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Impact of Food Insecurity on Clinical Outcomes in Newly Diagnosed Pediatric Ibd Patients
Journal of Pediatric Gastroenterology and Nutrition ; 75(Supplement 1):S412-S413, 2022.
Article in English | EMBASE | ID: covidwho-2058683
ABSTRACT

Purpose:

Inflammatory bowel disease (IBD) is an autoimmune disease that consists of Crohn's Disease (CD) and ulcerative colitis (UC). IBD is thought to result from an environmental trigger, one of which could be diet, in a genetically susceptible host. Food insecurity is defined as limited or uncertain access to enough food. It is estimated that 1 in 7 children in the United States experience food insecurity which is estimated to be about 13 million children. This number has increased since the COVID pandemic to 1 in 4. Louisiana has one of the higher rates of food insecurity in the country with an estimate of over 249,000 children affected. Food insecurity is higher in African American and Hispanic households. Despite nutrition playing a significant role in IBD, there is limited data on food insecurity and IBD. Only one adult study identified that adult IBD patients had 69% higher odds of being food insecure compared to peers without IBD. The purpose of this study is to evaluate if pediatric patients with IBD are food insecure. Our hypothesis is that newly diagnosed pediatric IBD patients who are food insecure have worse clinical outcomes than those who are food secure 6 months after diagnosis. The primary aim will be to assess if food insecurity is associated with escalations in therapy within the first 6 months of diagnosis. Secondary aim of the study is to determine if food insecurity is associated with other clinical outcomes. Food access will also be evaluated to see if patients who are food insecure live in areas defined as a food desert, decrease access to nearby grocery stores, or food swamps, defined as adequate access to food but mostly higher calorie food options over healthy food options. Method(s) This is a prospective study of newly diagnosed pediatric IBD patients seen in the Louisiana State University Health Science Center Pediatric Gastroenterology Division at Children's Hospital New Orleans. Patients were screened for food insecurity using the United States Department of Agriculture's food insecurity screening and the American Academy of Pediatrics' Food Insecurity 2-Question Screen. Data was collected including escalations in medication, hospitalizations, surgeries, emergency room visits and nutritional data over the first 6 months of diagnosis. To determine diet quality, food journals were completed, or comprehensive diet recalls were performed then analyzed by a licensed dietitian. Result(s) There are currently 13 patients enrolled in this ongoing study. All patients have Crohn's Disease and receive maintenance therapy with TNF alpha antagonist (infliximab or biosimilar). Most patients are female (69%), Medicaid insurer (54%), with approximately half identifying as white race (46%) and half identifying as African American (46%). The average age at diagnosis was 14.4 years (+/- 2.7 years). Nine of the patients (69%) have no grocery stores within 1 mile of their home. Three patients lived in a food swamp (23%), 1 of which also had low food security. There was one patient who did not live in a food desert or food swamp but identified as having low food security. The average BMI was 19.4 and 3 had a BMI z-score less than -1 at diagnosis. Two parents were identified as having low food security and 2 patients screened positive for low food security. Only one survey matched low food security for both parent and child. For transportation, many traveled to appointments by automobile but were not owners of the automobile. At one month after diagnosis, there was 1 medication change due to the development of antibodies, 2 courses of oral steroids, 2 patients had an additional medication added (methotrexate for both), 3 hospitalizations, 1 surgery;however, none of the patients fit criteria for low food security. There were 2 emergency room visits, 1 of 2 were food insecure. Weight gain in one month ranged from 0.3 to 10.4 kilograms. One food insecure patient lost 0.8 kilograms at 1 month. Conclusion(s) While there were few patients identified as food insecure, each patient had relatively poor access to healthy food options. Every patient in the study either fell into the category of having no grocery stores within a mile of their home, living in a food swamp or having low food security. Establishment of additional surrogates for food insecurity may be warranted to better assess the association of food insecurity with IBD. The significance of food insecurity in pediatric IBD remains unclear. However, longer follow-up is planned to further assess the relationship between food insecurity and clinical and nutritional outcomes. Additional studies are forthcoming to evaluate the impact food quality within the diet of pediatric IBD patients has on short-term and long-term health outcomes.
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Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies / Prognostic study Language: English Journal: Journal of Pediatric Gastroenterology and Nutrition Year: 2022 Document Type: Article

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Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies / Prognostic study Language: English Journal: Journal of Pediatric Gastroenterology and Nutrition Year: 2022 Document Type: Article