Perceived dietary intolerances, habitual intake and diet quality of patients with an ileoanal pouch: Associations with pouch phenotype (and behaviour).

BACKGROUND AND AIMS: Ileoanal pouch patients frequently attribute pouch-related symptoms and pouchitis with diet. We aimed to assess perceived food intolerance and habitual dietary intake and their relationship with pouch indication, symptoms and current or history of pouchitis. METHODS: In this cross-sectional study, patients with an ileoanal pouch completed a dietary intolerance and a food frequency questionnaire, that specifically quantifies habitual intake of FODMAPs. Perceived dietary intolerance rates, nutrient intake and diet quality, and their differences based on pouch indication, symptom, and current or history of pouchitis were assessed. Associations between intolerances and intake, and between dietary intake with pouchitis risk were analysed using univariable and multivariable regression analysis. RESULTS: Of the 58 (10 FAP and 48 UC) patients with complete data, 81% of UC and 80% of FAP patients reported dietary intolerances. Overall diet quality was good. Differences in dietary intake were limited to a few food groups. Patients with a history of pouchitis had a lower intake of fruits (p = 0.03) and nuts (p = 0.004). Patients with current pouchitis had a lower intake of nuts (p = 0.02). On multivariable logistic regression, intake of dietary fibre was associated negatively [OR 0.68(95%CI:0.51-0.92)] and of non-digestible oligosaccharides positively with pouchitis history [OR 5.5(95% CI:1.04-29.1)]. CONCLUSIONS: In patients with an ileoanal pouch, perceived dietary intolerances are common but had minimal impact on nutritional adequacy and diet quality. Negative associations of the intakes of fruits, nuts and dietary fibre and positive association with non-digestible oligosaccharides with a history of pouchitis require further study to inform dietary recommendations.

Exploring the impacts of a fresh produce market program: a realist economic evaluation.

OBJECTIVE: To determine the contexts under which a fresh food market program is cost-effective in improving dignified access to nutritious food for food-insecure individuals. METHODS: A realist economic evaluation was employed. Purported cost related theories about how the program may function, known as context-mechanism-outcome configurations were developed. In-depth interviews with key stakeholders (program developers, funder, local food relief agencies, volunteers) involved in the program (n=19) as well Photovoice with focus groups with market attendees (n=8) were conducted and coded for contexts, mechanisms and outcomes. A cost-effectiveness analysis of the program was calculated whereby the cost inputs associated with operating the program were compared to the quantity and value of produce distributed. Alternative cost scenarios were evaluated in a sensitivity analysis. The cost-effectiveness analysis was used together with qualitative data to refine theory. RESULTS: Food insecure individuals attending a partnership fresh food market with a small fee, experienced improved, yet infrequent access to nutritious food through community connections and support a more dignified, viable access to fresh nutritious food. CONCLUSIONS: Food relief should consider alternative models. IMPLICATIONS FOR PUBLIC HEALTH: More dignified food relief programs that support local connections may be part of the solution to addressing food insecurity.

Nutrition interventions implemented in hospital to lower risk of sarcopenia in older adults: A systematic review of randomised controlled trials.

AIM: There is no standardised interventional approach to preventing or treating sarcopenia in older adults in hospital. The aim of this review was to systematically identify and synthesise the effects of nutritional interventions on markers of sarcopenia in hospitalised patients aged 65 years and older. METHODS: Four databases were searched using terms for intervention, population and setting. Eligibility screening of title and abstract and then full-text papers was competed in duplicate, independently. The final included papers were assessed for quality, and outcome data extracted independently and in duplicate. Outcome data were synthesised by meta-analysis, where possible, or narratively. RESULTS: Seven hundred and thirty-two articles were screened for eligibility yielding six studies for inclusion. All studies provided oral nutritional support that aimed to increase protein intake ranging from an additional 10 to 40 g/d, each with a unique formulation of amino acids and/or micronutrients; three studies combined nutritional intervention with an enhanced physical activity program. Five studies measured hand grip strength, the mean difference was 1.97 kg (95% CI 0.55-3.39, P = .006) greater in the intervention group (n = 166) compared with control group (n = 165). Assessment of muscle mass and activities of daily living were heterogeneous and the changes inconsistent between studies. CONCLUSIONS: Few studies inform nutritional management of inpatients with sarcopenia or at risk of sarcopenia. High quality, large intervention trials are needed urgently to identify the optimal nutrition and physical activity intervention combinations to manage sarcopenia in older hospitalised adults. These studies need to include outcome measures of physical function and muscle quality.