P-089 A Novel Multi-Disciplinary Approach to Nutrition for Adults with Inflammatory Bowel Disease

Abstract

Background: Inflammatory bowel disease (IBD) is associated with diarrhea, bloating, postprandial pain, anorexia, malabsorption, impaired nutrient intake, and increased metabolic demands that can contribute to malnutrition and impact quality of life. Studies suggest that up to 85% of adults with IBD may have evidence of malnutrition. Registered dietitians (RD) can recognize, evaluate, and treat malnutrition but often work independent of the gastroenterology specialist. We have developed a novel multidisciplinary nutrition program that integrates the expertise of a physician together with a registered dietitian. For these visits, patients provided 1 or more pre-visit goals and food logs, and were provided with medical and nutritional guidance and recommendations directed by their personal goals. Methods: We performed a review of patient charts referred to the IBD Nutrition & Integrative Clinic (MD and RD clinic), and Nutrition Counseling Services (IBD RD clinic only) between October 2014 and July 2015. Patients met study inclusion criteria if they carried a diagnosis of IBD, requested nutritional evaluation and counseling, and had provided written consent to participate in IBD-related research at the medical facility. Results: A total of 48 patient profiles were reviewed. Subjects were between 17 and 83 years of age. The majority (69%) had Crohn's disease, 19% had ulcerative colitis, and 12% were classified as IBD-indeterminate. Twenty-three percent had previously interacted with an RD, primarily in the inpatient setting or via limited phone consultation; therefore, these patients received varying prior levels of personalized education. Stated patient nutritional counseling goals were grouped into the following 4 general categories: nutrition for symptom management (60%), nutrition for disease management (44%), nutrition for general health/cancer prevention (19%), and nutrition for weight management (4%). Patients commonly avoided dairy (69%) and fiber (40%), leading to potential inadequate intakes of calcium, vitamin D, B vitamins, vitamin E, and other micronutrients. Gluten (31%) and red meat (29%) were also common food avoidances, increasing risk of B vitamin, vitamin E, iron, and zinc deficiencies. Forty percent of patients had 3 or more food avoidances. Fifty eight percent of subjects did not take a daily multiple vitamin/mineral supplements. Of the subjects that avoided dairy, only 36% supplemented with calcium and vitamin D. Of the patients who had pre-visit nutritional laboratory values (56%), vitamin D insufficiency and deficiency was common (44%). Only 58% of vitamin D insufficient/ deficient patients were supplementing with vitamin D. Forty-six percent of patients had not previously had a bone density scan. Patient satisfaction with the program was high. Conclusions: Patients with IBD referred for nutrition evaluation commonly restrict dietary intake in order to manage symptoms, but these diets may not be nutritionally sound, particularly if pursued on a longer-term basis. An integrated approach to nutrition for adults with IBD is feasible, may identify metabolic and nutrition issues that might be missed by independent medical and nutrition evaluations, and provides high patient satisfaction.