Abstract
Objectives and Study: This study described the current practices of dietitians managing patients with CD in five countries; focusing predominantly on the use of diet therapies and Exclusive Enteral Nutrition (EEN).
Methods: Electronic questionnaire survey distributed to dietitians’ professional associations and networks.
Results: 198 responded; 124 responses were valid/mostly complete [n = 52 (42%) UK, n = 31 (25%) Canada, n = 16 (13%) Ireland, n = 15 (12%) Australia and n = 10 (8%) New Zealand (NZ)]. In UK, Ireland, Canada and NZ most responders worked with adult patients. 90% of Canadian responses were from paediatric dietitians.
There were no significant differences in EEN protocols used in all countries for maintenance of remission, before and after surgery. When used to induce remission, responders from UK, Canada and Australia advised mostly 6-8 weeks of EEN, whilst those from Ireland and NZ advised 4-6 weeks (p = 0.005). Use of EEN feeds/supplements varied across countries (p = 0.003), as was also the allowance of other foods/fluids alongside EEN (p = 0.024). Canada allowed food and fluids with EEN (73%), NZ and Australia only allowed EEN (89% and 73%) and UK and Ireland, allowed both equally (53% and 57% only EEN supplements). Practices on food-reintroduction after EEN cessation varied too. UK and Canada advised food reintroduction within 1 (24% and 29%) or 2 weeks (34% and 29%) after EEN, respectively, Ireland over 1 week (71%), Australia over 3 days (33%) or 1 week (33%) and NZ over 3 days (44%). Advice given for a diet after EEN also differed (p = 0.002) with UK, Ireland and Canada advising a modified diet (82%, 86% and 86%) and NZ and Australia advising patients to follow their usual diets (56% and 67%).
Conclusions: Despite some similarities, practices in dietary management of CD vary significantly among countries, most likely reflecting the absence of quality evidence and inconsistency in recommendations made among healthcare professional associations.