Assessment of Dietary Adequacy and Quality in a Sample of Patients with Crohn's Disease

Abstract

Both under-and over-nutrition are prevalent in patients with Crohn's Disease (CD). The aim of the present study was to evaluate dietary intake and compare it with relevant recommendations during active disease and remission, also taking into consideration the adequacy of energy reporting. Dietary quality was assessed through adherence to the Mediterranean diet and to the European dietary guidelines for cardiovascular disease prevention (CVD-score). Malnutrition was diagnosed with the GLIM criteria. There were 237 patients evaluated (54.9% males, 41.3 ± 14.1 years and 37.6% with active disease). In the total sample, high prevalence of overweight/obesity (61.6%) and low prevalence of malnutrition (11.4%) were observed, whereas 25.5% reported low protein intake in the sub-sample of adequate energy reporters. The mean MedDietScore was 28.0 ± 5.5 and the mean CVD-score was 5.25 ± 1.36, both reflecting moderate dietary quality. Patients with active disease reported higher prevalence of low protein intake, lower carbohydrate, fibers, fruits, vegetables, legumes, and sweets consumption and a lower MedDietScore compared to patients in remission. Consumption of fibers, fruits, vegetables, and legumes while in remission did not result in reaching the recommended intakes, and dietary quality was low as reflected by the MedDietScore. In conclusion, both protein undernutrition and energy overconsumption were prevalent in the current sample and overall patients adhered to a moderate quality diet irrespective of disease stage.

Keywords: Crohn’s disease; Mediterranean diet; dietary adequacy; dietary habits; dietary intake; disease activity; food groups; nutrients; under-reporting.

Figure 1

CONSORT chart. From November 2018 to November 2019, 382 patients with CD were referred by collaborating physicians for screening. Of the 382 patients, 82 declined to participate, 28 did not show up for the assessments and 22 were diagnosed with CD for less than 6 months. In total, 250 patients with CD included in a cross-sectional evaluation of nutritional status, were assessed for eligibility in the current analyses. Thirteen patients were excluded from the present analyses, because of missing data regarding REE measurement, leading to a final sample of 237 patients. Of the final sample, 89 patients were in active disease and 148 in remission. Four patients were on a weight loss diet and the rest were further classified according to adequacy of dietary intake based on Goldberg et al. criteria to 80 low energy reporters and 153 adequate energy reporters. Among the adequate energy reporters, 53 had active disease and 100 were in remission. Abbreviations: CD: Crohn’s Disease, REE: Resting Energy Expenditure.