Abstract：
BACKGROUND: Disorders of gut-brain interaction (DGBI) are common in patients with hypermobile Ehlers-Danlos syndrome/hypermobility spectrum disorder (hEDS/HSD). Food is a known trigger for DGBI symptoms, which often leads to dietary alterations and, increasingly, nutrition support. We aimed to explore dietary behaviors and influencing factors in patients with hEDS/HSD.
METHODS: In a cross-sectional study, patients with hEDS/HSD were recruited from Ehlers-Danlos Support UK (nontertiary) and tertiary neurogastroenterology clinics to complete questionnaires characterizing the following: dietary behaviors, nutrition support, DGBI (Rome IV), gastrointestinal symptoms, anxiety, depression, avoidant restrictive food intake disorder (ARFID), mast cell activation syndrome, postural tachycardia syndrome (PoTS), and quality of life. We used stepwise logistic regression to ascertain which factors were associated with dietary behaviors and nutrition support.
RESULTS: Of 680 participants (95% female, median age 39 years), 62.1% altered their diet in the last year and 62.3% regularly skipped meals. Altered diet was associated with the following: reflux symptoms ( P < 0.001), functional dyspepsia ( P = 0.008), reported mast cell activation syndrome ( P < 0.001), and a positive screen for ARFID, specifically fear of eating and low interest ( P < 0.001). Approximately 31.7% of those who altered their diet required nutrition support. The strongest predictor of requiring nutrition support was a positive screen for ARFID, specifically fear of eating (OR: 4.97, 95% CI: 2.09-11.8, P < 0.001).
CONCLUSIONS: Altered diet is very common in the patients with hEDS/HSD we studied and influenced by functional dyspepsia, reflux symptoms, and ARFID. Those with ARFID have a 4-fold increased risk of requiring nutrition support, and therefore, it is paramount that psychological support is offered in parallel with dietary support in the management of DGBI in hEDS/HSD.
METHODS: In a cross-sectional study, patients with hEDS/HSD were recruited from Ehlers-Danlos Support UK (nontertiary) and tertiary neurogastroenterology clinics to complete questionnaires characterizing the following: dietary behaviors, nutrition support, DGBI (Rome IV), gastrointestinal symptoms, anxiety, depression, avoidant restrictive food intake disorder (ARFID), mast cell activation syndrome, postural tachycardia syndrome (PoTS), and quality of life. We used stepwise logistic regression to ascertain which factors were associated with dietary behaviors and nutrition support.
RESULTS: Of 680 participants (95% female, median age 39 years), 62.1% altered their diet in the last year and 62.3% regularly skipped meals. Altered diet was associated with the following: reflux symptoms ( P < 0.001), functional dyspepsia ( P = 0.008), reported mast cell activation syndrome ( P < 0.001), and a positive screen for ARFID, specifically fear of eating and low interest ( P < 0.001). Approximately 31.7% of those who altered their diet required nutrition support. The strongest predictor of requiring nutrition support was a positive screen for ARFID, specifically fear of eating (OR: 4.97, 95% CI: 2.09-11.8, P < 0.001).
CONCLUSIONS: Altered diet is very common in the patients with hEDS/HSD we studied and influenced by functional dyspepsia, reflux symptoms, and ARFID. Those with ARFID have a 4-fold increased risk of requiring nutrition support, and therefore, it is paramount that psychological support is offered in parallel with dietary support in the management of DGBI in hEDS/HSD.
摘要：
背景：肠脑相互作用（DGBI）障碍在高移动Ehlers-Danlos综合征/高移动谱系障碍（hEDS/HSD）患者中很常见。食物是DGBI症状的已知诱因，这通常会导致饮食改变，越来越多,营养支持。探讨hEDS/HSD患者的饮食行为及其影响因素。
方法：在一项横断面研究中，从Ehlers-Danlos支持英国（非三级）和三级神经胃肠病诊所招募hEDS/HSD患者，以完成以下表征问卷：饮食行为，营养支持,DGBI(罗马四世),胃肠道症状,焦虑,抑郁症,避免限制性食物摄入障碍（ARFID），肥大细胞活化综合征,体位性心动过速综合征（PoTS），和生活质量。我们使用逐步逻辑回归来确定哪些因素与饮食行为和营养支持相关。
结果：在680名参与者中（95％为女性，中位年龄39岁)，62.1%的人在去年改变了他们的饮食，62.3%的人经常不吃饭。改变饮食与以下症状相关：反流症状（P<0.001），功能性消化不良（P=0.008），报道的肥大细胞活化综合征（P<0.001），和ARFID的正面屏幕，特别是对饮食的恐惧和低兴趣（P<0.001）。大约31.7％的改变饮食的人需要营养支持。需要营养支持的最强预测指标是ARFID的阳性筛查，特别是对进食的恐惧（OR：4.97，95％CI：2.09-11.8，P<0.001）。
结论：改变饮食在我们研究的hEDS/HSD患者中非常常见，并受功能性消化不良的影响，反流症状,和ARFID。那些有ARFID的人需要营养支持的风险增加了4倍，因此,在hEDS/HSD的DGBI管理中,最重要的是提供心理支持和饮食支持.
方法：在一项横断面研究中，从Ehlers-Danlos支持英国（非三级）和三级神经胃肠病诊所招募hEDS/HSD患者，以完成以下表征问卷：饮食行为，营养支持,DGBI(罗马四世),胃肠道症状,焦虑,抑郁症,避免限制性食物摄入障碍（ARFID），肥大细胞活化综合征,体位性心动过速综合征（PoTS），和生活质量。我们使用逐步逻辑回归来确定哪些因素与饮食行为和营养支持相关。
结果：在680名参与者中（95％为女性，中位年龄39岁)，62.1%的人在去年改变了他们的饮食，62.3%的人经常不吃饭。改变饮食与以下症状相关：反流症状（P<0.001），功能性消化不良（P=0.008），报道的肥大细胞活化综合征（P<0.001），和ARFID的正面屏幕，特别是对饮食的恐惧和低兴趣（P<0.001）。大约31.7％的改变饮食的人需要营养支持。需要营养支持的最强预测指标是ARFID的阳性筛查，特别是对进食的恐惧（OR：4.97，95％CI：2.09-11.8，P<0.001）。
结论：改变饮食在我们研究的hEDS/HSD患者中非常常见，并受功能性消化不良的影响，反流症状,和ARFID。那些有ARFID的人需要营养支持的风险增加了4倍，因此,在hEDS/HSD的DGBI管理中,最重要的是提供心理支持和饮食支持.
