title: Current practice in relation to nutritional assessment and dietary management of enteral nutrition in adults with Crohn's disease.
abstract: BACKGROUND
  Nutritional assessment and dietary intervention, particularly enteral nutrition, are important in the management of Crohn's disease (CD). National audits have reported that dietetic resourcing in gastroenterology is inadequate. The present study aimed to identify current practice in the nutritional assessment and dietary management of enteral nutrition in CD, as well as investigate the factors that influenced it.
  
  
  METHODS
  A nationwide questionnaire survey adopting complete population sampling of all 296 U.K. acute hospitals was undertaken aiming to determine dietetic resourcing for gastroenterology. In addition, the case-note review method was used to investigate approaches to nutritional assessment and dietary management of enteral nutrition as treatment for active CD.
  
  
  RESULTS
  Data were returned from 149 (56%) hospitals, providing assessment and management information on 190 patients. The median number of dietetic sessions dedicated to gastroenterology was 2 per week (interquartile range 4). Hospitals with five or more sessions per week dedicated to gastroenterology used a greater number of components in their nutritional assessment [mean (SD) 21.5 ( 5.0)] than those with fewer sessions [mean (SD) 19.6 (SD) 6.1, P = 0.05]. Enteral nutrition was perceived to be effective in 100 (55%) of 182 patients. The major reasons for limited success were poor compliance and inadequate volumes consumed, as well as insufficient treatment duration.
  
  
  CONCLUSIONS
  The components included in a nutritional assessment of CD patients are significantly lower in hospitals with fewer dietetic gastroenterology sessions. Focus on improving compliance and duration of enteral nutrition is urgently required to maximise the success of enteral nutrition in the treatment of CD.
authors.affiliation: Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK; Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, UK; Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, UK.
authors.forename: M C E
authors.initials: MC
authors.lastname: Lomer
authors.forename: R
authors.initials: R
authors.lastname: Gourgey
authors.forename: K
authors.initials: K
authors.lastname: Whelan
mesh_terms: D000328:Adult; D054869:Clinical Audit; D003424:Crohn Disease / Q000178:diet therapy*; D004046:Dietetics / Q000592:standards*; D004750:Enteral Nutrition; D005762:Gastroenterology; D006306:Health Surveys; D006761:Hospitals; D006801:Humans; D015596:Nutrition Assessment; D010349:Patient Compliance; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: Crohn's disease; dietary management; enteral nutrition; nutritional assessment