It is widely accepted patients with active inflammatory bowel disease (IBD) need dietetic input due to exclusive enteral nutrition treatment and/or risk of malnutrition ⁽¹⁾. However, the input required when in remission is less understood. Therefore, the gastroenterology dietetic team at a tertiary paediatric hospital completed a 12-month nutritional audit (October 2022) of IBD patients undergoing biologic treatment at the medical day care unit.

In line with national IBD guidelines, body mass index (BMI), dietary restrictions, calcium intake and plasma vitamin D was reviewed.¹ Calcium intake assessed using dietary history and the British Dietetic Association’s ‘Calcium: food fact sheet’.² Data was analysed using Excel.

From n=66 patients 67% were male, 33% female with an average age 15 (7–19). Biologic therapy use was 89% first line (e.g., infliximab) and 11% second line (e.g., vedolizumab). Diagnosis consisted of Crohns (71%), ulcerative colitis (21%) and IBD unclassified (8%). Overall, irrespective of remission, there was a correlation between higher BMI and higher PCDAI/PUCAI scores in females (F =0.56 p= 0.03), but not in males.

Based on PCDAI/PUACI, 76% (n=52) were classified as being in remission. In accordance with the World Health Organisation classification of BMI Z scores ⁽³⁾13% were obese, 29% overweight, 54% healthy and 4% thinness. Their modifiable risk factors for bone health are outlined below.

Dietary advice was given based on review data and clinical judgement, including improving calcium intake (75%), healthy eating (23%) and healthy eating with weight management (15%). Within the cohort, 69% of children had no food restrictions while spicy food was the most common food avoidance (10%).

Current IBD guidelines focus on supporting malnutrition.¹ However, BMIs described above are comparable to the general population.⁴ IBD teams, including dietitians, must accept the focus of nutritional intervention may change. Guidelines recommend an annual growth assessment regardless of disease state.⁶ Given our comparison of bone health to the general population, calcium and vitamin D should also be assessed annually to help overcome negative effects of steroids, commonly used in patients with IBD.¹ Exercise status could also be assessed. Our data would support further research into the link of disease scores and obesity.

References

1. Lomer MCE, Wilson B, Wall CL. British dietetic association consensus guidelines on the nutritional assessment and dietary management of patients with inflammatory bowel disease. J.Hum. Nutr. 2022: published online Jun 22. DOI:10.1111/jhn.13054.

2. Food fact sheet:Calcium. BDA. 2021.(Accessed January 2, 2022Calcium | British Dietetic Association (BDA).

3. BMI-for-age(5–19 years).WHO,2022.(Accessed January 2, 2022 BMI-for-age (5–19 years) (who.int).

4. Health survey for England in 2019 overweight and obesity in adults and children, 2020.(Accessed January,8,2022https://files.digital.nhs.uk/9D/4195D5/HSE19-Overweight-obesity-rep.pdf).

5. NDNS results from year 9 to 11 (combined) - statistical summary. Public health England, 2020.(Accessed January,8,2022https://www.gov.uk/government/statistics/ndns-results-from-years-9-to-11-2016-to-2017-and-2018-to-2019/ndns-results-from-years-9-to-11-combined-statistical-summary).

6. Ulcerative colitis: management. NICE guideline [NG130], 2019. (Accessed January 3, 2022. https://www.nice.org.uk/guidance/ng130/chapter/Recommendations#monitoring).