alanine transaminase( ALT) for MAFLD, and erythrocyte sedimentation rate( ESR) for IBD at two visits. We also noted whether patients were evaluated by an RDN during either an outpatient or inpatient visit at any point during the study period. During the study period, there was no dedicated RDN in the outpatient clinic, and visits were only accomplished through RDN referrals and separate follow-up. This study was approved by the West Virginia University Internal Review Board( Protocol # 1902469864).
All statistical analyses were conducted using SAS 9.4. Descriptive statistics included frequencies and percentages for categorical data and means and standard deviations( SD) for continuous data. We compared the zBMI data and laboratory data of the subjects at the two visits. A dependent-sample t-test was conducted to compare these outcomes for the overall study population and stratified by those patients who saw a RDN.
RESULTS
A total of 470 subjects met the diagnostic and visit criteria during the study period. Table 1 shows the number and percent of patients with each diagnosis, sex, and RDN visit status and location of inpatient and outpatient settings. Sex was included since EOE has a male predominance. Thirty percent of all patients saw an RDN, with 53 % of those being outpatient visits. Table 2 shows the percentage of patients with an RDN visit per diagnosis. Patients who were gastrostomy-dependent had the highest percentage of RDN visits at 63.16 %, and patients with EOE had the lowest at 8.89 %. Figure 1 shows the breakdown of outpatient versus inpatient RDN visits per diagnosis. Patients with a diagnosis of malnutrition, gastrostomy dependence, and IBD had higher percentages of inpatient RDN visits at 61 %, 61 %, and 77 % respectively.
When evaluating all measured metrics, BMI Z-scores in gastrostomy-dependent subjects were significantly improved( mean difference = 0.6577, 95 % CI 0.06 – 1.25) between the first( mean =-0.14, SD1.66) and second( mean = 0.51, SD 1.74) clinic visits if they saw an RDN versus not( p = 0.03). Regardless of RDN encounter, when grouping all diagnoses( excluding MAFLD) there was a statistically significantly improved BMI Z-score( mean difference = 0.3223, 95 %
TABLE 1: Diagnoses, Sex, and Dietitian Rates Diagnosis N % Malnutrition 99 21.06 Inflammatory Bowel Disease 105 22.34 Eosinophilic Esophagitis 90 19.15 G-tube Dependent 57 12.13 Celiac Disease 49 10.43 Fatty Liver Disease 32 6.81 Allergies / Intolerance 34 7.23 Other Liver Disease 4 0.85 Total 470 Sex N % Female 228 48.51 Male 242 51.49 Dietitian N % No 326 69.36 Yes 144 30.64 Dietitian Location N % Inpatient 67 46.53 Outpatient 77 53.47
TABLE 2: Percentage of Patients with Registered Dietitian Nutritionist Visits per Diagnosis
No Yes Total Inflammatory Bowel Disease 83 22( 20.95 %) 105 Eosinophilic Esophagitis 82 8( 8.89 %) 90 G-tube Dependent 21 36( 63.16 %) 57 Celiac Disease 31 18( 36.73 %) 49 Fatty Liver 18 14( 43.75 %) 32
Allergy / Intolerance 29 5( 14.71 %) 34
No: Did not have care from a registered dietician nutritionist Yes: Did have care from a registered dietician nutritionist
CI 0.16 – 0.48) between the first( mean =-0.1288, SD = 1.88) and second( mean = 0.1966, SD = 1.77) clinic visit( p < 0.0001). Patients with malnutrition had significantly improved BMI Z-scores( mean difference = 0.7342, 95 % CI 0.32 – 1.14) between the first( mean =-1.62, SD 2.62) and second( mean =-0.84, SD 1.91) clinic visits( p < 0.0006). Figure 2 shows BMI Z-score changes for each diagnosis. The laboratory values of ESR and TTG IgA significantly improved in patients with IBD and celiac disease respectively( p = 0.06, p = 0.018), but there was no significant difference when comparing IBD and celiac disease subjects who did( p = 0.1) and did not( p = 0.24) see an RDN. The ALT values did not significantly improve in patients with MAFLD between visits.
DISCUSSION
The national recommendations and guidelines from the North American and European Societies for Pediatric Gastroenterology, Hepatology and Nutrition, and other dietetic associations are clear that nutritional counseling and therapy are essential to the treat-
West Virginia Medical Journal • September 2025 • 17