Abstract
Inflammatory bowel disease (IBD) is a chronic and relapsing disease of the gastrointestinal tract. As there is no cure for IBD, treatment strategies focus on induction and maintenance of remission to prevent progression of disease and to ensure the psychosocial well-being, growth and nutritional status of a child is not negatively impacted. Many treatment strategies are dietary in nature.
This thesis aimed to explore the food-related quality of life (FR-QoL) of children with Crohn’s disease (CD) using the validated FR-QoL-29 instrument only previously used in adults with IBD to better understand a child’s psychosocial perspectives related their disease and food. This study indicated that children with CD had the poorest FR-QoL followed by their siblings and lastly a healthy control group. These findings are like those completed in adult populations.
A retrospective chart review of the outcomes and efficacy of EEN used as induction therapy for CD between 2010-2021 was completed. This study included children who resided within the South Island of New Zealand and the findings were compared to the international data. This study showed very high rates of completion, adherence and remission compared to the international data. Furthermore, a survey study was completed to evaluate children’s perspective of EEN, which showed that ‘support’ from peers, family and medical teams are the most key factors for a child to successfully complete EEN.
A retrospective audit was completed examining the outcomes and efficacy of the low FODMAP diet (LFD) for children with a functional bowel disorder, followed by a case series of the LFD used for children with IBD and concurrent functional gastrointestinal symptoms (FGS). Both studies showed the LFD was efficacious in reducing FGS, and with similar rates of efficacy as reported in adult studies.
Next, a prospective cross-sectional study assessed the adequacy of dietary nutrient intake and blood micronutrient status of children with CD compared to their shared-home environment, healthy siblings. Children with CD who consumed daily partial enteral nutrition (PEN) had superior diet quality; however, over 50% of both cohorts of children did not meet the recommended daily intakes (RDI) for several micronutrients.
Further to this study, a retrospective study was completed using the dietary data to compare the dietary micronutrient intakes of children with CD and their shared-home environment, healthy siblings with historical dietary data from an age-matched control group of New Zealand children from the 2002 Children’s National Nutrition Survey (CNS). This study demonstrated that the children from the CNS cohort had superior dietary micronutrient intakes compared with the two more recent cohorts of children.
Lastly, a pilot study was completed based upon the findings of this thesis to evaluate if intense and targeted nutritional education can improve the diet quality and FR-QoL of children with CD who are not taking daily PEN. The findings of this pilot may be used to develop a larger and well-designed future RCT.