ment of many conditions presenting to the pediatric GI clinic. 7-13 However, we found that only 30 % of our patients saw an RDN in the study period, and of those, only 16 % were seen as scheduled outpatient visits. At the time of this study, we had no dedicated RDN in the pediatric GI clinic, as is the case in primary and subspecialty pediatric clinics across WV. Therefore, patients are required to either return on a separate day or coordinate follow-up visits with GI and dietitian services. Many of our patients traveled significant distances to reach our clinic and many patients were seen at satellite locations where there are no embedded RDNs. All these barriers likely contribute to the low overall percentage of RDN utilization. Increasing access to RDNs is essential and can only be achieved by increasing the number of RDNs on staff.
Gastrostomy-dependent patients experienced significant improvement in BMI Z-scores if they saw an RDN in clinic versus not. The improved malnutrition outcomes across conditions regardless of RDN involvement can likely be contributed to the nutritional expertise of pediatric gastroenterologists. We hypothesize that RDNs embedded in primary care and other subspecialty clinics would lead to improved nutritional outcomes, particularly complex care clinics where a large portion of patients are gastrostomy-dependent.
We note that we found no significant difference in BMI Z-scores or ALT levels in the patient population with fatty liver, regardless of RDN involvement. Metabolic-associated liver disease is becoming more common as obesity prevalence rises. According to the 2021-2022 National Survey of Children’ s Health, 24.8 % of children ages 10-17 and 16.5 % of children ages 2-4 years are obese in WV. Of the 50 states, WV ranks highest for childhood obesity for the age group 10 to 17 years, and sixth highest for the age group of 2 to 4 years. 14 More research and healthcare expertise are needed to identify ways to effectively utilize RDNs to make a long-lasting change in this trend.
A limitation of our study includes the small sample sizes of each diagnosis, which may have contributed to the lack of improvement regarding RDN evaluation. As of 2021, there is a dedicated RDN in our main campus
Allergy NAFLD Celiac G-tube
clinic. Our ongoing follow-up study aims to compare utilization rates of RDN before and after 2021. We hypothesize that after having a dedicated RDN more of our patients will have RDN visits.
CONCLUSION
FIGURE 1: Percentage of RDN Visits Outpatient vs. Total
EoE IBD
Malnutrition
3 2.5 2 1.5 1 0.5 0-0.5-1-1.5-2
0 10
Our GI clinic saw an overall low utilization rate of RDNs, likely due to the lack of availability of these specialized services. Despite the lack of RDN involvement, our patients with disorders causing poor weight gain had
20 30 40 50 60 70
Note: Red bars indicate outpatient clinic RDN visits. Blue bars are all RDN visits, including clinic visits and inpatient visits.
RDN: Registered dietician nutritionist
BMI Z-scores
FIGURE 2: BMI Z-scores
1 2 out total
NAFLD: Non-alcoholic fatty liver disease( now referred to as metabolic associated fatty liver disease or MAFLD)
Malnutrition IBD EoE G-tube Celiac NAFLD Allergy
Blue bars indicate the mean first visit BMI Z-scores. Red bars indicate the mean second visit BMI Z-scores. P scores are listed for statistically significant differences.
BMI- body mass index; IBD – inflammatory bowel disease; EoE – eosinophilic esophagitis; G-tube – gastrostomy tube; NAFLD – nonalcoholic fatty liver disease( now referred to as metabolic associated fatty liver disease or MAFLD)
an overall increase in BMI Z-scores, indicating expert nutritional care by pediatric gastroenterologists. There was a significant improvement in gastronomy tube-dependent patients and / or malnourished patients if they saw a dietitian. Our study adds to the literature, which provides evidence that access to RDN care will benefit children with pediatric GI disorders, and in our study, it was especially so in children who depend upon gastronomy tube feedings for their nutrition.
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