Avoidant Restrictive Food Intake Disorder Prevalent Among Patients With Inflammatory Bowel Disease.

BACKGROUND & AIMS: Patients with inflammatory bowel disease (IBD) alter their dietary behaviors to reduce disease-related symptoms, avoid feared food triggers, and control inflammation. This study aimed to estimate the prevalence of avoidant/restrictive food intake disorder (ARFID), evaluate risk factors, and examine the association with risk of malnutrition in patients with IBD. METHODS: This cross-sectional study recruited adult patients with IBD from an ambulatory clinic. ARFID risk was measured using the Nine-Item ARFID Screen. Nutritional risk was measured with the Patient Generated-Subjective Global Assessment. Logistic regression models were used to evaluate the association between clinical characteristics and a positive ARFID risk screen. Patient demographics, disease characteristics, and medical history were abstracted from medical records. RESULTS: Of the 161 participants (Crohn's disease, 45.3%; ulcerative colitis, 51.6%; IBD-unclassified, 3.1%), 28 (17%) had a positive ARFID risk score (≥24). Most participants (92%) reported avoiding 1 or more foods while having active symptoms, and 74% continued to avoid 1 or more foods even in the absence of symptoms. Active symptoms (odds ratio, 5.35; 95% confidence interval, 1.91-15.01) and inflammation (odds ratio, 3.31; 95% confidence interval, 1.06-10.29) were significantly associated with positive ARFID risk. Patients with a positive ARFID risk screen were significantly more likely to be at risk for malnutrition (60.7% vs 15.8%; P < .01). CONCLUSIONS: Avoidant eating behaviors are common in IBD patients, even when in clinical remission. Patients who exhibit active symptoms and/or inflammation should be screened for ARFID risk, with referrals to registered dietitians to help monitor and address disordered eating behaviors and malnutrition risk.

A Clear Difference Emerges in Hormone Patterns Following a Standard Midday Meal in Young Women Who Regularly Eat or Skip Breakfast.

BACKGROUND: Multiple hormones are involved in the regulation of food intake and glucose metabolism. Past intervention studies showed a benefit of eating breakfast on satiety, but this was possibly confounded by the disruption of habitual meal patterns. OBJECTIVE: The objective of this study was to compare hormonal responses, including insulin, leptin, glucagon-like peptide-1, ghrelin, peptide YY (PYY3-36), and cholecystokinin (CCK), between habitual breakfast eaters (Br-Es) and habitual skippers (Br-Ss) to a standard midday meal. METHODS: Thirty-two women [mean ± SD age: 22.6 ± 3.3 y; body mass index (in kg/m2): 21.8 ± 2.0] participated in a cross-sectional study that consisted of a 3-h test protocol that included a standard test meal served at 1230 with pre- and postmeal blood sampling. The protocol required that Br-Es eat a typical breakfast between 0700 and 1000, whereas Br-Ss had no breakfast meal and had fasted for 12 h. Blood was drawn 35 and 5 min prelunch and 5, 20, 35, 50, and 110 min postlunch. RESULTS: Repeated-measures ANOVA revealed a group difference for PYY3-36 (P = 0.001), with the Br-E group exhibiting 50-90% higher concentrations throughout the test period. Leptin tended to be different (P = 0.08) between groups, with higher mean ± SD values for the Br-S group (27.6 ± 29.6 ng/mL) compared with the Br-E group (11.5 ± 9.8 ng/mL). Partial least squares regression analysis confirmed that these 2 hormones were important contributors to the patterns of the hormones, anthropometric, clinical, and behavioral variables that differed between groups; insulin and CCK were important as well. CONCLUSION: We found differences between the Br-E and Br-S groups in circulating gut and adipose-derived hormones measured midday, indicating that the breakfast habit is associated with the hormonal milieu before and after a midday meal. The different patterns may be short-lived or may impact metabolism later in the day. This report is a secondary analysis of a trial registered at clinicaltrials.gov as NCT01427556.

Poor nutrition status associated with low patient satisfaction six months into treatment for head and neck/esophageal cancer treatment: A prospective multicenter cohort study.

BACKGROUND: Patient-reported outcome measures have been associated with survival in oncology patients. Altered intake and malnutrition are common symptoms for patients treated for head and neck cancer and esophageal cancer (HNC/EC). The purpose of this study was to examine the relationship between patient-reported satisfaction with medical care and nutrition status. METHODS: This prospective cohort study collected data from 11 international cancer care sites. RESULTS: One hundred and sixtythree adult patients (n = 115 HNC; n = 48 EC) completed a patient satisfaction questionnaire (the Canadian Health Care Evaluation Project Lite) and were included. HNC/EC patient global satisfaction with medical care was 88.3/100 ± 15.3 at baseline and remained high at 86.6/100 ± 16.8 by 6 months (100 max satisfaction score). Poor nutrition status, as defined by the Patient-Generated Subjective Global Assessment Short Form, was associated with lower patient satisfaction with overall medical care, relationship with doctors, illness management, communication, and decision-making 6 months into treatment (P < 0.01). There was no difference in global satisfaction between patients who did and did not report swallowing difficulty (P = 0.99) and patients with and without feeding tube placement (P = 0.36). Patients who were seen by a dietitian for at least one nutrition assessment had global satisfaction with care that was 16.7 percentage points higher than those with no nutrition assessment (89.3 ± 13.8 vs 72.6 ± 23.6; P = 0.005) CONCLUSION: In HNC/EC patient-centered oncology care, decreasing malnutrition risk and providing access to dietitian-led nutrition assessments should be prioritized and supported to improve patient satisfaction and standard of care. Feeding tube placement did not decrease patient satisfaction with medical care.

Advance Quantity Meal Preparation Pilot Program Improves Home-Cooked Meal Consumption, Cooking Attitudes, and Self-Efficacy.

OBJECTIVE: To evaluate the effects of a group-based Advance Quantity Meal Preparation (AQMP) program on the consumption of home-cooked meals, cooking attitudes, and self-efficacy in healthy adults. METHODS: Participants (n = 10) in a group setting prepared healthy meals weekly consisting of 10 entrees and 5 snacks for 6 weeks. A survey assessing cooking attitudes, cooking self-efficacy, and cooking behavior and consumption at 3 time points: preprogram, postprogram (T2), and 3 months postprogram (T3). RESULTS: The AQMP program increased the proportion of overall home-cooked meal consumption (T2, P = 0.03), home-cooked dinner consumption (T2, P = 0.04), cooking attitudes (T3, P = 0.01), and cooking self-efficacy (T2, P = 0.002). CONCLUSIONS AND IMPLICATIONS: This pilot study indicates that AQMP may increase home-cooked meal consumption, cooking attitudes, and cooking self-efficacy.

Effects of Consuming Sugar-Sweetened Beverages for 2 Weeks on 24-h Circulating Leptin Profiles, Ad Libitum Food Intake and Body Weight in Young Adults.

Sugar-sweetened beverage (sugar-SB) consumption is associated with body weight gain. We investigated whether the changes of (Δ) circulating leptin contribute to weight gain and ad libitum food intake in young adults consuming sugar-SB for two weeks. In a parallel, double-blinded, intervention study, participants (n = 131; BMI 18-35 kg/m2; 18-40 years) consumed three beverages/day containing aspartame or 25% energy requirement as glucose, fructose, high fructose corn syrup (HFCS) or sucrose (n = 23-28/group). Body weight, ad libitum food intake and 24-h leptin area under the curve (AUC) were assessed at Week 0 and at the end of Week 2. The Δbody weight was not different among groups (p = 0.092), but the increases in subjects consuming HFCS- (p = 0.0008) and glucose-SB (p = 0.018) were significant compared with Week 0. Subjects consuming sucrose- (+14%, p < 0.0015), fructose- (+9%, p = 0.015) and HFCS-SB (+8%, p = 0.017) increased energy intake during the ad libitum food intake trial compared with subjects consuming aspartame-SB (-4%, p = 0.0037, effect of SB). Fructose-SB decreased (-14 ng/mL × 24 h, p = 0.0006) and sucrose-SB increased (+25 ng/mL × 24 h, p = 0.025 vs. Week 0; p = 0.0008 vs. fructose-SB) 24-h leptin AUC. The Δad libitum food intake and Δbody weight were not influenced by circulating leptin in young adults consuming sugar-SB for 2 weeks. Studies are needed to determine the mechanisms mediating increased energy intake in subjects consuming sugar-SB.

A Potential Tool for Clinicians; Evaluating a Computer-Led Dietary Assessment Method in Overweight and Obese Women during Weight Loss.

Many Americans are attempting to lose weight with the help of healthcare professionals. Clinicians can improve weight loss results by using technology. Accurate dietary assessment is crucial to effective weight loss. The aim of this study was to validate a computer-led dietary assessment method in overweight/obese women. Known dietary intake was compared to Automated Self-Administered 24-h recall (ASA24) reported intake in women (n = 45), 19-50 years, with body mass index of 27-39.9 kg/m². Participants received nutrition education and reduced body weight by 4%-10%. Participants completed one unannounced dietary recall and their responses were compared to actual intake. Accuracy of the recall and characteristics of respondent error were measured using linear and logistic regression. Energy was underreported by 5% with no difference for most nutrients except carbohydrates, vitamin B12, vitamin C, selenium, calcium and vitamin D (p = 0.002, p < 0.0001, p = 0.022, p = 0.010, p = 0.008 and p = 0.001 respectively). Overall, ASA24 is a valid dietary assessment tool in overweight/obese women participating in a weight loss program. The automated features eliminate the need for clinicians to be trained, to administer, or to analyze dietary intake. Computer-led dietary assessment tools should be considered as part of clinician-supervised weight loss programs.

Chronic Stress Is Associated with Indicators of Diet Quality in Habitual Breakfast Skippers.

BACKGROUND: Previous studies suggest skipping breakfast is associated with lower diet quality, but possible reasons underlying this relationship are not clear. OBJECTIVE: Our aim was to determine the relationship between chronic stress and variations in diet quality in the context of breakfast eating or breakfast skipping. DESIGN: Based on morning eating habits, 40 breakfast eaters and 35 breakfast skippers participated in a cross-sectional study. Diet assessment was based on unannounced 24-hour recalls. PARTICIPANTS/SETTING: Women, ages 18 to 45 years, with a body mass index (calculated as kg/m2) <40 were recruited in the greater Sacramento, CA, area between 2009 and 2013. Only women who consistently ate or skipped breakfast were enrolled. MAIN OUTCOME MEASURES: Compliance with the 2010 Dietary Guidelines for Americans was measured using the Healthy Eating Index 2010 (HEI-2010). Stress and executive function were evaluated with validated questionnaires and a computer-based task, respectively. STATISTICAL ANALYSES PERFORMED: Diet characteristics of breakfast eating and breakfast skipping were evaluated as nutrient densities (amounts per 1,000 kcal) and compared using a one-way analysis of covariance, with body mass index as covariate. Diet and stress variable associations were assessed using Pearson correlations. RESULTS: Despite no observed differences in daily energy intake between breakfast skipping and breakfast eating, overall diet quality (P=0.001), whole grains (P=0.002), fruit (P=0.002), empty calories (P=0.050), fiber (P=0.001), calcium (P=0.001), potassium (P=0.033), and folate (P=0.013) intakes were higher in breakfast eating. In the evening, breakfast skipping consumed more added sugars (P=0.012) and saturated fat (P=0.006). In breakfast skipping, reported stress was associated with empty calories (r=-0.39; P=0.027) and evening intake of added sugars (r=0.501; P=0.005). These relationships were not observed in breakfast eating. CONCLUSIONS: Breakfast skippers were less likely to meet the Dietary Guidelines for Americans and consumed more empty calories at night. Chronic stress was related to evening eating choices and overall empty calories in the diet of breakfast skippers, whereas breakfast eaters' dietary intake did not appear to be affected by chronic stress.