title: The White Diet is preferred, better tolerated, and non-inferior to a clear-fluid diet for bowel preparation: A randomized controlled trial.
abstract: OBJECTIVE
  Dietary restrictions contribute to the unpleasantness of bowel preparation for colonoscopy. We compare the effectiveness and tolerability of a low residue diet of white-colored foods ("White Diet") with a clear-fluid diet the day prior to colonoscopy in an endoscopist-blinded randomized non-inferiority trial.
  
  
  METHODS
  Adults undergoing outpatient colonoscopy were randomized with stratification by procedure timing to a White Diet or clear-fluid diet. All received a 2-L polyethylene glycol lavage solution with ascorbate, sodium sulfate, and electrolytes, the day-before for morning and as a split-dose for afternoon procedures. The primary end-point was successful bowel preparation (A or B on the Harefield Cleansing Scale). Regimen tolerance/acceptance was assessed by questionnaire. An intention-to-treat analysis with a predefined non-inferiority margin of 15% was used to compare efficacy.
  
  
  RESULTS
  A total of 226 patients (average age 52 years, 51% male) were randomized (111 clear diet, 115 White Diet). Bowel preparation was successful in 91% on the clear-fluid diet vs 84.4% on the White Diet, difference being -6.6% (lower one sided 95% CI -13.8%), with no difference according to diet. The split-dose regimen (in 55%) had a higher success rate than day-before regimen (96% vs 80%, p < 0.001). The White Diet was preferred with less hunger and interference with daily activities (p < 0.001). Procedural/withdrawal time and polyp/adenoma detection were similar between groups.
  
  
  CONCLUSIONS
  The White Diet was preferred and better tolerated by patients without detriment to the success of bowel preparation or colonoscopy performance, especially with the split-dose regimen.
authors.affiliation: Department of Gastroenterology, The Alfred Hospital.
authors.forename: Joshua
authors.initials: J
authors.lastname: Butt
authors.affiliation: Department of Gastroenterology, The Alfred Hospital.
authors.forename: Cate
authors.initials: C
authors.lastname: Bunn
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Eldho
authors.initials: E
authors.lastname: Paul
authors.affiliation: Department of Gastroenterology, The Alfred Hospital.
authors.forename: Peter
authors.initials: P
authors.lastname: Gibson
authors.affiliation: Department of Gastroenterology, The Alfred Hospital.
authors.forename: Gregor
authors.initials: G
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D002400:Cathartics; D003113:Colonoscopy / Q000379:methods*; D003116:Color; D004032:Diet; D005260:Female; D005502:Food; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D002400:Cathartics
keywords: bowel preparation; colonoscopy; diet; low fiber; low residue