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

Abstract

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 NIDDK Gastroparesis Registry and completed diet questionnaires at 7 centers. Medical history, gastroparesis symptoms, answers to a block food frequency questionnaire, and gastric emptying scintigraphy results were analyzed Results Caloric intake averaged 1,168±801 kcal/day, amounting to 58%±39% of daily total energy requirements (TER). One hundred ninety-four 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 a third of patients were taking multivitamin supplements. More severe symptoms (bloating and constipation) were characteristic of patients that reported an energy-deficient diet. Overall, 32% of patients had nutritional consultation after the onset of gastoparesis; 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 total energy requirements 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.

Taste and Smell Disturbances in Patients with Gastroparesis and Gastroesophageal Reflux Disease

“…Upper GI symptoms are usually exacerbated with eating, causing many patients to avoid food, leading to the onset of nutritional deficiencies. 4 Anorexia patients with a low body mass index (15 ± 2), indicative of substantial decrease in eating, reportedly experience impairment in olfaction. 12 Nutritional deficiencies, particularly proteins, decreases the ability of the GI epithelium to regenerate, which has been speculated to also affect the regeneration of olfactory epithelium, potentially serving as a cause of the smell dysfunction seen in malnourished anorexia patients.…”

“…3 Patients with both gastroparesis and GERD are advised to manage symptoms by eating less fats and decreasing the frequency and size of meals. 4 From experience in practice, it has been observed that some patients with gastroparesis and with GERD attribute decreased enjoyment when eating to changes in taste and smell function. However, no prior studies have identified taste and smell abnormalities in these upper GI disorders.…”

Abordaje nutricional del paciente con diabetes mellitus e insuficiencia renal crónica: a propósito de un caso

“…Los síntomas más habituales son las náuseas (37). La prueba "gold standard" para su diagnóstico es la gammagrafía de vaciamiento gástrico (38). Los pacientes con gastroparesia diabética son más susceptibles a sufrir un deterioro del estado nutricional y, en nuestro paciente, además, un deterioro de su ERC.…”

“…Los pacientes con gastroparesia diabética son más susceptibles a sufrir un deterioro del estado nutricional y, en nuestro paciente, además, un deterioro de su ERC. El manejo de la gastroparesia diabética inicialmente debe incluir (38):…”

Treatment of gastrointestinal autonomic neuropathy

“…The support of a dietitian increases the chances that the diet will have a nutrient intake that reaches the daily energy requirements. Indeed, there appears to be a great need for this support since most patients experience difficulties following dietary advice [5]. In general, in terms of symptom-relief, a meal with small particle size seems to be of central importance [6].…”