Weight gain during diet therapy linked to ‘worse EoE outcomes’ no matter baseline weight
Click Here to Manage Email Alerts
Key takeaways:
- Patients with EoE who gained weight during dietary therapy had lower histologic, endoscopic and symptomatic responses.
- Obese or overweight patients and healthy patients experienced weight gain.
WASHINGTON — Among adults with eosinophilic esophagitis, weight gain while undergoing dietary therapy was associated with poor treatment response, regardless of baseline weight status, according to data presented at Digestive Disease Week.
“EoE prevalence has increased alongside the obesity epidemic,” Stephanie A. Borinsky, MD, a gastroenterology fellow in the department of pediatrics at University of North Carolina School of Medicine, told Healio. “While multiple treatment options exist for EoE, a significant challenge lies in identifying which patients will respond best to specific therapies. One particular area of interest is dietary therapy, which can be used as a first-line treatment for EoE.”
To determine whether a patient’s baseline weight or weight change during dietary therapy altered outcomes for patients with EoE, Borinsky and colleagues conducted a retrospective cohort study at a large academic medical center of patients with EoE (n = 169) undergoing elemental (1%), empiric (81%) and targeted elimination (18%) diets.
The researchers noted that among these patients, 57% of whom were overweight or obese, baseline characteristics and dietary treatment types were similar between those with overweight or obesity and those with healthy weight.
Borinsky and colleagues used bivariate and multivariable analyses to examine the relationship of BMI (overweight/obesity: BMI > 25; healthy weight: BMI = 18.5-24.9) and weight gain on treatment response, as defined by global symptom, endoscopic and histologic responses (< 15 eosinophils/high-powered field, with added assessment of ≤ 6 and < 1 eosinophils/high-powered field).
According to study results, weight gain with diet therapy occurred in 38% of patients with overweight or obesity and 37% of patients with healthy weight (P = .88) without varying by diet type (P = .22).
“Patients with EoE and obesity responded similarly to dietary therapy as patients with a healthy weight,” Borinsky said. “This suggests that weight shouldn’t automatically exclude someone from trying dietary therapy for EoE.”
However, compared with patients who exhibited no weight gain during dietary therapy, those who did gain weight experienced lower histologic response at < 15 (19% vs. 47%, P < .001), < 6 (13% vs. 38%, P < .001) and < 1 (5% vs. 16%, P = .03), lower endoscopic response (47% vs. 61%, P = .07) and lower symptomatic response (56% vs. 72%, P = .03).
“An interesting finding from this study was that patients who gained weight during dietary therapy actually had worse EoE outcomes,” Borinsky told Healio. “This could be a sign of treatment nonadherence, or it could be related to the underlying pathophysiology of EoE itself.”
In their multivariable logistic regression, the researchers reported that a 1-unit rise in BMI with dietary therapy was linked to a decline in the odds of histologic response at < 15 (adjusted OR = 0.65; 95% CI, 0.44-0.95), ≤ 6 (aOR = 0.66; 95% CI, 0.45-0.98) and < 1 (aOR = 0.61; 95% CI, 0.39-0.96) and symptom response (aOR = 0.5; 95% CI, 0.3-0.84).
“Gastroenterologists should recommend dietary therapy to any EoE patient interested in trying it, regardless of their weight status,” Borinsky said. “If a patient gains weight and their EoE is not improving on the diet, gastroenterologists should investigate the cause of weight gain and consider whether to retry dietary therapy or transition to another EoE treatment.”
Perspective
Back to Top
David Gardinier, RD, LD
Dietary therapy is an effective treatment option for patients with EoE. Despite this, we do not have a good understanding of why some people respond to dietary therapy and others do not. This study aimed to help fill that gap by assessing the influence of weight and BMI on the response to dietary therapy in EoE.
Interestingly, the patients’ BMI at the time of diagnosis didn’t change their likelihood to respond to diet therapy. The amount of weight patients gained during the dietary treatment itself made a significant difference. This study informs us that it may be important for patients to avoid weight gain during diet therapy to help improve their disease outcomes.
The big question is: How do we help patients avoid gaining weight on these dietary therapies? Ninety-nine percent of patients in this study were following a form of elimination diet for EoE, which can exclude foods such as dairy, wheat, eggs, soy, fish, shellfish, peanuts and tree nuts for multiple weeks — or even months. Many of these foods in their natural form are associated with a healthy diet pattern.
Whenever we remove food from the diet, we always must ask: What will the patient replace this food with? If patients are not being counseled by a registered dietitian on how to follow these elimination diets, there is a risk that patients will replace eliminated foods with higher calorie alternatives and gain weight.
One big take-home point of this study is that it further emphasizes the role of a registered dietitian in the multidisciplinary team approach to caring for patients with EoE.
Collapse
Borinsky SA, et al. Weight gain is associated with decreased treatment response to diet therapy in adults with eosinophilic esophagitis. Presented at: Digestive Disease Week; May 18-21, 2024; Washington (hybrid).
Read more about
Click Here to Manage Email Alerts