Developing a dietary management algorithm for patients with IBD


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The use of a standardised IBD nutrition assessment and treatment algorithm will improve the identification of patients with suboptimal nutritional status and result in more patients accessing appropriate dietary treatment

Dr Miranda Lomer, Guy's and St Thomas' NHS Foundation Trust

What this research looked at 

Diet plays an important role in the way many people with Crohn’s or Colitis manage their condition. But there are currently no specific guidelines on assessing the dietary needs of people with IBD available to health professionals. Coupled with the shortage of dietitians within IBD teams this means that people’s nutritional needs often remain unmet. Many people consequently make changes to their diet without the appropriate clinical support, instead relying on advice from alternative sources such as internet forums. This can often lead to people missing out on vital nutrients and for some this can result in malnutrition. 

This research aimed to identify people who would benefit from nutritional input, develop best practice guidance for health professionals on dietary management for people with Crohn's and Colitis, and support the case for increased access to specialist dietitians.

To achieve these objectives the researchers developed:  

  • A standardised process of care (algorithm) which included:
    • a self‐assessment tool specifically for people with Crohn’s or Colitis to score and monitor their nutritional risk, this will help people identify when advice from a dietitian would be beneficial
    • recommendations for health professionals on nutritional assessment and dietary management of people with Crohn’s and Colitis.
  • A Business Case Model for local hospitals and communities to demonstrate the benefits and cost savings of including a dietitian within the IBD team.

What the research found

The IBD specific nutrition self‐screening tool developed for people to score their nutritional risk was found to be quick and easy to complete. It enables people with Crohn's or Colitis to monitor their nutrition risk so that when they score a moderate or high risk they can ask referral to a dietitian. This is now being used in some NHS Trusts across the UK. An online version is also in development to allow people to complete this between hospital visits.

Recommendations for nutritional assessment and dietary management of people with Crohn’s and Colitis have been produced. The next phase is underway as a new project to develop guidelines from experienced IBD health professionals and to incorporate them into a standardised process of care.

The Business Case Model to support IBD teams develop new posts for IBD dietitians is currently being tested by several NHS Trusts. When feedback has been received the resource will be made widely available.

What the researchers think this could this mean for people with Crohn's or Colitis

This standardised process of care will help identify people with Crohn’s or Colitis who would benefit from more advice on their diet, and those at nutritional risk.  It will mean that people across the country will have the same access to high-quality dietary care and so improve quality of life for many people with Crohn’s or Colitis.

Who is leading the research: Dr Miranda Lomer, Guy’s and St Thomas’ NHS Foundation Trust
Our Funding: £111,580
Duration: 18 months
Official title of the application: Development of a nutritional assessment and dietary management algorithm for patients with inflammatory bowel disease (IBD) 
Diet, service development