The Age of Artificial Intelligence: Use of Digital Technology in Clinical Nutrition

Purpose of review Computing advances over the decades have catalyzed the pervasive integration of digital technology in the medical industry, now followed by similar applications for clinical nutrition. This review discusses the implementation of such technologies for nutrition, ranging from the use of mobile apps and wearable technologies to the development of decision support tools for parenteral nutrition and use of telehealth for remote assessment of nutrition. Recent findings Mobile applications and wearable technologies have provided opportunities for real-time collection of granular nutrition-related data. Machine learning has allowed for more complex analyses of the increasing volume of data collected. The combination of these tools has also translated into practical clinical applications, such as decision support tools, risk prediction, and diet optimization. Summary The state of digital technology for clinical nutrition is still young, although there is much promise for growth and disruption in the future

Patients Prescribed Direct-acting Oral Anticoagulants Have Low Risk of Post-Polypectomy Complications

Background & Aims Use of direct-acting oral anticoagulants (DOACs) is increasing, but little is known about the associated risks in patients undergoing colonoscopy with polypectomy. We aimed to determine the risk of post-polypectomy complications in patients prescribed DOACs. Methods We performed a retrospective analysis using the Clinformatics Data Mart Database (a de-identified administrative database from a large national insurance provider) to identify adults who underwent colonoscopy with polypectomy or endoscopic mucosal resection (EMR) from January 1, 2011, through December 31, 2015. We collected data from 11,504 patients prescribed antithrombotic agents (1590 DOAC, 3471 warfarin, and 6443 clopidogrel) and 599,983 patients not prescribed antithrombotics of interest (controls). We compared 30-day post-polypectomy complications, including gastrointestinal bleeding (GIB), cerebrovascular accident (CVA), myocardial infarction (MI), and hospital admissions, of patients prescribed DOACs, warfarin, or clopidogrel vs controls. Results Post-polypectomy complications were uncommon but occurred in a significantly higher proportion of patients receiving any antithrombotic vs controls (P<0.001). The percentage of patients in the DOAC group with GIB was 0.63% (95% CI, 0.3%–1.2%) vs 0.2% (95% CI, 0.2%–0.3%) in controls. The percentage of patients with CVA in the DOAC group was 0.06% (95% CI, 0.01%–0.35%) vs 0.04% (95% CI, 0.04%–0.05%) in controls. After we adjusted for bridge anticoagulation, EMR, Charlson comorbidity index (CCI), and CHADS2 (congestive heart failure, hypertension, age over 75, diabetes, stroke [double weight]) score, patients prescribed DOACs no longer had a statistically significant increase in the odds of GIB (odds ratio [OR], 0.90; 95% CI, 0.44–1.85), CVA (OR, 0.45; 95% CI, 0.06–3.28), MI (OR, 1.07; 95% CI, 0.14–7.72), or hospital admission (OR, 0.86; 95% CI, 0.64–1.16). Clopidogrel, warfarin, bridge anticoagulation, higher CHADS2, CCI, and EMR were associated with increased odds of complications. Conclusion In our retrospective analysis of a large national dataset, we found that patients prescribed DOACs did not have significantly increased adjusted odds of post-polypectomy GIB, MI, CVA, or hospital admission. Bridge anticoagulation, higher CHADS2 score, CCI, and EMR were risk factors for GIB, MI, CVA, and hospital admissions. Studies are needed to determine the optimal peri-procedural dose for high-risk patients

Diet Therapy for Inflammatory Bowel Diseases: A Call to the Dining Table

The article comments on the recent systematic review and meta-analysis of dietary interventions for Crohn’s disease and ulcerative colitis. We discuss the pitfalls of current data and emphasize the importance of further research into diets and inflammatory bowel diseases

Avoidant Restrictive Food Intake Disorder Prevalent Among Patients With Inflammatory Bowel Disease

Background & Aims Inflammatory bowel disease (IBD) patients alter their dietary behaviors to reduce disease-related symptoms, avoid feared food triggers, and control inflammation. This study aimed to estimate the prevalence of avoidant/restrictive food intake disorder (ARFID), evaluate risk factors, and examine the association with risk of malnutrition in patients with IBD. Methods This cross-sectional study recruited adult patients with IBD from an ambulatory clinic. ARFID risk was measured using the Nine-Item ARFID Screen. Nutritional risk was measured with the Patient Generated-Subjective Global Assessment. Logistic regression models were used to evaluate the association between clinical characteristics and a positive ARFID risk screen. Patient demographics, disease characteristics, and medical history were abstracted from medical records. Results Of the 161 participants (Crohn’s disease, 45.3%; ulcerative colitis, 51.6%; IBD-unclassified, 3.1%), 28 (17%) had a positive ARFID risk score (≥24). Most participants (92%) reported avoiding 1 or more foods while having active symptoms, and 74% continued to avoid 1 or more foods even in the absence of symptoms. Active symptoms (odds ratio, 5.35; 95% confidence interval, 1.91–15.01) and inflammation (odds ratio, 3.31; 95% confidence interval, 1.06–10.29) were significantly associated with positive ARFID risk. Patients with a positive ARFID risk screen were significantly more likely to be at risk for malnutrition (60.7% vs 15.8%; P \u3c .01). Conclusions Avoidant eating behaviors are common in IBD patients, even when in clinical remission. Patients who exhibit active symptoms and/or inflammation should be screened for ARFID risk, with referrals to registered dietitians to help monitor and address disordered eating behaviors and malnutrition risk

The Role of Vitamin D in Inflammatory Bowel Disease Pathogenesis and Severity

Vitamin D has traditionally been known for its role in bone metabolism, but more recently been implicated in immune function. Emerging evidence has further suggested that vitamin D may be involved in inflammatory bowel disease (IBD) pathogenesis and activity. Studies found lower vitamin D levels among IBD patients, particularly in the setting of increased disease activity, implying that vitamin D influenced IBD. However, interpretation of these findings is challenged by the concept of reverse causation, where intestinal inflammation is already known to reduce vitamin D levels. These studies have therefore not established vitamin D deficiency as a cause or effect of IBD in humans. The principal objective of this thesis was to clarify the causal role of vitamin D in IBD pathogenesis and severity, while employing diverse methodologic approaches to overcome the issue of reverse causation. The first study was a case-control comparison of vitamin D levels from sera that were prospectively collected before and around the time of diagnosis of Crohn’s disease (CD). This longitudinal analysis permitted the evaluation of vitamin D levels as precursors to CD pathogenesis, while reducing interference by reverse causation. Vitamin D levels were similar between cases and controls prior to diagnosis, but significantly lower among cases around the time of diagnosis. The second study was an ecologic study that evaluated the association of ultraviolet (UV) exposure – a surrogate marker of vitamin D that was not influenced by IBD – and IBD hospitalization severity. Low UV exposures were associated with increased rates of hospitalization, prolonged hospitalization, and need for bowel surgeries. The third study was a systematic review of randomized trials that evaluated the effect of vitamin D supplementation on IBD activity. Randomization in these trials would have theoretically permitted assessment of the effect of vitamin D on IBD independent of disease activity. The meta-analysis of 4 studies with 12-month follow-up showed a trend toward fewer clinical relapses, but this was not statistically significant. Nonetheless, most studies had small sample sizes, significant risk of bias, and substantial methodologic heterogeneity. In conclusion, this thesis investigation did not find vitamin D to significantly influence CD pathogenesis. There was nonetheless some evidence to suggest that vitamin D may influence IBD activity. Further investigation with high-quality and larger randomized trials of vitamin D intervention in IBD is warranted

Prebiotics and Probiotics for Gastrointestinal Disorders.

The complex role of the gut microbiome in the pathogenesis of gastrointestinal (GI) disorders is an emerging area of research, and there is considerable interest in understanding how diet can alter the composition and function of the microbiome. Prebiotics and probiotics have been shown to beneficially modulate the gut microbiome, which underlies their potential for benefit in GI conditions. Formulating specific recommendations for the public regarding these dietary supplements has been difficult due to the significant heterogeneity between strains, doses, and duration of treatment investigated across studies, as well as safety concerns with administering live organisms. This review aims to summarize the existing evidence for the use of prebiotics and probiotics in various GI disorders, paying special attention to strain-specific effects that emerged and any adverse effects noted