Micronutrient Status in Adult Crohn's Disease during Clinical Remission: A Systematic Review.

Adults with Crohn's disease (CD) may be at risk of micronutrient insufficiency in clinical remission through restrictive eating, malabsorption, abnormal losses or inflammation. This systematic review synthesises the literature on micronutrient insufficiency in CD in clinical remission in terms of the prevalence of low circulating micronutrient concentrations and as a comparison against a healthy control (HC). Studies were included if the population was predominantly in remission. A total of 42 studies met the inclusion criteria; 12 were rated as low quality, leaving 30 studies covering 21 micronutrients of medium/high quality that were included in the synthesis. Vitamins D and B12 were the most frequently reported nutrients (8 and 11); there were few eligible studies for the remaining micronutrients. The prevalence studies were consistent in reporting individuals with low Vitamins A, B6, B12 and C, ß-carotene, D, Magnesium, Selenium and Zinc. The comparator studies were inconsistent in finding differences with CD populations; Vitamin D, the most reported nutrient, was only lower than the HC in one-quarter of the studies. Adult CD populations are likely to contain individuals with low levels of one or more micronutrients, with the most substantial evidence for Vitamins D and B12. The studies on other micronutrients are of insufficient number, standardisation and quality to inform practice.

The Crohn's Disease Exclusion Diet: A Comprehensive Review of Evidence, Implementation Strategies, Practical Guidance, and Future Directions.

Dietary therapy is increasingly recognized for the management of Crohn's disease (CD) over recent years, including the use of exclusive enteral nutrition (EEN) as first-line therapy for pediatric CD according to current guidelines. The Crohn's disease exclusion diet (CDED) is a whole-food diet designed to reduce exposure to dietary components that are potentially pro-inflammatory, mediated by negative effects on the gut microbiota, immune response, and the intestinal barrier. The CDED has emerged as a valid alternative to EEN with cumulative evidence, including randomized controlled trials, supporting use for induction of remission and possibly maintenance in children and adults. We gathered a group of multidisciplinary experts, including pediatric and adult gastroenterologists, inflammatory bowel diseases (IBD) expert dietitians, and a psychologist to discuss the evidence, identify gaps, and provide insights into improving the use of CDED based on a comprehensive review of CDED literature and professional experience. This article reviews the management of CDED in both children and adults, long-term aspects of CDED, indications and contraindications, selecting the best candidates, identifying challenges with CDED, globalization, the role of the multidisciplinary team, especially of dietitian, and future directions. We concluded that CDED is an established dietary therapy that could serve as an alternative to EEN in many pediatric and adult cases, especially with mild to moderate disease. In severe disease, complicated phenotypes, or with extraintestinal involvement, CDED should be considered on a case-by-case basis, according to physician and dietitians' discretion. More studies are warranted to assess the efficacy of CDED in different scenarios.

The Crohn's disease exclusion diet (CDED) has emerged as an alternative to exclusive enteral nutrition for the treatment of pediatric Crohn's disease. In this review, we summarize data on efficacy and challenges and identify research priorities, clinical gaps, and opportunities.

People with enteral tubes and their carers' views of living with a tube and managing associated problems: A qualitative interview study.

BACKGROUND: Nutrition by enteral tube is a complex therapy requiring significant management to ensure safe, timely delivery of nutrients and avoidance of complications. In the home setting, people with enteral tubes and their carers are required to self-manage the therapy, including the need to cope with problems that arise. Whilst previous studies have conveyed experiences of people with enteral tubes, few have described views on enteral tube problems. AIMS AND OBJECTIVES: Drawing on the findings of a previously reported study (Journal of Human Nutrition and Dietetics, 2019), this paper aims to describe in-depth the experiences of people with enteral tubes and their carers of living with the tube day to day and managing problems that arise. DESIGN: A qualitative descriptive design using semi-structured in-depth interviews was employed. METHODS: A purposive sample of 19 people with enteral tubes and 15 carers of people with tubes participated. Interviews were recorded and transcribed. Using a thematic analysis approach, codes were defined and applied; themes developed and refined. Five themes with associated subthemes were generated, of which one, "living with the tube," is reported in-depth. The COREQ checklist was used. RESULTS: Participants described the tube affecting both physical and psychosocial being and revealed it had resulted in significant changes to their daily living, necessitating adaptation to a new way of life. Participants reported spending much time and effort to manage tube problems, at times without support from healthcare practitioners knowledgeable in tube management. Discomfort associated with the tube was commonly described. CONCLUSIONS: Living with an enteral tube impacts significantly on daily life requiring adaptations to normal routine. People with tubes and their carers use a range of strategies to manage common complications. RELEVANCE TO CLINICAL PRACTICE: Knowledge and understanding of how people with enteral tubes live with their tube and manage issues as they arise will enable healthcare practitioners to provide better support.

Cognitive complaints in a general population of older adults: prevalence, association with pain and the influence of concurrent affective disorders.

Previous studies examining the associations between pain and cognitive complaints have been in pain clinic outpatients; there has been no research in the general population setting. A cross-sectional postal survey of 7878 older adults, aged 50 years and over, registered with three general practices (n=11230) in North Staffordshire using self-complete questionnaires was conducted. The questionnaire included the Alertness Behaviour Subscale from the Sickness Impact Profile to measure cognitive complaint, a full-body manikin to record presence and location of any recent pain (past 4 weeks) and the Hospital Anxiety and Depression Scale. The prevalence of any cognitive complaint was 46.5%; this increased with age (41.6% in 50-59 year olds to 63.4% in 80-100 year olds) and was higher in females than males (48.6% vs. 43.8%). Reporting recent pain was associated with a statistically significant increase in also reporting any cognitive complaint (odds ratio: 2.49; 95% confidence interval: 2.2, 2.8) and altered little after adjusting for age and gender. A dose-response relationship was seen when examining the association between pain and degree of cognitive complaint. Statistically significant associations between cognitive complaints and pain were seen across all anxiety and depression status. Cognitive complaints are common in a general population of older adults and are strongly related to the reporting of pain; a relationship which is independent of the presence of concurrent affective disorders. Taken together with previous work suggesting that subjective memory complaints are strongly correlated to risk of future cognitive decline, these results have implication for clinical practice in an aging population.