Health Literacy and Nutrition of Adolescent Patients with Inflammatory Bowel Disease

Abstract

Background/Objectives: Nutrition in inflammatory bowel disease (IBD) is a central concern for both patients and healthcare professionals, as it plays a key role not only in daily life but also in disease outcomes. The Mediterranean diet represents a healthy dietary pattern that may be suitable in many cases of IBD. Among other factors, health literacy (HL) influences patients' dietary habits and their ability to follow nutritional recommendations. The aim of this study was to assess HL and dietary patterns in adolescent and pediatric patients with IBD. Methods: We conducted a cross-sectional study that included a total of 99 participants (36 patients with IBD receiving biological therapy recruited from a single center and 63 healthy controls). HL was assessed using the Newest Vital Sign (NVS) tool regardless of disease activity, whereas diet quality was evaluated by the KIDMED questionnaire exclusively in patients in remission. Linear regression models were used to evaluate the effects of sex, age and group (patients vs. control) on NVS and KIDMED scores. Results: Most participants (87.9%) had an adequate HL, which was positively associated with age. While the most harmful dietary habits (such as frequent fast-food consumption) were largely absent in the patient group, KIDMED scores indicated an overall poor diet quality. Conclusions: Although HL increased with age and was generally adequate in this cohort, it did not translate into healthier dietary patterns as measured by the KIDMED score. Further research with larger, more diverse samples is needed to clarify the relationship between HL and dietary adherence in adolescents with IBD.

Keywords: Mediterranean diet; adolescent; health literacy; inflammatory bowel disease; nutrition.

Figure 1

NVS score by sex in the patient group. Boxplot illustrating the distribution of Newest Vital Sign (NVS) health literacy scores by sex. Median scores are indicated by the horizontal lines within the boxes. The interquartile ranges (IQR) are represented by the box boundaries. Individual data points are displayed as dots. No significant difference was observed between male and female participants.

Figure 2

Predicted values of NVS (Newest Vital Sign) score by age and group. The figure shows predicted NVS scores by age for patients (blue) and controls (red), based on linear regression models. NVS scores increase with age in both groups, but the rise is steeper in controls. Shaded areas represent 95% confidence intervals.

Figure 3

Predicted values of NVS score in patients by age and sex. The figure shows predicted NVS scores by age for male (blue) and female (red) participants, based on linear regression models. NVS scores increase with age in both groups. Shaded areas represent 95% confidence intervals.

Figure 4

Upset plot for Newest Vital Sign “subscales”. Question 4 (NVS4); Question 1 (NVS1); Question 3 (NVS3); Question 2 (NVS2); Question 6 (NVS6); Question 5 (NVS5). The upset plot represents the response pattern for the Newest Vital sign tool. The dots show variable combinations in the top section. Individual variable frequencies are on the left, and combination frequencies are at the top.

Figure 5

KIDMED score by sex. Boxplot illustrating the distribution of KIDMED dietary adherence scores by sex. Median scores are indicated by the horizontal lines within the boxes. The interquartile ranges (IQR) are represented by the box boundaries. Individual data points are displayed as dots. No significant difference was observed between male and female participants.

Figure 6

Upset plot KIDMED score “subscales”. Q stands for “Question”, and the following number refers to the item in the KIDMED questionnaire. The upset plot represents the response pattern for the KIDMED Mediterranean diet adherence screening tool. The dots show variable combinations in the top section. Individual variable frequencies are on the left, and combination frequencies are at the top.