Does a minority of children with functional gastrointestinal disorders receive formal diet advice

Authors: CRUZ, LIGIA - East Tennessee State University; MINARD, CHARLES - Baylor College Of Medicine; GUFFEY, DANIELLE - Baylor College Of Medicine; CHUMPITAZI, BRUNO - Children'S Nutrition Research Center (CNRC); SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC)

Submitted to: Journal of Parenteral and Enteral Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/10/2019
Publication Date: 2/4/2020
Citation: Cruz, L.A., Minard, C., Guffey, D., Chumpitazi, B.P., Shulman, R.J. 2020. Does a minority of children with functional gastrointestinal disorders receive formal diet advice?. Journal of Parenteral and Enteral Nutrition. https://doi.org/10.1002/jpen.1771.
DOI: https://doi.org/10.1002/jpen.1771

Interpretive Summary: Although specialized diets often are effective for treating children and adults with gastrointestinal problems, it is not known how often children actually have these diets recommended by their physicians and how often they receive direction from a dietitian. In reviewing the records of children with irritable bowel syndrome we found that few receive dietary advice and even fewer speak with a dietitian. These findings are important as its clear that providing diet education is necessary to help those with gastrointestinal concerns as the diet consumed and diet interventions can provide a better overal lifestyle.

Technical Abstract: Diet therapies may be recommended for pediatric functional gastrointestinal disorders (FGIDs). However, little isknown about the frequency with which diet therapy is recommended in FGIDs. Our aims were to determine and contrast thefrequency and types of diet recommendations provided to children with FGIDs by pediatric gastroenterologists (PGIs) versusprimary care pediatricians (PCPs). A retrospective chart review was performed using data from a large, metropolitanchildren’s academic healthcare system to identify subjects meeting Rome IV criteria for functional abdominal pain, functionaldyspepsia, irritable-bowel syndrome (IBS), and/or abdominal migraine over a period of 23 months. Of 1929 patient chartsreviewed, 268 were included for further analyses. Of these, 186 patients (69%) were seen by a PGI and 82 (31%) by a PCP. Themost common diagnosis was IBS (49% for PGIs and 71% for PCPs). Diet recommendations were provided to 115 (43%) patients(PGI group: 86 [75%] vs PCP group: 29 [25%];P<.1). The most frequent recommendations were high fiber (PGI: 15%; PCP:14%) and low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) diet (PGI: 12%; PCP: 4%).Of those provided with diet recommendations, only 20% (n=23) received an educational consult by a dietitian. Provision ofdiet recommendations was not affected by years in practice. Despite increasing awareness of the role of diet in thetreatment of childhood FGIDs, a minority of patients receive diet recommendations in tertiary care or primary care settings. Whendiet recommendations were given, there was great variability in the guidance provided.