Dietary Intake and Nutritional Deficiencies in Patients With Diabetic or Idiopathic Gastroparesis

doi:10.1053/j.gastro.2011.04.045

Gastroenterology

Volume 141, Issue 2, August 2011, Pages 486-498.e7

https://doi.org/10.1053/j.gastro.2011.04.045 Get rights and content

Background & Aims

Gastroparesis can lead to food aversion, poor oral intake, and subsequent malnutrition. We characterized dietary intake and nutritional deficiencies in patients with diabetic and idiopathic gastroparesis.

Methods

Patients with gastroparesis on oral intake (N = 305) were enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Registry and completed diet questionnaires at 7 centers. Medical history, gastroparesis symptoms, answers to the Block Food Frequency Questionnaire, and gastric emptying scintigraphy results were analyzed.

Results

Caloric intake averaged 1168 ± 801 kcal/day, amounting to 58% ± 39% of daily total energy requirements (TER). A total of 194 patients (64%) reported caloric-deficient diets, defined as <60% of estimated TER. Only 5 patients (2%) followed a diet suggested for patients with gastroparesis. Deficiencies were present in several vitamins and minerals; patients with idiopathic disorders were more likely to have diets with estimated deficiencies in vitamins A, B₆, C, K, iron, potassium, and zinc than diabetic patients. Only one-third of patients were taking multivitamin supplements. More severe symptoms (bloating and constipation) were characteristic of patients who reported an energy-deficient diet. Overall, 32% of patients had nutritional consultation after the onset of gastroparesis; consultation was more likely among patients with longer duration of symptoms and more hospitalizations and patients with diabetes. Multivariable logistic regression analysis indicated that nutritional consultation increased the chances that daily TER were met (odds ratio, 1.51; P = .08).

Conclusions

Many patients with gastroparesis have diets deficient in calories, vitamins, and minerals. Nutritional consultation is obtained infrequently but is suggested for dietary therapy and to address nutritional deficiencies.

Section snippets

General Study Design

The National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Gastroparesis Clinical Research Consortium is a cooperative network of 7 clinical centers and a data coordinating center. The NIDDK Gastroparesis Registry, an observational study of prospectively enrolled patients with gastroparesis and gastroparesis-like symptoms who have met specific entry criteria, was begun in January 2007. Entry criteria for the Gastroparesis Registry included age 18

Patients

Of 396 patients with delayed gastric emptying in the Gastroparesis Registry, 376 completed the Block Brief FFQ. Of these, 49 (13%) receiving either total parenteral nutrition or enteral feedings were excluded because we did not have accurate caloric intake on these patients from their total parenteral nutrition or enteral feedings. In addition, 22 patients were identified with postsurgical or other causes of gastroparesis (eg, systemic lupus erythematosus, reflex sympathetic dystrophy),

Discussion

This report has examined dietary intake of patients with diabetic or idiopathic gastroparesis enrolled in the NIDDK Gastroparesis Registry using the Block FFQ to assess their food intake. This study has found that the majority of patients with gastroparesis consume diets deficient in calories, carbohydrates, protein, vitamins, and minerals. The dietary intake of patients with gastroparesis appears to be influenced by several factors, including etiology of gastroparesis, body weight, severity of

Acknowledgments

Members of the Gastroparesis Clinical Research Consortium are listed in Supplementary Table 2.

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: Conflicts of interest The authors disclose no conflicts.

: Funding The Gastroparesis Clinical Research Consortium is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (grants U01DK073983, U01DK073975, U01DK073985, U01DK074007, U01DK073974, U01DK074008).

View full text

Original ResearchClinical—Alimentary TractDietary Intake and Nutritional Deficiencies in Patients With Diabetic or Idiopathic Gastroparesis

Background & Aims

Methods

Results

Conclusions

Section snippets

General Study Design

Patients

Discussion

Acknowledgments

Gastroenterology

Am J Gastroenterol

Am J Clin Nutr

Nutrition aspects of gastroparesis and therapies for drug-refractory patients

Nutr Clin Pract

Nutrition intervention for the patient with gastroparesis: an update

Practical Gastroenterol

Treatment of gastroparesis: a multidisciplinary clinical review

Neurogastroenterol Motil

Idiopathic gastroparesis is associated with a multiplicity of severe dietary deficiencies

Am J Gastroenterol

A data-based approach to diet questionnaire design and testing

Am J Epidemiol

A reduced dietary questionnaire: development and validation

Epidemiology

Dietary intake and risk of gastro-esophageal reflux disease: a cross sectional study in volunteers

Gut

Dietary patterns and risk of Barrett's esophagus

Am J Epidemiol

Obesity is an independent risk factor for GERD symptoms and erosive esophagitis

Am J Gastroenterol

Comparison of Food Frequency Questionnaires: the reduced Block and Willett Questionnaires differ in ranking on nutrient intakes

Am J Epidemiol

Third National Health and Nutrition Examination Survey (NHANES III) public-use data files

Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients)

Development and psychometric evaluation of the patient assessment of upper gastrointestinal symptom severity index (PAGI-SYM) in patients with upper gastrointestinal disorders

Qual Life Res

Original Research
Clinical—Alimentary Tract
Dietary Intake and Nutritional Deficiencies in Patients With Diabetic or Idiopathic Gastroparesis