Co-Development of Three Dietary Indices to Facilitate Dietary Intake Assessment of Pediatric Crohn’s Disease Patients
Publication: Canadian Journal of Dietetic Practice and Research
18 April 2024
Abstract
Literature on dietary behaviours of the pediatric Crohn’s Disease (CD) population and the relationship between dietary intake and CD activity is limited. Three dietary indices were developed and tested to conduct dietary pattern analysis in pediatric patients with CD consuming a free diet following remission induction via exclusive enteral nutrition (n = 11). Index scores underwent descriptive and inferential analysis. The mean adjusted scores (out of 100) for the Pediatric Western Diet Index, Pediatric Prudent Diet Index, and Pediatric-Adapted 2010 Alternate Healthy Eating Index (PA2010-AHEI) were 29.82 ± 15.22, 34.25 ± 15.18, and 51.50 ± 11.69, respectively. The mean Western-to-Prudent ratio was 0.94 ± 0.55. A significant correlation (r = −0.71) and relationship (F[1, 9] = 9.04, P < 0.05, R2 = 0.501) between the Western-to-Prudent ratio and PA2010-AHEI was found. The results suggest participants were not following a Western or Prudent diet, and were consuming foods not captured by the indices. More research is needed to describe dietary intake of individuals with CD, validate dietary indices in diverse samples, and explore the utility of these indices in CD assessment and treatment. The co-authors hope this work will stimulate/inspire subsequent interprofessional, dietitian-led research on this topic.
Résumé
La littérature sur les comportements alimentaires de la population pédiatrique atteinte de la maladie de Crohn (MC) et sur la relation entre l’apport alimentaire et l’activité de la MC est limitée. Trois indices alimentaires ont été créés et testés en vue d’analyser les habitudes alimentaires de patients pédiatriques atteints de la MC et ayant une alimentation libre après induction d’une rémission par nutrition entérale exclusive (n = 11). Les scores associés aux indices ont fait l’objet d’une analyse descriptive et inférentielle. Les scores moyens ajustés (sur 100) pour l’Indice pédiatrique d’alimentation occidentale, l’Indice pédiatrique d’alimentation prudente et l’Indice alternatif d’alimentation saine de 2010 adapté pour les enfants (PA2010-AHEI) étaient respectivement de 29,82 ± 15,22, 34,25 ± 15,18 et 51,50 ± 11,69. Le ratio occidentale/prudente moyen était de 0,94 ± 0,55. Une corrélation (r = −0,71) et une relation (F[1, 9] = 9,04, p < 0,05, R2 = 0,501) significatives ont été observées entre le ratio occidentale/prudente et le PA2010-AHEI. Les résultats suggèrent que les participants ne suivaient pas une alimentation occidentale ou prudente et qu’ils consommaient des aliments non pris en compte par les indices. Des recherches supplémentaires sont nécessaires pour décrire les apports alimentaires des personnes atteintes de MC, valider les indices alimentaires dans divers échantillons et explorer l’utilité de ces indices dans l’évaluation et le traitement de la MC. Les coauteurs espèrent que ce travail encouragera la tenue d’autres recherches interprofessionnelles menées par des diététistes à ce sujet.
Formats available
You can view the full content in the following formats:
Financial support: The MAREEN Study has received funding from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) through the NASPGHAN Foundation Young Investigators Development Award (2013–2015.) In addition, JVL was supported by a Canadian Institutes of Health Research (CIHR)-Canadian Association of Gastroenterology-Crohn’s Colitis Canada New Investigator Award (2015–2019), a Canada Research Chair Tier 2 in Translational Microbiomics (2018–2019) and a Canadian Foundation of Innovation John R. Evans Leadership fund (awards #35235 and #36764), a Nova Scotia Health Research Foundation (NSHRF) establishment award (2015–2017), an IWK Health Centre Research Associateship, a Future Leaders in IBD project grant, a donation from the MacLeod family, a CIHR-SPOR-Chronic Diseases grant (Inflammation, Microbiome, and Alimentation: Gastro-Intestinal and Neuropsychiatric Effects: the IMAGINE-SPOR Chronic Disease Network), and the Wetenschappelijke Adviesraad of Stichting Steun Emma kinderziekenhuis. SG was supported by a Mount Saint Vincent University New Scholar Grant (grant number 42-0-165426) during the study period. AH received a CIHR Canada Graduate Scholarship for the 2016/2017 academic year. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.
Competing interests: AH reports travel support from The Wolfson Medical Centre Pediatric Inflammatory Bowel Disease (PIBD) Retreat Grant. JVL reports consulting, travel and/or speaker fees, and research support from AbbVie, Janssen, Nestlé Health Science, Novalac, Pfizer, Merck, P&G, GSK, Illumina, and Otsuka. SG, BM, MP, LC, JC, and AO declare no actual or perceived conflict of interest.
Note: A previous version of this article was published with incomplete authorship; the current version is complete and correct.
REFERENCES
1
Penagini F, Dilillo D, Borsani B, Cococcioni L, Galli E, Bedogni G, et al. Nutrition in pediatric inflammatory bowel disease: from etiology to treatment. A systematic review. Nutrients, 2016;8:334.
2
Logan M, Gkikas K, Svolos V, Nichols B, Milling S, Gaya DR, et al. Analysis of 61 exclusive enteral nutrition formulas used in the management of active Crohn’s disease—new insights into dietary disease triggers. Aliment Pharmacol Ther. 2020;51(10):935–47.
3
Mallon D and Suskind D. Nutrition in pediatric inflammatory bowel disease. Nutr Clin Pract. 2010:335–9.
4
Zachos M, Tondeur M, and Griffiths A. Enteral nutritional therapy for induction of remission in Crohn’s disease. Cochrane Database Syst Rev. 2007;24:CD000542.
5
Wiskin A, Wootton S, and Beattie R. Nutrition issues in pediatric Crohn’s disease. Nutr Clin Pract. 2007;22:214–22.
6
Levine A, Wine E, Assa A, Sigall Boneh R, Shaoul R, Kori M, et al. Crohn’s disease exclusion diet plus partial enteral nutrition induces sustained remission in a randomized controlled trial. Gastroenterology, 2019;157:440–50.
7
Johnson T, Macdonald S, Hill S, Thomas A, and Murphy M. Treatment of active Crohn’s disease in children using partial enteral nutrition with liquid formula: a randomised controlled trial. Gut, 2006;55:356–61.
8
Cameron F, Gerasimidis K, Papangelou A, Missiou D, Garrick V, Cardigan T, et al. Clinical progress in the two years following a course of exclusive enteral nutrition in paediatric patients with Crohn’s disease. Aliment Pharmacol Ther. 2013;37:622–9.
9
El-Matary W. Enteral nutrition as a primary therapy of Crohn’s disease: the pediatric perspective. Nutr Clin Pract. 2009;24:91–7.
10
Sigall-Boneh R, Pfeffer-Gik T, Segal I, Zangen T, Boaz M, and Levine A. Partial enteral nutrition with a Crohn’s disease exclusion diet is effective for induction of remission in children and young adults with Crohn’s disease. Inflamm Bowel Dis. 2014 Aug;20(8):1353–60.
11
Wall CL, Gearry RB, and Day AS. Treatment of active Crohn’s disease with exclusive and partial enteral nutrition: a pilot study in adults. Inflamm Intest Dis. 2018 Jul;2(4):219–27.
12
Levine A and Wine E. Effects of enteral nutrition on Crohn’s disease: clues to the impact of diet on disease pathogenesis. Inflamm Bowel Dis. 2013;19:1322–29.
13
Martino J, Van Limbergen J, and Cahill L. The role of Carrageenan and Carboxymethylcellulose in the development of intestinal inflammation. Front Pediatr. 2017;1:96.
14
Kamada N, Seo S, Chen G, and Núñez G. Role of the gut microbiota in immunity and inflammatory disease. Nat Rev Immunol. 2013;13:321–35.
15
Rapozo D, Bernardazzi C, and de Souza H. Diet and microbiota in inflammatory bowel disease: the gut in disharmony. World J Gastroenterol. 2017 Mar;23(12):2124–40.
16
Koh A, De Vadder F, Kovatcheva-Datchary P, and Bäckhed F. From dietary fiber to host physiology: short-chain fatty acids as key bacterial metabolites. Cell, 2016;165:1332–45.
17
Ríos-Covián D, Ruas-Madiedo P, Margolles A, Gueimonde M, de Los Reyes-Gavilán C, and Salazar N. Intestinal short chain fatty acids and their link with diet and human health. Front Microbiol. 2016;7:185.
18
Ocké M. Evaluation of methodologies for assessing the overall diet: dietary quality scores and dietary pattern analysis. Proc Nutr Soc. 72;191–9.
19
Panagiotakos D. A-priori versus a-posterior methods in dietary pattern analysis: a review in nutrition epidemiology. Nutr Bull. 2008 Nov;33(4):311–5.
20
Hu F. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002;13:3–9.
21
Khoury M, Bigras J-L, Cummings EA, Harris KC, Hegele RA, Henderson M, et al. The detection, evaluation, and management of dyslipidemia in children and adolescents: a Canadian Cardiovascular Society/Canadian Pediatric Cardiology Association Clinical Practice Update. Can J Cardiol. 2022;38:1168–79.
22
Pearson GJ, Thanassoulis G, Anderson TJ, Barry AR, Couture P, Dayan N, et al. 2021 Canadian Cardiovascular Society Guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in adults. Can J Cardiol. 2021;37:1129–50.
23
Sievenpiper J, Chan C, Dworatzek P, Freeze C, and Williams S. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: nutrition therapy. Can J Diabetes, 2018, 42, S64–79.
24
Matsunaga M, Hurwitz E, and Li D. Development and evaluation of a dietary approaches to stop hypertension dietary index with calorie-based standards in equivalent units: a cross-sectional study with 24-hour dietary recalls from adult participants in the National Health and Nutrition Examination Survey 2007–2010. J Acad Nutr Diet. 2018;118:62–73.
25
Rumawas M, Dwyer J, McKeown N, Meigs J, Rogers G, and Jacques P. The development of the Mediterranean-style dietary pattern score and its application to the American Diet in the Framingham Offspring Cohort. J Nutr. 2009;139:1150–6.
26
Cheng G, Duan R, Kranz S, Libuda L, and Zhang L. Development of a dietary index to assess overall diet quality for Chinese school-aged children: the Chinese Children Dietary Index. J Acad Nutr Diet. 2016;116:608–17.
27
Kant A. Dietary patterns and health outcomes. J Am Diet Assoc. 2004;104:615–35.
28
Lane E, Zisman T, and Suskind D. The 340 Microbiota in inflammatory bowel disease: current and therapeutic insights. J Inflamm Res. 2017;10:63–73.
29
Pastorino S. The association of adult lifecourse body mass index, waist circumference and dietary patterns with type 2 diabetes incidence in the MRC National Survey of Health and Development. London, UK: University College London; 2014.
30
Jessri M, Wolfinger R, Lou W, and L’Abbé M. Identification of dietary patterns associated with obesity in a Nationally Representative Survey of Canadian Adults: application of a priori, hybrid, and simplified dietary pattern techniques. Am J Clin Nutr. 2017;105:669–84.
31
D’Souza S, Lambrette P, Ghadirian P, Deslandres C, Morgan K, Seidman E, et al. Dietary patterns and risk for Crohn’s disease in children. Inflamm Bowel Dis. 2008;14:367–73.
32
Brand-Miller J, Holt S, Pawlak D, and McMillan J. Glycemic index and obesity. Am J Clin Nutr. 2002;76:281S–5S.
33
Ananthakrishnan A, Khalili H, Song M, Higuchi L, Richter J, Nimptsch K, et al. High school diet and risk of Crohn’s disease and ulcerative colitis. Inflamm Bowel Dis. 2015;21:2311–9.
34
Jenkins D, Kendall C, McKeown-Eyssen G, Josse R, Silverberg J, Booth G, et al. Effect of a low-glycemic index or a high-cereal fiber diet on type 2 diabetes: a randomized trial. JAMA. 2008;300:2742–53.
35
Sievenpiper J and Dworatzek P. Food and dietary pattern-based recommendations: an emerging approach to clinical practice guidelines for nutrition therapy in diabetes. Can J Diabetes. 2013;37:51–7.
36
Azadbakht L, Surkan P, Esmaillzadeh A, and Willett W. The dietary approaches to stop hypertension eating plan affects C-reactive protein, coagulation abnormalities, and hepatic function tests among type 2 diabetic patients. J Nutr. 2011;141:1083–8.
37
Nutrition Evidence Library. A Series of Systematic Reviews on the Relationship between Dietary Patterns and Health Outcomes. Alexandria, VA: United States Department of Agriculture; 2014, p. 501.
38
Khalili H, Håkansson N, Chan S, Chen Y, Lochhead P, Ludvigsson J, et al. Adherence to a Mediterranean diet is associated with a lower risk of later-onset Crohn’s disease: results from two large prospective cohort studies. Gut, 2020;9:1637–44.
39
Li F, Hou L, Chen W, Chen P, Lei C, Wei Q, et al. Associations of dietary patterns with the risk of all-cause, CVD and stroke mortality: a meta-analysis of prospective cohort studies. Br J Nutr. 2015;113:16–24.
40
Scarallo L, Banci E, Pierattini V, and Lionetti P. Crohn’s disease exclusion diet in children with Crohn’s disease: a case series. Curr Med Res Opin. 2021;37:1115–20.
41
Nestle Health Science ModuLife The Link Between Crohn’s Disease & Diet Nestle Health Science. Available from: https://mymodulife.com/ (accessed on 24 June 2020).
42
Levine A, Sigall Boneh R, and Wine E. Evolving role of diet in the pathogenesis and treatment of inflammatory bowel diseases. Gut, 2018;67:1726–738.
43
Svolos V, Hansen R, Nichols B, Quince C, Ijaz U, Papadopoulou R, et al. Treatment of active Crohn’s disease with an ordinary food-based diet that replicates exclusive enteral nutrition. Gastroenterology, 2019;156:1354–67.
44
Jones C, Connors J, Dunn K, Bielawski J, Comeau A, Langille M, et al. Bacterial taxa and functions are predictive of sustained remission following exclusive enteral nutrition in pediatric Crohn’s disease. Inflamm Bowel Dis. 2020;26:1026–37.
45
Connors J, Dunn K, Allott J, Bandsma R, Rashid M, Otley A, et al. The relationship between fecal bile acids and microbiome community structure in pediatric Crohn’s disease. ISME J. 2020;14:702–13.
46
NutritionQuest Assessment and Analysis Services [cited 15 September 2017]. Available from: https://nutritionquest.com/assessment/list-of-questionnaires-and-screeners/.
47
McCullough M, Feskanich D, Stampfer M, Giovannucci E, Rimm E, Hu F, et al. Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr. 2002;76:1261–71.
48
Belin R, Greenland P, Allison M, Martin L, Shikany J, Larson J, et al. Diet quality and the risk of cardiovascular disease: the Women’s Health Initiative (WHI). Am J Clin Nutr. 2011;94:49–57.
49
Chiuve S, Fung T, Rimm E, Hu F, McCullough M, Wang M, et al. Alternative dietary indices both strongly predict risk of chronic disease. J Nutr. 2012;142:1009–18.
50
Fung T, McCullough M, van Dam R, and Hu F. A prospective study of overall diet quality and risk of type 2 diabetes in women. Diabetes Care. 2007;30:1753–7.
51
Health Canada Eating Well with Canada’s Food Guide 2007 [cited 28 June 2020]. Available from: https://www.canada.ca/en/health-canada/services/food-nutrition/reports-publications/eating-well-canada-food-guide-2007-development-food-intake-pattern.html.
52
Hu F, Rimm E, Smith-Warner S, Feskanich D, Stampfer M, Ascherio A, et al. Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire. Am J Clin Nutr. 1999;69:243–9.
53
Hu F, Rimm E, Stampfer M, Ascherio A, Spiegelman D, and Willett W. Prospective study of major dietary patterns and risk of coronary heart disease in men. Am J Clin Nutr. 2000;72:912–21.
54
Nova Scotia Department of Education and Nova Scotia Department of Health Promotion and Protection. Food and Beverage Standards for Nova Scotia Public Schools; Nova Scotia, CA, 2006. [cited 20 June 2023] Available from: https://www.ednet.ns.ca/docs/foodnutritionfoodbeveragestandard.pdf.
55
Wadsworth L, McHugh T, Thompson A, Campagna P, Durant M, Murphy R, et al. Dietary intake of Nova Scotia youth in grades 7 and 11. Can J Diet Pract Res. 2012;73:14–20.
56
Garriguet D. Canadians’ eating habits. Health Rep. 2007;18:17–32.
57
Health Canada The Development and Use of a Surveillance Tool: The Classification of Foods in the Canadian Nutrient File According to Eating Well with Canada’s Food Guide; Ottawa (Cad), 2014. [cited 20 June 2023] Available from: https://publications.gc.ca/collections/collection_2014/sc-hc/H164-158-2-2014-eng.pdf.
58
Hosseini S, Papanikolaou Y, Isalm N, Rashmi P, Shamloo A, and Vatanparast H. Consumption patterns of grain-based foods among children and adolescents in Canada: evidence from Canadian Community Health Survey-Nutrition 2015. Nutrients, 2019;11:623.
59
Jessri M, Nishi M, and L’Abbe M. Assessing the nutritional quality of diets of Canadian Children and Adolescents using the 2014 Health Canada Surveillance Tool Tier System. BMC Public Health. 2016;16:381.
60
Tsiountsioura M, Wong J, Upton J, McIntyre K, Dimakou D, Buchanan E, et al. Detailed assessment of nutritional status and eating patterns in children with gastrointestinal diseases attending an outpatients clinic and contemporary healthy controls. Eur J Clin Nutr. 2014;68:700–6.
61
Maconi G, Ardizzone S, Cucino C, Bezzio C, Russo A, and Bianchi Porro G. Pre-illness changes in dietary habits and diet as a risk factor for inflammatory bowel disease: a case-control study. World J Gastroenterol. 2010;16:4297–307.
62
Satherley R, Howard R, and Higgs S. Disordered eating practices in gastrointestinal disorders. Appetite, 2015;84:240–50.
63
MacLellan A, Connors J, MacIntyre B, Douglas G, Dunn K, Bielawski J, et al. Fibre intake is associated with microbiome changes in pediatric Crohn’s disease patients following remission induction with exclusive enteral nutrition. J Crohns Colitis. 2017;11:477.
64
Ruemmele F, Veres G, Kolho K, Griffiths A, Levine A, Escher J, et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn’s disease. J Crohns Colitis. 2014;8:1179–207.
65
Kim H, Song H, Han H, Kim K, and Kim M. Translation and validation of the dietary approaches to stop hypertension for Koreans intervention: culturally tailored dietary guidelines for Korean Americans with high blood pressure. J Cardiovasc Nurs. 2013;28:514–23.
66
Grant S, Noseworthy R, Thompson A, Seider M, O’Connor D, Josse R, et al. The effect of low glycaemic index education on satisfaction, knowledge, behaviour, and glycaemic control in women with gestational diabetes. Can. J. Diabetes. 2017;41:S18.
67
Mai J, Pilcher R, and Frommelt-Kuhle M. Fostering interprofessional collaboration and critical thinking between nursing and physical therapy students using high-fidelity simulation. J Interprofess Educ Pract. 2018;10:37–40.
68
Miles A, Friary P, Jackson B, Sekula J, and Braahuis A. Simulation-based dysphagia training: teaching interprofessional clinical reasoning in a hospital environment. Dysphagia, 2016;31:407–15.
69
Johansson L, Solvoll K, Opdahl S, Bjørneboe GE, and Drevon C. Response rates with different distribution methods and reward, and reproducibility of a quantitative food frequency questionnaire. Eur J Clin Nutr. 1997;1997:346–53.
70
Rashid M, Haskett J, Parkinson McGraw L, Noble A, van Limbergen J, and Otley A. Teaching families of children with celiac disease about gluten-free diet using distributed education: a pilot study. Can J Diet Pract Res. 2021;82:38–40.
71
Myhre J, Anderson L, Holvik K, Astup H, and Kristiansen A. Means of increasing response rates in a Norwegian dietary survey among infants – results from a pseudo-randomized pilot study. BMC Med Res Methodol. 2019;19:9.
Supplementary Material
File (cjdpr-2024-005suppla.docx)
- Download
- 84.77 KB
Information & Authors
Information
Published In
Canadian Journal of Dietetic Practice and Research
e-First
Pages: 1 - 8
Editor: Naomi Cahill
History
Version of record online: 18 April 2024
Copyright
© 2024.
Key Words
Mots-clés
Authors
Metrics & Citations
Metrics
Other Metrics
Citations
Cite As
AntoniaHarveyPDt, MScAHN, JessicaMannetteMA, RotemSigall-BonehRD, MSc, BradMacintyreBScH, MatthewParrottPhD, LeahCahillRD/PDt, PhD, JessicaConnorsPhD, AnthonyOtleyMD, MSc, JenniferHaskettPDt, BSNH, Johanvan LimbergenMD, PhD, and ShannanGrantPDt, MSc, PhD. Co-Development of Three Dietary Indices to Facilitate Dietary Intake Assessment of Pediatric Crohn’s Disease Patients. Canadian Journal of Dietetic Practice and Research.
e-First
https://doi.org/10.3148/cjdpr-2024-005
Export Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.
There are no citations for this item
View Options
Get Access
Login options
Check if you access through your login credentials or your institution to get full access on this article.
Subscribe
Click on the button below to subscribe to Canadian Journal of Dietetic Practice and Research
