Self-imposed Dietary Restrictions Research Articles

P1183 Perception of the role of diet on symptom exacerbation in patients with Inflammatory Bowel Disease

Abstract Background A substantial proportion of patients with inflammatory bowel disease (IBD) believe that diet plays an important role in disease activity. As a result, IBD patients often change their dietary regimen in order to improve their symptoms and to prevent recurrences, however most of them choose self-imposed dietary restrictions that may lead to malnutrition and to a significant reduction in quality of life. The aim of our study was to evaluate dietary habits and the perception of the relationship between diet and symptoms in IBD patients. Methods A semi-structured questionnaire assessing demographics, clinical features, perception of the role of diet on symptom exacerbations and dietary habits including adoption of food restrictions was developed by our gastroenterologists and dietitians and was administered to patients with IBD. Results 85 patients with IBD (56 with Ulcerative Colitis and 29 with Crohn’s Disease, mean age 55.0 ± 15.9 years, 43 males) were enrolled in the study. Most IBD patients did not perceive diet as a possible cause of disease (68/85 patients, 80.0%) or relapses (70/85 patients, 82.3%), but the majority of them (55/85 patients, 64.7%) believed that certain foods and drinks could worsen disease symptoms. Alcohol, carbonate drinks, milk, spicy and fat foods were often considered as a possible cause of symptom deterioration. Although 50/85 patients (58.8%) stated that they changed their diet after the diagnosis, only 19/85 patients (22.3%) declared to adopt a "restrictive" diet by reducing or avoiding some foods. However, 64/85 patients (75.3%) showed low/intermediate adherence to Mediterranean Diet (MD) (calculated with the MediLite Score), and no patient had high adherence to MD. Finally, the majority of IBD patients declared that they would like to receive more information on diet in relation to their disease. Conclusion In our study, the majority of IBD patients perceived that certain foods and drinks could worsen disease symptoms and accordingly changed their diet after the diagnosis. The adoption of restrictive diets is probably more frequent than declared by IBD patients, as suggested by the high prevalence of low/intermediate adherence to MD. Education of healthcare providers is important to improve knowledge and quality of nutrition in IBD patients.

Reproductive tradeoffs govern sexually dimorphic tubular lysosome induction in Caenorhabditis elegans.

Sex-specific differences in animal behavior commonly reflect unique reproductive interests. In the nematode Caenorhabditis elegans, hermaphrodites can reproduce without a mate and thus prioritize feeding to satisfy the high energetic costs of reproduction. However, males, which must mate to reproduce, sacrifice feeding to prioritize mate-searching behavior. Here, we demonstrate that these behavioral differences influence sexual dimorphism at the organelle level; young males raised on a rich food source show constitutive induction of gut tubular lysosomes, a non-canonical lysosome morphology that forms in the gut of hermaphrodites when food is limited or as animals age. We found that constitutive induction of gut tubular lysosomes in males results from self-imposed dietary restriction through DAF-7/TGFβ, which promotes exploratory behavior. In contrast, age-dependent induction of gut tubular lysosomes in hermaphrodites is stimulated by self-fertilization activity. Thus, separate reproductive tradeoffs influence tubular lysosome induction in each sex, potentially supporting different requirements for reproductive success.

Nutrient, Fibre, and FODMAP Intakes and Food-related Quality of Life in Patients with Inflammatory Bowel Disease, and Their Relationship with Gastrointestinal Symptoms of Differing Aetiologies.

Background and AimsCertain foods are reported as gut symptom triggers in inflammatory bowel disease [IBD], and fructans are shown to worsen non-inflammatory symptoms in inactive IBD, which may result in self-imposed dietary restrictions. The aim of this study was to investigate nutrient and FODMAP intakes, and the relationship between gut symptoms and dietary intake, in IBD.MethodsNutrient, fibre, and FODMAP intakes were estimated using 7-day food records in patients with active IBD [Active IBD], inactive IBD with non-inflammatory gut symptoms [Inactive IBD-GI], inactive IBD without gut symptoms [Inactive IBD], and healthy controls. Nutrient intakes, numbers of participants achieving national recommendations, and food-related quality of life [FR-QoL] were compared across study groups.ResultsFood diaries were obtained from 232 patients with IBD [65 Active IBD, 86 Inactive IBD-GI, 81 Inactive IBD] and 84 healthy controls. Patients with Active IBD had significantly lower intakes of numerous micronutrients, including iron, folate, and vitamin C, compared with controls. All IBD groups consumed less total fibre [4.5 to 5.8 g/day] than controls [p = 0.001], and total FODMAP and fructan intakes were lower in Active IBD compared with controls. Strikingly, FR-QoL was significantly lower in all IBD groups compared with controls [all p = 0.001].ConclusionsThis study revealed lower intakes of fibre, FODMAPs, and micronutrients, in addition to poorer FR-QoL, in Active IBD and Inactive IBD-GI with gut symptoms compared with healthy controls. Future research should address dietary restrictions responsible for these differences.

Nutritional Deficiency Disease Secondary to ARFID Symptoms Associated with Autism and the Broad Autism Phenotype: A Qualitative Systematic Review of Case Reports and Case Series

BackgroundThe demographics, weight statuses, and dietary patterns of people with autism or the broad autism phenotype who experience a severe nutrient deficiency disease due to symptoms of avoidant/restrictive food intake disorder have not been well established. ObjectiveThe primary objective of this review was to examine the relationship between the demographics, weight statuses, dietary patterns, and nutrient deficiency diseases that characterize the most severe manifestations of avoidant/restrictive food intake disorder symptomology associated with autism or the broad autism phenotype. MethodsA systematic review of English and non-English articles published up to August 29, 2019, on the Scopus, PubMed, and Cumulative Index to Nursing and Allied Health Literature Plus electronic databases was conducted. Additional cases were identified through the reference list of all included articles. The search terms used were “autis∗ AND (deficiency OR scurvy)”. Only case reports or case series in which a person of any age who had been identified as having a formal diagnosis of autism or autism symptoms and a disease of nutritional deficiency due to self-imposed dietary restrictions were included. Data were independently extracted by 8 authors using predefined data fields. ResultsA total of 76 cases (patients were aged 2.5 to 17 years) from 63 articles that were published from 1993 through 2019 were found. More than 85% cases (65 of 76 patients) were from articles published in the past 10 years. The largest percentage of published cases (69.7% [53 of 76]) involved scurvy, a vitamin C deficiency. The second-largest percentage of published cases (17.1% [13 of 76]) involved eye disorders secondary to vitamin A deficiency. Other primary nutrient deficiencies reported were thiamin, vitamin B-12, and vitamin D. In 62.9% (22 of 35) of the patients for which a body mass index or a weight percentile for age was provided, the patient was within normal weight parameters, per Centers for Disease Control weight status categories. ConclusionsBased on the 63 articles extracted for this systematic review, nutritional deficiency diseases related to inadequate intakes of vitamin A, thiamin, vitamin B-12, vitamin C, and vitamin D were found in individuals with autism and the broad autism phenotype who had severe self-imposed dietary restrictions. When weight information was provided, most of the youth in these cases were not reported to be underweight. Individuals of any weight who present with symptoms of avoidant/restrictive food intake disorder can benefit from early and frequent screening for adequacy of micronutrient intake, regardless of whether they have a clinical diagnosis of autism.

Developing mouse models to identify novel therapeutic targets for anorexia nervosa

Genetic influences on eating behavior and eating disorders risk emerge in adolescence; the neural substrates remain unknown. We developed a mouse model to study gene x environment interactions that promote severe self-imposed dietary restriction. Using this paradigm, we discovered a novel therapeutic target for anorexia nervosa. However, our efforts to study the underlying circuits and to translate our findings into humans were hindered by the unpredictable and low-throughout nature of the model. We have now developed an acute feeding behavioral assay that is sensitive to genetic influences (conferred by the BDNF-Val66Met gene variant) during adolescence in female mice. We are leveraging this system to apply state-of-the-art unbiased whole-brain mapping approaches to identify causal relationships between brain plasticity and abnormal feeding behaviors. This platform will accelerate our efforts to map the underlying circuits and to identify and test novel therapeutic compounds.

Planet, Ethics, Health and the New World Order in Proteins

While meat consumption is increasing in the developing world, it has plateaued in many developed economies. Optimal for health and projected trends suggest global meat consumption is set to rise further into this century, but not everywhere, especially in the Western world. Plant-based dieting appears to be taking a larger place in how consumers view food systems in developed economies. The aim of this exploratory study is to better understand consumer attitudes about meat consumption and assess the intersections between meat avoidance and attachment. It also investigates how prominent plant-based, or self-imposed dietary restrictions related to meat consumption are in the marketplace. Results show that a significant number of Canadians have adopted a diet which either limits or eliminates the consumption of meat. Some generational differences were reported. While many vegans are under the age of 38 (Millennials and Gen Zs), a great number of boomers consider themselves as flexitarians. Health benefits appear to be important for both genders. Women appear to be more concerned about animal welfare and taste preferences. Some limitations are presented, and future research ideas are put forward.

P554 Dietary practices and beliefs of patients with inactive ulcerative colitis: A prospective UK study

Abstract Background Our understanding of the aetiopathogenesis of inflammatory bowel disease (IBD), in particular the impact of environmental factors, remains limited. The role of diet in IBD appears to be of particular importance to patients. The dietary habits of the IBD population with inactive disease have scarcely been reported. We describe the dietary practices of patients with inactive ulcerative colitis (UC) and the information resources which guide these beliefs. Methods We developed a questionnaire assessing demographics, dietary practices and the use of information resources in patients with inactive UC (defined as a PRO2 score ≤ 1 (rectal bleeding subscore = 0)). This is being prospectively administered to 200 consecutive patients with inactive UC. Results Data from 168 patients are available to date. Mean patient age is 54 years, 58% male and 89% Caucasian. Mean disease duration is 12 years. Disease extent is 20% E1, 43% E2 and 29% E3. Sixty-three per cent of patients report no relapse in the last year. 32% consider diet to be an initiating factor for their UC and this is based on their own experience (93%), the internet (30%) and a gastroenterologist’s advice (22%). 39% of patients feel that diet has previously triggered a relapse of their disease, the most commonly reported triggers being spicy foods (45%), alcohol (38%), fatty foods (38%), coffee (27%) and milk products (26%). Fifty-four per cent of patients avoid certain foods, at least sometimes, to prevent relapse. Spicy foods are most frequently avoided (76%) followed by fatty foods (65%), alcohol (53%), coffee (46%), carbonated drinks (44%), milk products (42%) and red meat (36%). Female patients are significantly more likely to restrict their diet in an attempt to prevent a relapse of their UC (p = 0.002). A fifth of patients consume specific foods or nutritional supplements to prevent a UC relapse, most commonly probiotics or turmeric. Fifty-seven per cent of patients believe that the recommended diet in disease remission is different to that in relapse however less than half of patients report being able to find specific dietary advice for UC. Dietary recommendations are most commonly sourced via the internet. Conclusion A significant proportion of patients with inactive UC have strong beliefs pertaining to diet and specific dietary triggers. Credible sources of dietary information for IBD patients remain lacking. A high prevalence of self-imposed dietary restriction may risk nutritional deficiency in such patients and impact upon the quality of life. More data and mechanistic explanations are needed to understand the complicated relationship between dietary components and gut inflammation. A larger dataset will be presented at conference proceedings.

Complementary and alternative medicine (CAM) practices and dietary patterns in children with inflammatory bowel disease in Singapore and Malaysia

BackgroundThe use of complementary and alternative medicine (CAM) has been associated with adverse effects and self-imposed dietary restrictions. The prevalence of its use in Asian children with inflammatory bowel disease (IBD) is unknown. We aimed to determine the prevalence, types, and factors associated with the use of CAM among children with IBD from Singapore and Malaysia, and to ascertain if dietary restriction was prevalent in patients who used CAM. MethodsA cross-sectional study was conducted in which parents of children with IBD attending two tertiary pediatric IBD referral centres in Singapore and Malaysia were interviewed. Data about demographics, conventional treatment, complementary therapies and dietary patterns were collected in a questionnaire. ResultsOf 64 children with IBD interviewed, 83% (n = 53) reported the use of CAM (Singapore [90%] vs. Malaysia [76%]; p = 0.152). The median number of CAM agents used was two (range 1–10). The three most common types of CAM used were probiotics (64%), vitamin and mineral supplements (55%), and food-based therapies (36%). Among individual CAM categories, the use of food-based therapies was correlated significantly with nationality (r = 0.497, p < 0.001), history of weight loss due to IBD (r = 0.340, p = 0.013) and avoidance of certain foods to prevent a relapse (r = 0.289, p = 0.036). Parents who rated their child's disease activity as more severe were less likely to use CAM (r = −0.257, p = 0.041). Fifty-nine percent of CAM users reported physician awareness of their CAM use. The overall self-perceived efficacy of CAM in improving IBD symptoms was 34%. Of the dietary patterns explored, only intake of dairy products was associated with CAM use (r = 0.306, p = 0.019). ConclusionUse of CAM is prevalent in children with IBD in Malaysia and Singapore. Further studies to elucidate reasons influencing CAM use, dietary patterns and efficacy of commonly used CAM would be required.

PTU-093 An Exploration of Adverse Reactions to Foods in Adults with Crohn’s Disease

Introduction Crohn’s Disease (CD) has been associated with an increased risk of food allergies due to damage to the epithelial intercellular junctions and the ensuing immune response. However, since this population has increased micronutrient requirements it is important that dietetic advice is sought in favour of self-imposed dietary restrictions. The aim of this study was to explore individuals with CD’s experiences of self-reported adverse reactions to food. Methods A phenomenological design utilised in-depth semi-structured interviews with adults with CD. Convenience sample recruitment via Coventry Ileostomy and Internal Pouch Support Group was employed. A topic guide included the areas of experinces of adverse reactions to foods, ways of coping and impact of adverse reactions to foods. Interviews were recorded and transcribed verbatim. Data was explored and findings interpreted using Interpretive Phenomenological Analysis. NVIVO software was used for data management. Member checking and internal peer review were undertaken. Participants gave written informed consent. Results Ten adults (4 men 6 women) with a mean age of 52.2 (±19) years had a mean experience of 20.2 years living with CD. Four main themes emerged which illustrated the experience of adverse reactions to food (1) Physiological symptoms; pain; swelling; diarrhoea; breathing difficulty (2) Difficulties Identifying and telling the difference between allergy and intolerance; being able to identify an allergic reaction, Hypersensitivity to food items dependent on situation rose, e.g. inside/outside home (3) Psychological reaction to food, questioning their own working diagnosis and reactions to certain foods (4) Dietary self-management; excluding offending foods from diet; taking antihistamine medication; not re-engaging with dietitians due to perceived lack of adverse food reaction knowledge in CD. Conclusion Adults with CD reported common adverse reactions to certain foods. Coping strategies included identifying the symptoms and ascribing them either to an allergic reaction or intolerance, with subsequent exclusion of offending foods or decisions on excluding foods likely to cause intolerance. Health professionals may need to be aware and more supportive around reports of adverse reactions to foods and the potential impact on quality of life in CD. Building working relationships is required to support the patient and ensure the nutritional consequences of food avoidance are minimised. Disclosure of Interest None Declared

BDNF-Val66Met variant and adolescent stress interact to promote susceptibility to anorexic behavior in mice.

There is an urgent need to identify therapeutic targets for anorexia nervosa (AN) because current medications do not impact eating behaviors that drive AN's high mortality rate. A major obstacle to developing new treatments is the lack of animal models that recapitulate the pattern of disease onset typically observed in human populations. Here we describe a translational mouse model to study interactions between genetic, psychological and biological risk factors that promote anorexic behavior. We combined several factors that are consistently associated with increased risk of AN—adolescent females, genetic predisposition to anxiety imposed by the BDNF-Val66Met gene variant, social isolation stress and caloric restriction (CR). Approximately 40% of the mice with all of these risk factors will exhibit severe self-imposed dietary restriction, sometimes to the point of death. We systematically varied the risk factors outlined above to explore how they interact to influence anorexic behavior. We found that the Val66Met genotype markedly increases the likelihood and severity of abnormal feeding behavior triggered by CR, but only when CR is imposed in the peri-pubertal period. Incidence of anorexic behavior in our model is dependent on juvenile exposure to social stress and can be extinguished by adolescent handling, but is discordant from anxiety-like behavior. Thus, this study characterized gene × environment interactions during adolescence that could be the underlying driver of abnormal eating behavior in certain AN patients, and represents a promising system to identify possible targets for therapeutic intervention.

OLDER ADULTS’ ATTITUDES TO FOOD AND NUTRITION: A QUALITATIVE STUDY

Objective: To explore the factors that influence food choices of older adults and identify potential sources of dietary advice. Design: A qualitative research design using semi-structured, one on one interviews. Setting: A general medical practice in Victoria, Australia. Participants: Twelve community dwelling adults aged 75 to 89 (mean 82.8 ± 4.4) years, 92% living alone and 92% female. Measurements: Interview questions addressed usual daily food pattern, shopping routines, appetite, importance of diet and potential sources of dietary advice or assistance. Results: Thematic analysis identified key themes influencing food choices were maintaining independence; value of nutrition; childhood patterns; and health factors. Dietary restrictions and concerns with weight gain were expressed, and although these were managed independently, the GP was identified as the first source of information if required. Conclusion: This sample of older adults placed high value on eating well as they age, however a number followed self-imposed dietary restrictions which have the potential to compromise their nutritional status as dietary requirements change. Further research is needed into how to communicate changing nutritional needs to this group.

Stress reduces self-control

Neuroscience![Figure][1] Stress can lead people to make unhealthy food choices PHOTO: © RUTH BLACK/THE PICTURE PANTRY/CORBIS Everyone experiences situations in which our willpower fades, and we abandon self-control for choices that we later regret. Maier et al. assessed how stress affects self-control in young adults that have a healthy lifestyle but reported indulging in fast-food treats regularly. Compared to control participants, participants who were experimentally stressed preferred tastier foods more often in a two-choice taste test, regardless of whether their choice was less healthy and in disagreement with their self-imposed dietary restrictions. Brain imaging revealed more-active reward and taste circuits in stressed participants and less activity in regions associated with self-control. This suggests that stressed individuals prefer immediate reward over following a long-term goal. Neuron 87 , 621 (2015). [1]: pending:yes

PWE-039 Malnutrition in inflammatory bowel disease: is body mass index enough?: Abstract PWE-039 Table 1

<h3>Introduction</h3> Malnutrition in inflammatory bowel disease (IBD) can occur as a result of poor dietary intake, malabsorption, self-imposed dietary restrictions and treatment. High rates of malnutrition (80%) have previously been described in hospitalised patients with severe active disease.¹In remission malnutrition is not frequently encountered and one third of patients with Crohn–s Disease are reported to be overweight.²The aim of this audit was to assess the nutritional status of IBD patients attending an outpatient clinic in a tertiary referral centre. <h3>Method</h3> This was a prospective audit completed from June–October 2014. All IBD patients were asked to complete a malnutrition screening tool based on national guidelines.³Height and weight were measured by nurses and patients were asked to recall any weight loss over the last 3–6 months. Patients were identified as malnourished if they had a body mass index (BMI) &lt;18.5 kg/m², unintentional weight loss &gt;10% within the last 3–6 months, or a BMI &lt;20 kg/m²and weight loss &gt;5% over the last 3–6 months. <h3>Results</h3> One hundred patients completed the audit, 58 females and 42 males with a mean age of 47 ± 18 years. Fifty four patients (54%) had Crohn–s Disease, 45 had Ulcerative Colitis (45%) and 1 had Indeterminate Colitis (1%). A third of patients (33%) had undergone surgical resection. Mean weight was 68.2 ± 14.1 kg and mean BMI was 24.4 ± 4.7 kg/m². Thirty eight patients (38%) experienced weight loss over the last 3–6 months. Only 7 patients (7%) were classified as malnourished whereas over a third of patients (37%) had a BMI &gt;25 kg/m²similar to previous studies.⁴Of the malnourished patients, 3 had active disease, 2 had undergone a flare up in the last 3–6 months, 1 had short bowel and 1 had chronic fatigue. <h3>Conclusion</h3> A low prevalence of malnutrition was demonstrated in IBD patients based on national guidelines. BMI is a crude measure of nutritional status and does not necessarily exclude malnutrition or changes in body composition. More sensitive measures of nutritional status including skinfold thickness and muscle circumferences are required to identify changes in lean body mass in the context of the obesity epidemic. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Harries and Heatley, Postgrad Med J. 1983;<b>59</b>:690–7 Vadan <i>et al</i>. Clin Nutr. 2011;30:86-91 NICE www.nice.org.uk/CG32 Bin <i>et al</i>. Dig Dis Sci. 2010;55:137

Weight-loss strategies used by the general population: how are they perceived?

BackgroundThe rising prevalence of obesity and the social pressure for thinness increase the prevalence of dieting. However, little is known about the overall perception of dieting strategies actually used by the general population.ObjectivesOur main objective was to investigate perceptions of weight-loss practices in an observational study in order to identify the most favourable strategy.DesignAdults from the ongoing Nutrinet-Santé cohort study who had reported engaging in dieting in the three previous years were included in the study. For each diet, detailed information was collected on types of diets, circumstances and perception of the diet, and outcomes. Perceptions were compared across diets using sex-specific mixed effects models.ResultAmong the 48 435 subjects who had completed the respective questionnaire, 12 673 (26.7%, 87.8% of women) had followed at least one weight-loss diet in the previous three years. Diet plans prescribed by health professionals and diets conforming to official dietary recommendations were the most favourably perceived among all assessed weight-loss strategies. Alternatively, commercial diet plans and self-imposed dietary restrictions were more negatively perceived (Odds ratios (OR) for adherence difficulty 1.30 (95% confidence interval (0.99;1.7)) in men and OR 1.92 (1.76;2.10) in women compared to official nutritional guidelines; OR 1.06 (0.82;1.38) in men and OR 1.39 (1.26;1.54) in women respectively) compared to official nutritional guidelines.ConclusionOfficial dietary recommendations could be useful tools for maintaining a dietary balance while following a weight-loss diet.

Complementary and alternative medicine use in adolescents with inflammatory bowel disease and juvenile idiopathic arthritis

BackgroundThe use of complementary alternative medicine (CAM) is potentially prevalent among paediatric patients with chronic diseases but with variable rates among different age groups, diseases and countries. There are no recent reports on CAM use among paediatric patients with inflammatory bowel disease (IBD) and juvenile idiopathic arthritis (JIA) in Europe. We hypothesized that CAM use associates with a more severe disease in paediatric IBD and JIA.MethodsA cross-sectional questionnaire study among adolescent outpatients with IBD and JIA addressing the frequency and type of CAM use during the past year. The patients were recruited at the Children’s Hospital, University of Helsinki, Finland.ResultsOf the 147 respondents, 97 had IBD (Crohn’s disease: n = 46; median age 15.5, disease duration 3.4 years) and 50 had JIA (median age 13.8, disease duration 6.9 years). During the past 12 months, 48% regularly used CAM while 81% reported occasional CAM use. Compared to patients with JIA, the use of CAM in IBD patients tended to be more frequent. The most commonly used CAM included probiotics, multivitamins, and mineral and trace element supplements. Self-imposed dietary restrictions were common, involving 27.6% of the non-CAM users but 64.8% of all CAM users. Disease activity was associated with CAM use in JIA but not in IBD.ConclusionsCAM use is frequent among adolescents with IBD and JIA and associates with self-imposed dietary restrictions. Reassuringly, adherence to disease modifying drugs is good in young CAM users. In JIA, patients with active disease used more frequently CAM than patients with inactive disease. As CAM use is frequent, physicians should familiarise themselves with the basic concepts of CAM. The potential pharmacological interaction or the toxicity of certain CAM products warrants awareness and hence physicians should actively ask their patients about CAM use.

Case 1: Foot drop and numbness in a 16-year-old girl

A 16-year-old girl presented with a two-week history of right foot drop and numbness along the dorsum of her right foot and anterolateral aspect of the lower limb. She also described a pinching pain behind the medial aspect of the right knee. There were no complaints of bowel or bladder incontinence, radiating back pain or saddle paresthesia. Review of systems revealed a three-month history of constipation, believed to be related to a two-year self-imposed dietary restriction. Her medical history included appendectomy as a child and a right patellar subluxation one year previously. The patient reported no recent trauma or previous neurological problems. Pertinent neurological findings included: weakness in right dorsiflexion (2 of 5), ankle eversion (4+ of 5) and toe extension (4+ of 5); decreased pin-prick sensation in the right anterolateral calf, dorsolateral aspect of the foot and webspace between the first and second toes; and dragging of the right foot during gait analysis, with impaired dorsiflexion on heel strike. All other neurological findings were normal. Her head circumference was 54 cm, height was 165 cm and weight was 47.5 kg. The patient’s body mass index was 17.4 kg/m2 (eighth percentile for age). Before food restriction, the patient had weighed 59 kg (body mass index 21.7 kg/m2, 70th percentile). At the time of presentation, she was awaiting hospital admission for treatment of a newly diagnosed eating disorder. Her general physical examination revealed no other pertinent findings. Further investigations confirmed the diagnosis and underlying cause.

NUTRITIONAL CHARACTERISTICS AND DIETARY INTAKE OF PATIENTS ATTENDING THE PRE-DIALYSIS ASSESSMENT CLINIC

Poor nutrition status at the start of dialysis is associated with morbidity and mortality. Timely management of patients with ESKD pre-dialysis including providing nutrition intervention is important. The aim of this study was to describe the baseline nutritional status and dietary intake of patients attending the pre-dialysis assessment clinic. Of the 210 patient assessed, 60.5% were male; mean age was 65.7±13.6 years and mean GFR was 17.0±4.2 ml/min. 17.1% were underweight (BMI<23 kg/m2) while 62.5% were overweight or obese (BMI>26 kg/m2). 39.5% were rated as malnourished (SGA score B&C) and 18.5% were overweight/obese and malnourished. 26.7% had MAMC 10% less than 50th percentile of the standard. Mean energy and protein intakes were 23.4±6.9 kcal/kg IBW/d and 1.16±0.43 g/kg IBW/d with 65.5% and 15.6% did not meet the recommended intake of energy and protein respectively. 48% of patients experienced symptoms (e.g. poor appetite and nausea) affecting dietary intake while 15.7% of patients self-imposed dietary restriction inappropriately due to misconception of nutrition requirements in ESKD. 41.4% and 85.2% did not consume adequate fruit and vegetables of 2 and 5 serves per day respectively based on the Australian Guide to Healthy Eating. Nutrient intake (prevalence %) below the Recommended Daily Intake (DRI) levels were: VitB1 (36.5%), VitB2 (43.5%), Niacin (3.9%), VitC (202%), VitE (41.0%), folate (83.2%), VitA (50.5%), Mg (94.5%), Fe (36.1%), Zn (70.8%) and dietary fibre (83.3%). In conclusion, patients attended the current pre-dialysis assessment clinic presented with parameters indicative of poor nutritional health. This clinic may provide an opportunity to optimise nutritional status of ESKD patients before dialysis is required.

Dietary Counseling Versus Dietary Supplements for Malnutrition in Chronic Pancreatitis: A Randomized Controlled Trial

Up to 50% of patients with chronic pancreatitis (CP) are malnourished. There are limited data on the role of dietary intervention in improving the nutritional status of such patients. The aim was to compare the efficacy of medium chain triglyceride (MCT)-enriched commercial dietary supplements with dietary counseling for homemade food in the management of malnutrition in patients with CP. In a randomized controlled trial, consecutive undernourished patients with CP (body mass index [BMI] <18.5 kg/m(2)) at a tertiary care hospital were randomized to receive either dietary counseling for regular homemade food or commercial MCT-enriched dietary supplements for a period of 3 months to compensate for the dietary calorie deficit. All patients received standard management for CP including pancreatic enzyme supplements. Primary outcome measure was improvement in BMI. Sixty malnourished patients with CP were randomized to counseling group (n = 29; mean age, 32 +/- 10 years; male, 83%) and supplementation group (n = 31; mean age, 28 +/- 10 years; male, 84%). BMI increased in both the counseling group and supplementation group (17.2 +/- 1.7 vs 18.1 +/- 1.8 kg/m(2), P = .001; 16.7 +/- 1.6 vs 18.2 +/- 1.6 kg/m(2), P = .001). There were similar improvements in triceps skinfold thickness, dietary intake, fecal fat, and pain score during a period of 3 months in both groups. There was, however, no significant difference between the counseling and supplementation groups with regard to any of the outcome measures. Dietary counseling for a balanced homemade diet is as good as commercial food supplements in improving malnutrition in patients with CP.

Nutritional dwarfing: a growth abnormality associated with reduced erythrocyte Na+,K+-ATPase activity

To assess whether nonorganic nutritional dwarfing (ND) is accompanied by a biochemical adaptation to reduced nutrient intake, Na+,K(+)-ATPase activity of erythrocytes was examined. The study included 27 children with ND who demonstrated deteriorating linear growth and poor weight gain (caused by self-imposed dietary restrictions), 20 patients who initially exhibited ND growth patterns and subsequently experienced catch-up weight gain and growth after nutritional rehabilitation (NDR), and 32 normally growing children who had familial short stature and/or constitutional growth delay (F/CSS). Na+,K(+)-ATPase activity in erythrocytes was significantly lower in ND patients than in the NDR and F/CSS groups. Furthermore, Na+,K(+)-ATPase activity was positively correlated with incremental body weight gain. Na+,K(+)-ATPase concentrations did not differ significantly with regard to sex, chronological age, bone age, or pubertal status. These data suggest that the growth retardation of ND patients is associated with decreased erythrocyte Na+,K(+)-ATPase activity without other biochemical evidence of malnutrition.

Salivary response to olfactory food stimuli as a function of dietary restraint and body weight

The effects of food and non-food odors on salivation rate and the relation between this response, body weight for height and dietary restraint score were investigated in college students. Potential confounding variables, such as dieters' anxiety due to expectations of food consumption, intrusive methods of salivation collection, and the degree of dieting strictness, were controlled. Results indicated that dietary restraint, but not body weight per se, predicted hyper-responsiveness to food cues, supporting the view that self-imposed dietary restriction heightens external salivary responsiveness to food-related stimuli.