| Objectives:Referred to as "nonlethal cancer," ulcerative colitis(UC)is distinguished by persistent and recurring intestinal symptoms.The role of diet in UC is significant,as scientific dietary management not only aids in controlling the occurrence and relapse of UC but also serves as a supplementary treatment.However,the current state of dietary management for UC patients in China is suboptimal,necessitating the establishment of a scientific support system for dietary management.Consequently,utilizing the multiphase optimization Strategy(MOST)theory,we developed a dietary management model that incorporates automatic dietary assessment,intelligent dietary decision support and standardized dietary management to improve the quality of lifeand health management level of UC patients.Methods:This study was conducted in three phases,guided by the MOST theory.1.Screening stage.A survey was administered to 327 UC patients from four general hospitals in Nanjing,aiming to gain a comprehensive understanding of the beliefs,behaviors,and influencing factors related to dietary management among UC patients.Subsequently,a subset of 148 patients in remission was selected for analysis to determine the characteristics of their dietary patterns.Additionally,employing the integrated change model(ICM),the distribution of stages and factors influencing the dietary behavior of UC patients were examined to identify key interventions.2.Refining stage.The stage involved the comprehensive collection of the most recent clinical evidence in accordance with the principles of evidence-based medicine theory,resulting in the formation of an evidence summary pertaining to the dietary management of adult patients with UC.Additionally,the core interventions were carefully selected based on survey results and group discussions,and the dietary management model was further enhanced through applicability testing and expert deliberation.Ultimately,the design of the Wechat applet "HealthyGut" was accomplished.3.Confirming stage:The study employed a randomized controlled design,wherein a total of 112 patients diagnosed with UC were recruited from four general hospitals in Nanjing.These patients were then randomly assigned to either the intervention group(n=60)or the control group(n=52).Over a period of three months,the intervention group received a diet management model,while the control group received routine diet guidance.The objective of this study was to assess the impact of these interventions on the diet quality,health-related behavior change,and quality of life of UC patients.The findings from this study were subsequently utilized to optimize the dietary management program for UC patients.Results:1.Main results in screening stage:(1)A significant proportion of UC patients,specifically 53.8%,maintain a positive belief regarding the role of diet in managing their disease.Upon diagnosis,a substantial majority,97.6%,exhibited modifications in their dietary habits and adopted healthier eating behaviors.These changes included regular meal consumption by 84.4%of patients and the utilization of necessary dietary supplements by 44.3%.However,there is a need for further attention to be given to more restrictive eating behaviors.(2)Acquiring comprehensive and specialized dietary knowledge is of utmost significance for individuals diagnosed with UC.A significant proportion of patients have primarily relied on gastroenterologists,health brochures,fellow patients,and online sources for dietary guidance.Nevertheless,it is crucial to acknowledge the insufficiency of specialized guidance from dietitians,which may lead to potential inaccuracies in dietary management.(3)The dietary nutritional status of UC patients in remission can be considered relatively satisfactory,with a slight imbalance observed.This imbalance primarily manifests in the inadequate consumption of dietary fiber and micronutrients,as well as a slightly excessive intake of grain,livestock,and poultry.Additionally,there appears to be an insufficient intake of fruits,milk and dairy products.(4)The intention and action stage of dietary management is prevalent among over 90%of UC patients.The transformation of stages is influenced by several crucial factors,including willingness,self-efficacy,the progression of the disease,and resilience.2.Main results in refining stage:(1)A comprehensive review was conducted to examine the dietary management strategies for adult patients with ulcerative colitis(UC).This review encompassed various aspects such as nutritional risk screening,assessment of nutritional status,determination of nutrient requirements,implementation of nutritional treatment,provision of dietary suggestions,consideration of perioperative nutritional support,evaluation of nutritional needs during pregnancy and lactation,resulting in the formulation of 43 evidence-based recommendations.(2)A dietary management program for UC patients was developed based on the MOST(Multidimensional Optimization and Supportive Therapy)theory.This program incorporated a thorough assessment process,including comprehensive evaluation and dynamic monitoring,leading to the provision of tailored dietary recommendations to optimize the management of UC.(3)The study constructed a dietary management model for patients with UC,incorporating an intelligent diet management platform called "HealthyGut" WeChat applet.This platform consists of various functional modules,including user management,diet record,diet evaluation,and diet suggestion.It offers automatic dietary assessment,intelligent dietary decision support,and standardized dietary management.Main results in confirming stage:The implementation of dietary management model helps to enhance the dietary quality and self-efficacy of UC patients.Conclusion:The theory-based diet management model for patients with UC,which incorporates automatic dietary assessment,intelligent dietary decision support,and standardized dietary management,has been found to enhance the diet quality and selfefficacy of individuals with UC. |
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