SCIENTIFIC
Registered Dietitian Nutritionist Utilization and Nutrition Outcomes in an Academic Pediatric Gastroenterology Clinic in West Virginia
AUTHORS: Cortney Ballengee Menchini, MD
Amna Umer, PhD Alyssa Lorenze, MD Karen Higginbotham, RD Amy Guido, MD Audra Rouster, MD
AFFILIATIONS: Department of Pediatrics
Divisions of Pediatric Gastroenterology, Hepatology and Nutrition
West Virginia University School of Medicine
CORRESPONDING AUTHOR: Cortney B. Menchini, MD DISCLOSURES: None
ETHICS STATEMENT:
This study was approved by the West Virginia University Internal Review Board( Protocol # 1902469864).
FUNDING: None
INTRODUCTION
Most diagnoses in pediatric gastroenterology( GI) require some degree of nutritional therapy. 1 Some diagnoses, like celiac disease and metabolic associated( formerly called non-alcoholic) fatty liver disease( MA- FLD) are exclusively treated by nutritional intervention; while others like inflammatory bowel disease( IBD), eosinophilic esophagitis( EOE), and chronic pancreatitis have adjunct nutritional and pharmaceutical therapy. Often, malnutrition is the patient’ s chief complaint with a non-organic cause. 2-4 Pediatric gastroenterologists often prescribe these nutritional interventions with the help of a registered dietitian nutritionist( RDN). 5 Pediatric RDNs are experts in
ABSTRACT
INTRODUCTION
Nutrition is the primary therapy for many conditions in pediatric gastroenterology( GI), and registered dietitian nutritionist( RDN) access is limited. We aimed to evaluate RDN utilization and nutrition outcomes in the pediatric GI clinic in an academic university hospital in West Virginia.
METHODS
We performed a retrospective chart review on all patients who presented to our clinic from July 2018 to July 2019. We reviewed multiple nutritional outcomes at the pre- and post-visits, including body mass index( BMI) and varied laboratory data.
providing nutrition recommendations tailored to the patient’ s age, development, and medical condition. 5 They educate parents and other care givers about formula mixing instructions, reading nutritional labels, and supplementing restrictive diets, while considering a child’ s total energy needs based on activity level or underlying disease.
While multiple societies and expert panels have endorsed the use of RDNs, there is little published evidence to support that role. Walia et al. has outlined evidence that supports the use of RDN involvement in pediatric gastroenterology disorders, which include conditions requiring enteral nutrition support, intestinal failure obesity, celiac disease, allergic GI disorders, and constipation. 5
The main objective of this study was to quantify the types of chronic GI diagnoses and examine the rate of patients who were evaluated by an RDN over a one-year study period in an academic university hospital in West Virginia( WV). The secondary objective was to examine the outcomes for these patients overall and for those who had seen an RDN.
RESULTS
Approximately 30 % of patients saw an RDN during the one-year study period. Nutrition outcomes were improved between clinic appointments regardless of RDN involvement; however, gastrostomy-tube and malnourished patients had the most significant improvement in BMI and were most likely to receive RDN care.
CONCLUSIONS
RDN utilization was low and nutritional outcomes for many diagnoses were improved regardless of RDN involvement. However, patients with gastrostomy-tube dependency and malnourishment experienced the highest RDN utilization and nutritional improvement when RDNs were involved in their care.
METHODS
We performed a retrospective chart review of all subjects with the following diagnoses: EOE, celiac disease, MAFLD, IBD( Crohn’ s disease, ulcerative colitis), gastrointestinal allergy or intolerance( milk-protein intolerance, food protein-induced enterocolitis syndrome), gastrostomy tube dependence, and malnutrition / failure to thrive. Subjects had at least two visits to the pediatric GI clinic at our academic university hospital between July 1, 2018, and July 1, 2019. International Classification of Disease( ICD) 10 codes in the problem list, billing codes, or visit diagnoses list were used to identify the diagnoses listed above. With manual chart review, we verified the diagnoses and noted body mass index( BMI) Z-scores at two visits at least six months apart. Body weight was measured using an electronic scale( Weight Tronix, New York City, New York) to the nearest 0.1 kg, and height was measured using a stadiometer( Holtain, Crosswell, Wales) to the nearest 0.1 cm and the average of three measurements was recorded. BMI Z-score was computed from the Centers for Disease Control and Prevention reference values. 6 We also obtained other diseasespecific metrics for individual diagnoses, including tissue transglutaminase immunoglobulin A( TTG IgA) for celiac disease,
16 • www. wvsma. org