Thanks to those who attended yesterday’s talk (10/24/14) at the clinical practice session and to those who provided helpful feedback.
This blog entry has abbreviated/summarized the presentations. Though not intentional, some important material is likely to have been omitted; in addition, transcription errors are possible as well. If you make it to the bottom of this post, you will find some useful patient resources along with previous related blog entries.
Diet and the Microbiome –Robert Baldassano (CHOP) pg 140 in Syllabus
This was a very effective lecture; it brought together a lot of useful information.
Trying to sort out balance between health and disease and role of dysbiosis (altered microbiome)
- Things that we ingest such as food (diet), antibiotics, and xenobiotics shape the composition of the gut microbiota and serve as substrates for the gut microbiota to produce metabolites
- We are not the only organism consuming what we eat
- Wu G, et al. Science. 2011 Oct 7;334(6052):105-8 The Bacteroides enterotype was highly associated with animal protein and saturated fats, which equates to frequent meat consumption as in a Western diet. The Prevotella enterotype high values for carbohydrates and simple sugars, indicating association with a carbohydrate-based diet more typical of agrarian societies.
- De Filippo C, et al. PNAS 2010: 14691-96: African children (compared with European) with more bacterial diversity & richness along with higher levels of short-chain fatty acids
- Holmes et al. Cell Met 2012; 16: 559. Diet serves as a substrate for the microbiota to produce certain metabolites.
IBD and diet (Hou JK et al. American Journal of Gastro 2011;106:563-73)
- High dietary intakes of total fats, PUFAs, omega-6 and meat were associated with an increased risk of CD and UC
- High fiber and fruit intakes were associated with decreased CD risk
- High vegetable intake was associated with decreased UC risk.
- Consumption of meat, particularly red and processed meat increased the likelihood of relapse (Jowett et al Gut 2004)
- Enteral diet for IBD can improve stool calprotectin within 1-2 weeks.
Take-home messages: Don’t tell your patients with non-stricturing IBD to eat a low fiber diet. Reduced red meat and reduced oral iron may be helpful. Vegetarian diet and Mediterranean diets may be helpful.
Related blog posts:
FODMAP: Navigating this Novel Diet –Bruno Chumpitazi, MD, MPH (Texas Children’s Hospital) -page 152 in Syllabus
- Fermentable Oligosaccharides Disaccharides and Polyols (FODMAPs): Poorly absorbed, osmotically active, rapidly fermented (produce gas)
- Higher FODMAPs increase breath hydrogen (Murray K et al. Am J Gastroenterol 2014;109:110-9)
- Higher FODMAPs increase stool/ileostomy output (Barret JS et al. Aliment Pharmacol Ther 2010;31:874-882,Halmos EP J Gastroenterol Hepatol 2013;28(Suppl4):25-28)
Evidence for use of low FODMAPs diet is best in adult irritable bowel syndrome.
- Shepherd SJ et al. Clin Gastroenterol Hepatol 2008;6:765-71
- Staudacher HM et al J Nutr 2012;142:1510-18
- Ong DK et al. J Gastroenterol Hepatol 2010;25:1366-1373
- Halmos EP et al. Gastroenterology 2014;146:67-75
Limited studies in children.
- Chumpitazi BP et al. NASPGHAN 2014 abstract n=33 pediatric IBS. Favorable response noted to low FODMAP diet.
Dietary recommendations were reviewed along with the caveat that obtaining the assistance of a dietician/nutritionist is recommended.
Related blog posts:
Nutrition in the Child with Neurological Disabilities –Kathleen Motil (Baylor College of Medicine) pg 162 in Syllabus
- Nutritional disorders are highly prevalent in children with neurological disabilities: 29-46% are underweight; 8-14% are overweight.
- Improved nutrition improves behavior, activity level, improves growth, and reduces infections.
- Cause of nutritional disorders mostly related to inappropriate dietary intake but other factors can play a role
- Growth/anthropometric measures are key determinant of nutritional assessment
- Key questions: Is child taking all day to eat? Is child choking with feedings?
- Critical BMI <12 kg/m-squared
- Goal for BMI ~25%
Reasons for gastrostomy:
- Flat growth >6 months/weight below curve
- Parental request
- Medication administration
www.feedingtubeawareness.com This site contains a terrific PDF download which explains enteral tubes in an easy to understand style along with good graphics. “What You Need to Know Now, A Parent’s Introduction to Tube Feeding is the guide book that every parent wished they had when they were first introduced to feeding tubes.”
Related blog posts: