Pre-Diagnosis Diet Predicts Response to Exclusive Enteral Nutrition and Correlates with Microbiome in Pediatric Crohn Disease.

Exclusive enteral nutrition (EEN) is effective in inducing remission in pediatric Crohn disease (CD). EEN alters the intestinal microbiome, but precise mechanisms are unknown. We hypothesized that pre-diagnosis diet establishes a baseline gut microbiome, which then mediates response to EEN. We analyzed prospectively recorded food frequency questionnaires (FFQs) for pre-diagnosis dietary patterns. Fecal microbiota were sequenced (16SrRNA) at baseline and through an 18-month follow-up period. Dietary patterns, Mediterranean diet adherence, and stool microbiota were associated with EEN treatment outcomes, disease flare, need for anti-tumor necrosis factor (TNF)-α therapy, and long-term clinical outcomes. Ninety-eight patients were included. Baseline disease severity and microbiota were associated with diet. Four dietary patterns were identified by FFQs; a "mature diet" high in fruits, vegetables, and fish was linked to increased baseline microbial diversity, which was associated with fewer disease flares (p < 0.05) and a trend towards a delayed need for anti-TNF therapy (p = 0.086). Baseline stool microbial taxa were increased (Blautia and Faecalibacterium) or decreased (Ruminococcus gnavus group) with the mature diet compared to other diets. Surprisingly, a "pre-packaged" dietary pattern (rich in processed foods) was associated with delayed flares in males (p < 0.05). Long-term pre-diagnosis diet was associated with outcomes of EEN therapy in pediatric CD; diet-microbiota and microbiota-outcome associations may mediate this relationship.

Gender Distribution of Faculty Is Strongly Correlated With Resident Gender at Canadian Radiology Residency Programs.

Objective: Women are underrepresented in radiology overall, in radiology subspecialties, and in radiology leadership and academic positions. It is unclear why this disparity persists despite greater gender diversification in medicine. We sought to determine if a correlation exists between the proportion of female faculty at an institution, and the proportion of female residents in the associated residency program across Canada. Methods: Faculty gender for each Canadian Diagnostic Imaging Residency Program was obtained through publicly available sources (departmental websites and provincial physician registries) in the fall of 2020. Resident gender data was obtained through a survey emailed to programs following the April 2021 CaRMS match. Data was analyzed using Pearson's correlation coefficient. Research ethics approval was obtained. Results: Faculty information was available for 15 of the 16 Canadian radiology residency programs (94%) and resident information was obtained for 16 programs (100% response rate). Overall, women accounted for 31.4% of radiologist faculty and 31.9% of radiology residents, with a wide range between institutions (19.5-47.8% for faculty and 13.3%-47.1% for residents). There was a strong positive correlation between the proportion of female faculty and the proportion of female residents within individual programs (r=0.73; R2=0.54; p=0.002). Conclusion: Approximately one third of faculty and residents at Canadian Diagnostic Radiology residency programs were female but there was a wide range across the country with a strong correlation between faculty and resident gender distribution. Further exploration is warranted to determine causes of this correlation including the possible influence of role modeling, mentoring, female-friendly culture, and bias.

Global Variation in Use of Enteral Nutrition for Pediatric Crohn Disease.

OBJECTIVES: Exclusive enteral nutrition (EEN) is an effective induction treatment for pediatric Crohn disease. Given the center-based variation in use and diversity in practice, we constructed a survey aimed at sharing experience and strategies in administering EEN, stimulating further research, and optimizing therapy. METHODS: This survey was constructed after consultation with experts and designed to address key knowledge gaps. The survey was disseminated through the Pediatric IBD Porto Group of ESPGHAN, Canadian Children IBD Network, selective experts, and was sent twice through the Pediatric Gastrointestinal-Bulletin Board (PEDGI-BB). Data were collected into REDCap and analyzed using descriptive statistics. RESULTS: In total, 146 participants from 26 countries completed the survey. Sixty-five percentage of participants were general, non-inflammatory bowel diseases (IBD)-focused pediatric gastroenterologists, 21% were IBD-focused, and 10% were dietitians. The most common indications (∼90% use) were for ileocecal and ileocolonic disease (Paris L1 and L3). The most common duration was 8 weeks and 66% preferred oral to nasogastric administration. Most (63%) did not allow any additional intake and 69% instructed patients to continue partial enteral nutrition (EN) after completing treatment. Dietitians were identified as essential to EEN success while the primary challenges of EEN programs were adherence and lack of support. Regional and professional practice differences were observed in EEN indication, age, exclusivity, program structure/support, and cost coverage. CONCLUSIONS: We found significant variation in practice and use of EEN with several regional and professional differences. Global variation offers opportunities for research and improving care. This survey establishes a framework and provides resources for collaboration and information sharing.