Correlation between Food Literacy and Avoidant/Restrictive Food Intake Disorder in Patients with Inflammatory Bowel Disease

doi:10.12114/j.issn.1007-9572.2023.0503

Abstract

Abstract:

Background

Dietary over-restriction is common in patients with inflammatory bowel disease (IBD) and can lead to avoidant/restrictive food intake disorder (ARFID) in severe cases. Studies have shown that food literacy may influence patients' eating behavior to some extent, but whether it can directly affect ARFID in IBD patients has not been reported.

Objective

To understand the current status of food literacy and ARFID in patients with IBD, and analyse the correlation between the two.

Methods

This was a cross-sectional study, and convenience sampling method was used to select IBD patients who attended or were hospitalized in the outpatient clinics of gastroenterology and anorectal medicine in four general hospitals in Nanjing, including Jiangsu Province Hospital of Chinese Medicine (Affiliated Hospital of Nanjing University of Chinese Medicine), Nanjing Hospital of Chinese Medicine (Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine), Nanjing Drum Tower Hospital and Zhongda Hospital, Southeast University, from October 2022 to June 2023 as the study subjects. A self-made general information questionnaire, 9-item Avoidant/Restrictive Food Intake Disorder Screen (NIAS), and Food Literacy Scale were used to investigate the study subjects, to compare the NIAS and food literacy scores of IBD patients with different characteristics, and Pearson correlation analysis was used to explore the relationship.

Results

A total of 438 questionnaires were distributed and 429 valid questionnaires were recovered, with a valid recovery rate of 97.95%. The NIAS score of IBD patients was (20.82±8.65), and the incidence of ARFID was 18.41% (79/429) ; the food literacy score was (32.72±9.68). Comparison of NIAS scores of patients with different disease types and disease activity showed statistically significant differences (P<0.05). Pearson correlation analysis showed that food literacy scores, planning and management dimensions of food literacy scale and the attitude towards making scores were negatively correlated with NIAS scores in patients with IBD (P<0.05) .

Conclusion

The level of food literacy in IBD patients needs to be improved. ARFID was common (18.41%), and food literacy was negatively associated with ARFID. Clinical medical staff should regularly evaluate patients' food literacy, monitor their eating behavior, and develop precise health education intervention paths to improve the level of food literacy, and reduce the incidence of ARFID.

Key words: Inflammatory bowel diseases, Dietary restriction, Avoidant/restrictive food intake disorder, Food literacy, Correlation

摘要：

背景

炎症性肠病（IBD）患者饮食过度限制现象普遍，严重者可导致避免/限制性食物摄入障碍（ARFID）。研究显示食物素养可在一定程度上影响患者的饮食行为，其能否直接影响IBD患者ARFID报道较少。

目的

了解IBD患者食物素养及ARFID现状，剖析两者的相关性。

方法

本研究为横断面研究，采用便利抽样法选取2022年10月—2023年6月在江苏省中医院（南京中医药大学附属医院）、南京市中医院（南京中医药大学附属南京中医院）、南京鼓楼医院、东南大学附属中大医院4家综合性医院的消化科和肛肠科门诊就诊或住院的IBD患者为研究对象。使用一般资料调查表、9条目避免/限制性食物摄入障碍筛查量表（NIAS）、食物素养量表对研究对象进行调查，比较不同特征的IBD患者NIAS和食物素养得分，采用Pearson相关分析探讨两者的关系。

结果

共发放问卷438份，回收有效问卷429份，有效回收率为97.95%。IBD患者NIAS得分为（20.82±8.65）分，ARFID发生率为18.41%（79/429），食物素养得分为（32.72±9.68）分。不同疾病类型、疾病活动度的患者NIAS得分比较，差异有统计学意义（P<0.05）。Pearson相关分析结果显示，IBD患者食物素养得分、食物素养量表中的计划、管理维度以及制作态度得分与NIAS得分均呈负相关（P<0.05）。

结论

IBD患者食物素养水平有待提高，ARFID现象普遍（18.41%），食物素养与ARFID呈负相关。临床医护人员应定期评估患者的食物素养，监测其饮食行为，制订精准健康教育干预路径提升食物素养水平，降低ARFID发生率。

关键词: 炎症性肠病, 饮食限制, 避免/限制性食物摄入障碍, 食物素养, 相关性

YIN Tingting,TU Wenjing,ZHANG Sumin, et al. Correlation between Food Literacy and Avoidant/Restrictive Food Intake Disorder in Patients with Inflammatory Bowel Disease[J]. Chinese General Practice, 2024, 27(12): 1445-1451. DOI: 10.12114/j.issn.1007-9572.2023.0503.
尹婷婷,徒文静,张苏闽等. 炎症性肠病患者食物素养与避免/限制性食物摄入障碍的相关性研究[J]. 中国全科医学, 2024, 27(12): 1445-1451. DOI: 10.12114/j.issn.1007-9572.2023.0503.

Figures/Tables 2

References 33

[1]	NG S C, SHI H Y, HAMIDI N，et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century：a systematic review of population-based studies[J]. Lancet，2017,390(10114):2769-2778. DOI：10.1016/S0140-6736(17)32448-0.
[2]	SHAO B L, YANG W J, CAO Q. Landscape and predictions of inflammatory bowel disease in China：China will enter the Compounding Prevalence stage around 2030[J]. Front Public Health，2022,10:1032679. DOI：10.3389/fpubh.2022.1032679.
[3]	SOOD A, AHUJA V, KEDIA S，et al. Diet and inflammatory bowel disease：the Asian Working Group guidelines[J]. Indian J Gastroenterol，2019,38(3):220-246. DOI：10.1007/s12664-019-00976-1.
[4]	YAMAMOTO T, SHIMOYAMA T. Nutrition and diet in inflammatory bowel disease[J]. Curr Opin Gastroenterol，2023,39(2):110-114. DOI：10.1097/MOG.0000000000000905.
[5]	王昱，徒文静，张萍，等. 炎症性肠病患者饮食限制现况及其饮食限制种类影响因素的多中心研究[J]. 中国全科医学，2022,25(6):663-668. DOI：10.12114/j.issn.1007-9572.2021.02.065.
[6]	CROOKS B, MISRA R, AREBI N，et al. The dietary practices and beliefs of British South Asian people living with inflammatory bowel disease：a multicenter study from the United Kingdom[J]. Intest Res，2022,20(1):53-63. DOI：10.5217/ir.2020.00079.
[7]	DAY A S, DAVIS R, COSTELLO S P，et al. The adequacy of habitual dietary fiber intake in individuals with inflammatory bowel disease：a systematic review[J]. J Acad Nutr Diet，2021,121(4):688-708.e3. DOI：10.1016/j.jand.2020.12.001.
[8]	FIRST M B. Diagnostic and statistical manual of mental disorders，5th edition，and clinical utility[J]. J Nerv Ment Dis，2013,201(9):727-729. DOI：10.1097/NMD.0b013e3182a2168a.
[9]	BOURNE L, BRYANT-WAUGH R, COOK J，et al. Avoidant/restrictive food intake disorder：a systematic scoping review of the current literature[J]. Psychiatry Res，2020,288:112961. DOI：10.1016/j.psychres.2020.112961.
[10]	GIBSON D, WATTERS A, MEHLER P S. The intersect of gastrointestinal symptoms and malnutrition associated with anorexia nervosa and avoidant/restrictive food intake disorder：functional or pathophysiologic?—a systematic review[J]. Int J Eat Disord，2021,54(6):1019-1054. DOI：10.1002/eat.23553.
[11]	CROOKS B, MCLAUGHLIN J, MATSUOKA K，et al. The dietary practices and beliefs of people living with inactive ulcerative colitis[J]. Eur J Gastroenterol Hepatol，2021,33(3):372-379. DOI：10.1097/MEG.0000000000001911.
[12]	QIAN W W, JIANG Q, WANG H，et al. Food Literacy Evaluation Questionnaire （Chinese version，FLEQ-Ch）：a validity and cross-cultural adaptation[J]. Public Health Nurs，2022,39(6):1386-1394. DOI：10.1111/phn.13118.
[13]	VIDGEN H A, GALLEGOS D. Defining food literacy and its components[J]. Appetite，2014,76:50-59. DOI：10.1016/j.appet.2014.01.010.
[14]	朱文丽，许雅君，王军波，等. 营养素养概念框架及人群适用性[J]. 营养学报，2022,44(3):213-217. DOI：10.13325/j.cnki.acta.nutr.sin.2022.03.004.
[15]	ROBELIN K, SENADA P, GHOZ H，et al. Prevalence and clinician recognition of avoidant/restrictive food intake disorder in patients with inflammatory bowel disease[J]. Gastroenterol Hepatol，2021,17(11):510-514.
[16]	PETERS J E, BASNAYAKE C, HEBBARD G S，et al. Prevalence of disordered eating in adults with gastrointestinal disorders：a systematic review[J]. Neurogastroenterol Motil，2022,34(8):e14278. DOI：10.1111/nmo.14278.
[17]	FIORINDI C, COPPOLINO G, LEONE S，et al. Inadequate food literacy is related to the worst health status and limitations in daily life in subjects with inflammatory bowel disease[J]. Clin Nutr ESPEN，2022,52:151-157. DOI：10.1016/j.clnesp.2022.10.016.
[18]	吴开春，梁洁，冉志华，等. 炎症性肠病诊断与治疗的共识意见（2018年·北京）[J]. 中国实用内科杂志，2018,38(9):796-813. DOI：10.19538/j.nk2018090106.
[19]	卓琳，王胜锋，詹思延. 横断面调查的论文报告规范[J]. 中国卫生监督杂志，2017,24(3):210-216. DOI：10.3969/j.issn.1007-6131.2017.03.001.
[20]	ZICKGRAF H F, ELLIS J M. Initial validation of the Nine Item Avoidant/Restrictive Food Intake disorder screen （NIAS）：a measure of three restrictive eating patterns[J]. Appetite，2018,123:32-42. DOI：10.1016/j.appet.2017.11.111.
[21]	YELENCICH E, TRUONG E, WIDAMAN A M，et al. Avoidant restrictive food intake disorder prevalent among patients with inflammatory bowel disease[J]. Clin Gastroenterol Hepatol，2022,20(6):1282-1289.e1. DOI：10.1016/j.cgh.2021.08.009.
[22]	HE J B, ZICKGRAF H F, ELLIS J M，et al. Chinese version of the nine item ARFID screen：psychometric properties and cross-cultural measurement invariance[J]. Assessment，2021,28(2):537-550. DOI：10.1177/1073191120936359.
[23]	钱炜炜. 居民食品素养问卷的汉化与信效度检验[D]. 苏州：苏州大学，2020.
[24]	DAY A S, YAO C K, COSTELLO S P，et al. Food-related quality of life in adults with inflammatory bowel disease is associated with restrictive eating behaviour，disease activity and surgery：a prospective multicentre observational study[J]. J Hum Nutr Diet，2022,35(1):234-244. DOI：10.1111/jhn.12920.
[25]	张杰，甘胜莲，余芳，等. 2型糖尿病患者营养素养与饮食依从性的调查[J]. 慢性病学杂志，2023,24(2):175-179. DOI：10.16440/J.CNKI.1674-8166.2023.02.03.
[26]	陈华东，廖晓阳，刘长明，等. 《健康中国行动（2019—2030年）》之重大专项行动核心要点解读与启示：全科医生视角[J]. 中国卫生事业管理，2020,37(12):958-960.
[27]	程旭，赵梅，于宁宁，等. 营养素养及其测评工具的研究进展[J]. 中国食物与营养，2023,29(2):69-73,80. DOI：10.19870/j.cnki.11-3716/ts.20220401.002.
[28]	叶绍灼. 糖尿病饮食知识教育对饮食治疗依从性的效果研究[J]. 糖尿病新世界，2021,24(22):51-53,57. DOI：10.16658/j.cnki.1672-4062.2021.22.051.
[29]	林霞，温陈媛，陈淑华. 糖尿病患者实施饮食营养健康管理效果评价[J]. 糖尿病新世界，2022,25(3):25-28. DOI：10.16658/j.cnki.1672-4062.2022.03.025.
[30]	LEE Y, KIM T, JUNG H. The relationships between food literacy，health promotion literacy and healthy eating habits among young adults in South Korea[J]. Foods，2022,11(16):2467. DOI：10.3390/foods11162467.
[31]	国务院发布《国民营养计划（2017—2030年）》[J]. 中国标准化，2017(15):28.
[32]	雒培琳，卞薇. 慢性病病人营养素养干预研究进展[J]. 护理研究，2023,37(6):1015-1020. DOI：10.12102/j.issn.1009-6493.2023.06.014.
[33]	张振香，任娟娟，林蓓蕾，等. 老年脑卒中患者心理健康素养与健康行为的相关性研究[J]. 中国全科医学，2021,24(22):2860-2865. DOI：10.12114/j.issn.1007-9572.2021.00.207.

一般资料	例数	NIAS			食物素养
一般资料	例数	总分	F（t）值	P值	总分	F（t）值	P值
性别			-1.249^a	0.208		0.676^a	0.539
男	278	20.43±8.54			32.51±9.66
女	151	21.53±8.23			33.11±9.73
教育水平			1.101	0.348		1.948	0.121
硕士及以上	9	20.56±4.83			33.00±7.76
大专及本科	368	20.97±8.66			32.43±9.66
中学及中专	42	20.44±8.72			33.85±10.12
小学及以下	10	16.00±10.39			39.50±8.50
工作类型			1.816	0.164		0.291	0.748
在职或在读	291	20.98±8.55			32.50±9.54
自由职业	89	21.47±8.96			33.39±10.18
病假、退休或其他	49	18.67±8.56			32.82±9.70
居住地			0.949	0.388		0.697	0.499
城市	392	20.97±8.50			32.61±9.62
乡镇	21	18.38±10.73			35.14±12.20
农村	16	20.13±9.23			32.31±7.33
疾病类型			-2.509^a	0.012		0.115^a	0.210
溃疡性结肠炎	238	19.89±9.04			33.25±9.45
克罗恩病	191	21.96±8.01			32.07±9.94
疾病活动度			-10.794^a	<0.001		6.528^a	<0.001
缓解期	296	17.89±6.49			35.48±9.03
活动期	133	27.54±9.25			26.37±8.00
服药情况			0.548^a	0.584		0.004^a	0.471
有	411	20.86±8.64			32.65±9.67
无	18	19.72±9.03			34.33±9.94
手术情况			1.894^a	0.059		0.059^a	0.038
有	98	22.27±9.52			30.94±9.69
无	331	20.39±8.34			33.25±9.62

一般资料	例数	NIAS			食物素养
一般资料	例数	总分	F（t）值	P值	总分	F（t）值	P值
性别			-1.249^a	0.208		0.676^a	0.539
男	278	20.43±8.54			32.51±9.66
女	151	21.53±8.23			33.11±9.73
教育水平			1.101	0.348		1.948	0.121
硕士及以上	9	20.56±4.83			33.00±7.76
大专及本科	368	20.97±8.66			32.43±9.66
中学及中专	42	20.44±8.72			33.85±10.12
小学及以下	10	16.00±10.39			39.50±8.50
工作类型			1.816	0.164		0.291	0.748
在职或在读	291	20.98±8.55			32.50±9.54
自由职业	89	21.47±8.96			33.39±10.18
病假、退休或其他	49	18.67±8.56			32.82±9.70
居住地			0.949	0.388		0.697	0.499
城市	392	20.97±8.50			32.61±9.62
乡镇	21	18.38±10.73			35.14±12.20
农村	16	20.13±9.23			32.31±7.33
疾病类型			-2.509^a	0.012		0.115^a	0.210
溃疡性结肠炎	238	19.89±9.04			33.25±9.45
克罗恩病	191	21.96±8.01			32.07±9.94
疾病活动度			-10.794^a	<0.001		6.528^a	<0.001
缓解期	296	17.89±6.49			35.48±9.03
活动期	133	27.54±9.25			26.37±8.00
服药情况			0.548^a	0.584		0.004^a	0.471
有	411	20.86±8.64			32.65±9.67
无	18	19.72±9.03			34.33±9.94
手术情况			1.894^a	0.059		0.059^a	0.038
有	98	22.27±9.52			30.94±9.69
无	331	20.39±8.34			33.25±9.62

食物素养	NIAS
食物素养	总分	挑食	食欲	恐惧
总分	-0.383^a	-0.307^a	-0.359^a	-0.306^a
计划和管理	-0.391^a	-0.305^a	-0.374^a	-0.314^a
选择	0.037	0.050	0.026	0.020
制作态度	-0.472^a	-0.401^a	-0.429^a	-0.369^a

食物素养	NIAS
食物素养	总分	挑食	食欲	恐惧
总分	-0.383^a	-0.307^a	-0.359^a	-0.306^a
计划和管理	-0.391^a	-0.305^a	-0.374^a	-0.314^a
选择	0.037	0.050	0.026	0.020
制作态度	-0.472^a	-0.401^a	-0.429^a	-0.369^a