‘Sociocultural influences’ must factor into nutritional strategies for patients with IBD
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DENVER — Health care providers should apply cultural competency, sensitivity and humility when making dietary recommendations for patients with inflammatory bowel disease, noted a presenter at the Crohn’s and Colitis Congress.
“There is a rising prevalence of IBD in racial and ethnic groups in the United States,” Neha D. Shah, MPH, RD, CNSC, CHES, owner of Neha Shah Nutrition and senior dietitian at UCSF Health, said. “Given that population demographics are changing rapidly, and the United States will soon become a nation of minorities as the majority, social and cultural influences on food culture and diet acculturation become factoring concepts when learning how the food culture can use diet as part of treatment and management of IBD.”
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Understand food culture, diet acculturation
According to Shah, diet acculturation may lead patients to adopt the Western diet, which includes increased intake of refined carbohydrates, non-whole grains, added sugar and foods high in omega-6 fatty acids from animal protein, as well as a diet low in fiber.
“Although diet is not the sole risk factor for IBD, we want to be able to reduce intake of the Western diet and move toward the incorporation of fiber to aid in treatment and management of IBD,” Shah said.
In an interview with Healio, Shah said physicians must work backwards to apply cultural competence. “We must learn first what food groups, especially of fiber, are included and how, most importantly, they are used in the diet.”
She advised physicians to understand components of the diet before providing input and learn what works well — and what does not — for a patient. Then, she said, find ways to optimize the diet and make modifications, such as blending, mashing or chopping fruits and vegetables into smaller sizes, or consuming smaller portions.
To help find the right diet for patients with IBD, Shah noted it is important to first find the cultural fiber.
“With a focus on fiber, all food cultures will include some element of fruits, vegetables, whole grains and legumes,” she said. “The goal is what to add more often within their culture than to take away, so we can provide positive reinforcement for diet.”
For patients with active disease, Shah recommends including at least one cultural fiber to each meal, and for patients transitioning, she recommends reintroducing an extra half cup of cultural fiber to one meal, then to two meals and eventually to three meals. Patients in remission can add two to three foods with cultural fiber to each meal.
“If the patient is not comfortable with that, we select the number of meals, the portion, how often during the week that the patient can be comfortable with,” she said. “Again, we want to work backwards to learn a little bit more what that cultural cycle is.”
Cultural competence is key
According to Shah, it is imperative physicians learn sociocultural influences when evaluating nutritional strategies to successfully balance IBD management with food culture, especially when caring for patients of various races and ethnicities.
“As providers, we can gain expertise in how to apply concepts for cultural competence, cultural sensitivity and cultural humility to help us understand and appreciate how personal culture — food culture — can be to an individual.”
She continued, “Cultural competence is overall what we are aiming for, which involves the capacity to apply skills and function effectively to enhance cross-cultural communication in practice. In order to apply cultural competence, additional skills for cultural sensitivity and cultural humility will need to come in play, which involves awareness for cultural sensitivity and self-reflection and openness for cultural humility.”
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Shah ND, et al. Presentation Sp27. Presented at: Crohn’s and Colitis Congress; Jan. 19-21, 2023; Denver.
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