Food avoidance in outpatients with Inflammatory Bowel Disease - Who, what and why

Food avoidance is common with Inflammatory Bowel Disease (IBD) and adherence to dietary guidelines is poor, contributing to under and over nutrition. Reasons for food avoidance have not been previously explored in detail. This study of IBD outpatients aimed to describe food avoidance patterns and rationale behind this, and describe source and confidence with dietary advice.

A prospective cross-sectional study using structured interview, nutritional assessment and medical record review was conducted in patients with confirmed diagnosis of IBD (n = 117) attending outpatient clinics over a six-month period. Participants were interviewed on foods avoided, rationale for food avoidance and previous dietary advice (source and confidence). Means ± SD or medians (IQR), percentages and counts were used to describe participant characteristics, food avoidance, and source and confidence in dietary advice. Bivariate analysis was used to explore relationships between food avoidance and disease factors (IBD subtype; disease activity: active disease vs remission), and between confidence in dietary advice and disease activity.

Almost all participants reported food avoidance (90%), with more foods avoided during active disease (5.2 ± 3.6 foods/food categories, versus remission 2.9 ± 2.5, p < 0.001). Lactose-containing foods were avoided by 40% of patients in active disease and 33% in remission. Pain/cramping, increased bowel motions and diarrhea were the most common reasons for avoiding foods/food categories during both active disease and remission. Participants were most confident in advice received from the internet (3.3 ± 1.2; dietitian: 2.8 ± 1.5) in active disease; in remission participants had greatest confidence in advice received from gastroenterologists (4.1 ± 0.8; dietitian: 3.5 ± 1.2).

High prevalence of avoidance of nutritious foods and low confidence in dietetic advice amongst people with IBD is of concern. Further work is needed to build trust and ensure patients are provided with evidence-based nutrition recommendations to manage their symptoms whilst optimizing nutritional quality of their diet.