Background: Crohn's disease (CD) patients suffer from nutritional deficiencies when in active disease and it is hypothesised that a disordered eating behaviour might be contributory to this. This study aimed to examine calorific intake, macronutrient choice and the prevalence of disordered eating behaviour in males and females with CD compared to healthy controls (HC).
Methods: 21 CD subjects (14M:7F, Age: 33.7±2.3, BMI: 25.1±0.9) and 21 HC (14M:7F, Age: 33.8±2.4, BMI: 25.1±0.6) were recruited to this matched pairs cross-sectional study. Main inclusion criteria were active CD defined by a Harvey-Bradshaw index (HBI) of ≥5 or faecal calprotectin >250ug/g or C-reactive protein >5mg/dl, or active disease seen at ileocolonoscopy or MRI. Calorific intake was assessed using a 24-h dietary recall procedure. Disordered eating was assessed using validated psychometric questionnaires [Binge Eating Scale (BES); Power of Food Scale (PFS); Control of Eating Questionnaire (CoEQ); Dutch Eating Behaviour Questionnaire (DEBQ); Three Factor Eating Questionnaire (TFEQ)]. Independent t-tests were conducted to examine the presence of disordered eating across groups. Trial registration number was NCT02379117.
Results: Patients had active disease with mean HBI of 5.5±0.5, faecal calprotectin of 595±157 ug/g and CRP of 10.3±3.8mg/dl. CD patients were characterised by higher scores on BES [p<0.001], TFEQ-Disinhibition [p<0.01] and Hunger [p<0.01], DEBQ-Emotional [p<0.001] and External eating [p<0.05], PFS [p<0.001] and by lower levels of CoEQ-Craving control [p<0.01] and CoEQ-Mood [p<0.001] compared to HC. There were no differences in dietary restraint measures. A greater proportion of CD patients (37%) scored above the clinical cut-off criteria for binge eating (>17 BES) compared to HC (0%) [χ2(1)=8.9, p<0.01] and BES score was negatively associated with CoEQ-Mood [r(39)=−0.512, p<0.001]. Scores on the Hospital Anxiety and Depression scale were higher in CD patients compared to HC [p<0.01]. There were no differences in calorific or macronutrient intake between groups.
Conclusions: Disordered eating behaviour traits were more prevalent in CD with active disease compared to HC. The greater prevalence of binge eating in CD may be attributed to the lower levels of mood and higher levels of anxiety observed in this group. The higher scores on measures of hedonic responsiveness (i.e. PFS, TFEQ-Disinhibition, DEBQ-External) in CD may be associated with increased food monitoring behaviour that occurs in patients with dietary-controlled conditions. Stronger psychological support with firm dietetic advice for healthy eating should be advocated in CD.