Food-related quality of life is impaired in inflammatory bowel disease and associated with reduced intake of key nutrients

Abstract

Background Inflammatory bowel disease (IBD) may impact the extent to which food, eating, and drinking bring satisfaction and enjoyment to peoples’ lives, and this may impact dietary intake. The prevalence of an impaired food-related quality of life (FR-QoL), its associated factors, and its impact on diet have not been explored. Objectives To measure the prevalence and nature of the burden of impaired FR-QoL in people with IBD, the factors associated with these, and their associations with nutrient intake. Methods We recruited 1576 outpatients with IBD (≥16 years old) in person from 7 IBD centers across the United Kingdom. Patients completed validated questionnaires to measure their FR-QoL, quality of life (QoL), distress, fatigue, anxiety, and depression. Dietary intake was recorded using the European Prospective Investigation into Cancer FFQ. A health professional recorded disease activity, Montreal classification, blood results, BMI, and malnutrition risk. FR-QoL was regressed onto explanatory variables using univariable and multivariable analyses. Results Data from 1221 patients were available (77.4% response; Crohn's disease, 65%; ulcerative colitis, 35%). The FR-QoL mean (± SD) score was 80.8 ± 26.9, with wide ranges (minimum, 29; maximum, 145). Following multivariable regression, the strongest associations with FR-QoL were the number of recent disease flares (5 flares β = −12.7; P < 0.001), the IBD-specific QoL (β = 0.33; P < 0.001), and IBD-related distress (β = −0.26; P < 0.001). Patients with poorer FR-QoL had lower intakes of fiber (nonstarch polysaccharide; Q1 to Q5 difference = 2.1 g/d; 95% CI: 0.4–3.8; P = 0.048), calcium (192.6 mg/d; 95% CI: 112.5–272.6; P < 0.001), phosphorus (167 mg/d; 95% CI: 58–276; P = 0.041), and magnesium (34.4 mg/d; 95% CI: 9.3–59.4; P = 0.041). Conclusions Impaired FR-QoL is prevalent in IBD and is associated with recurrent disease flares, a reduced IBD-specific QoL, and greater IBD-related distress. A poorer FR-QoL was associated with lower intakes of key nutrients of importance to IBD, including those relating to gut health and bone mineralization.

Food‐related quality of life in adults with inflammatory bowel disease is associated with restrictive eating behaviour, disease activity and surgery: A prospective multicentre observational study

“…Our data add to the current evidence that poorer FRQoL exists in those with clinically active disease or more frequent flares, who experience greater symptom severity 24,25 . In the absence of defined cut‐off values categorising poorer or greater FRQoL, the findings can be compared to previous studies.…”

“…Recent data in 1221 people with IBD indicated recurrent disease flares and worse IBD‐related distress were associated with poorer FRQoL, which itself was independently associated with lower intakes of fermentable fibres and calcium 24 . An inverse relationship between FRQoL, IBD disease activity and symptom severity, and attempts to follow multiple pieces of dietary advice has also been established 25 .…”

Nutrient, Fibre, and FODMAP Intakes and Food-related Quality of Life in Patients with Inflammatory Bowel Disease, and Their Relationship with Gastrointestinal Symptoms of Differing Aetiologies

“…needing to be close to a toilet], can lead to impaired FR-QoL in IBD. 3 The current study assesses FR-QoL for the first time in IBD patients with inflammatory [Active IBD] and non-inflammatory [Inactive IBD-GI] gut symptoms compared with IBD patients without gut symptoms [Inactive IBD] and healthy controls. The FR-QoL scores increased in a stepwise fashion from Active IBD to healthy controls and are in line with a previous FR-QoL assessment in IBD and IBS, in which FR-QoL scores increased from the lowest in Active IBD, followed by IBS, and the highest in Inactive IBD.…”

“… 1 These nutritional problems can have a profound psychosocial impact, 2 and problems of food-related quality of life [FR-QoL] are prevalent in IBD. 3 A priority-setting partnership consisting of patients and clinicians identified several dietary research priorities for IBD. 4 During the priority setting, of all the questions pertaining to diet, 72% were raised by patients, including those regarding the role of diet in managing gut symptoms, in disease relapse, and in disease treatment.…”

Risk Factors for Malnutrition among IBD Patients

“…The prevalence of malnutrition in inflammatory bowel diseases (IBD) is estimated to be between 6.1% and 69.7% depending on the definition used, the type of IBD, the clinical setting and disease activity [1,2]. Malnutrition and sarcopenia are associated with poor clinical outcomes, hospital admissions, response to therapy and quality of life [1,3,4]. Among hospitalized patients, malnutrition is an independent risk factor for venous thromboembolism, non-elective surgery, longer admission and increased mortality [5].…”