief and eating habits (P < 0.05). The longer the duration was, the better the dietary belief and eating habits were. The reasons included that: 1) patients with longer duration relatively accepted more guidance and attained more knowledge about diet; 2) with the extension of duration, patients had much experience in managing their dietary behavior to control disease. It suggests that patients with short-term duration should be paid more attention. If necessary, discharge nursing service can be provided [
This study showed that the level of education was an independent factor for eating habits (P < 0.05), which was consistent with the study of Ying Zhu [
In this study, the intake of fat in males was more than that in females and sex was an influence factor of dietary pattern (P < 0.05). Xiqian Zhu [
According to PG-SGA, there were 75.9% of participants along with malnutrition which was consistent with the result of the research done by Wenying He [
There are some problems existing patients with IBD, such as weak diet idea, poor diet habits and deficiency intake of three major nutrients. What is worse, majority of patients are combined with malnutrition. So, it should strengthen the management and health education of diet to develop good dietary behavior meeting the requirement of disease rehabilitation, especially paying attention on those who are female or along with lower level of education degree and short-term duration.
Authors declare no potential conflicts of interest for this article.
Li Ji,Jiaojiao Bai,Xiaofeng Yu,Yang Yu,Ruobing Chen, (2016) Investigation of Status Quo of Dietary Behavior in Patients with Inflammatory Bowel Disease. Open Journal of Gastroenterology,06,136-145. doi: 10.4236/ojgas.2016.65018