Diet Quality in Children and Adolescents with Gastrointestinal and Liver Disease

  • Author / Creator
    Alzaben, Abeer Salman
  • Assessment of overall diet quality (DQ), rather than single nutrient intake analysis, provides a broader view of an individual’s nutrition status. Overall DQ is assessed using DQ tools that evaluate overall nutritional quality including Adequacy, Moderation and Variety. The association between overall DQ and nutritional status and health related outcomes were reported using different DQ tools in healthy children and adolescents. The objectives of this thesis were to assess and compare overall DQ between children and adolescents with chronic gastrointestinal (Celiac Disease [CD] following a gluten-free diet) or liver disease (Non-Alcoholic Fatty Liver Disease [NAFLD]) and (children post-liver transplantation [LTX]) to lean children or disease control populations and to assess the interrelationships between overall DQ and anthropometric, body composition, health related quality of life (HRQOL) and cardio-metabolic dysregulation in children and adolescents with gastrointestinal and liver disease. Three studies were conducted to assess DQ between children with CD (n=30) and gastrointestinal disease no-CD control (CON) (n=49) (Chapter 3), between children five years post-LTX (n=27) and healthy controls (n=28) (Chapter 4), and between children with NAFLD (n=18) and healthy control (n=19) (Chapter 5). Overall DQ was assessed in different methods: DQ tools [Healthy Eating Index-Canada (HEI-C), Dietary Guideline Index for Children and Adolescents (DGI-CA), Diet Quality Index-International (DQI-I)], glycemic index (GI) and glycemic load (GL). DQ tools were adapted based on the Canadian recommendations for nutrients and the Alberta Nutrition Guidelines for Children and Youth. Data regarding anthropometric, HRQOL (self-reported and parent proxy), body composition, and/or markers of cardio-metabolic dysregulation were measured. In Chapter 3, the majority of children with CD were adherent to the gluten-free diet. No significant difference was found in age or Kcal intake between children with CD and CON. Children with CD had higher GI than CON but no significant difference in DQ scores and GL between children with CD and CON. Around 40-60% of children with CD and CON had moderate-to-poor DQ score. Children with CD reported higher HRQOL scores in physical, psychological, school and average scores than CON. The present of gastrointestinal symptomology, child age (>9 years) and gender (females) were negatively associated with HRQOL. Chapter 4 illustrates that no significant difference was found in age, Kcal, GI, GL and DQ between children post-LTX and healthy controls. Around 50-80% of children post-LTX and healthy controls had moderate-to-poor DQ scores. Chapter 5 shows no significant difference in age or Kcal intake between children with NAFLD. The majority of children with NAFLD and healthy controls 60-80% had poor DQ scores. Children with NAFLD had significantly lower total DQ, Adequacy and Moderation scores than healthy controls. Adequacy and Moderation scores are associated with obesity and cardio-metabolic dysregulation. This thesis demonstrates that children with CD, CON, and post-LTX have poor DQ. Children with NAFLD have reduced DQ compared to healthy controls. Poor DQ is indirectly associated with poor HRQOL in children with CD. In children with NAFLD, poor DQ is associated with obesity and cardio-metabolic dysregulation.

  • Subjects / Keywords
  • Graduation date
  • Type of Item
  • Degree
    Doctor of Philosophy
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
  • Language
  • Institution
    University of Alberta
  • Degree level
  • Department
    • Department of Agricultural, Food, and Nutritional Science
  • Specialization
    • Nutrition and Metabolism
  • Supervisor / co-supervisor and their department(s)
    • Mager, Diana (AFNS)
  • Examining committee members and their departments
    • Turner, Justine (Department of Pediatrics Division of Pediatric Gastroenterology & Nutrition)
    • Wismer, Wendy (AFNS)
    • Mazurak, Vera (AFNS)
    • Field, Catherine (AFNS, Chair of the Examination Committee)
    • Hanning, Rhona (Public Health and Health Systems, University of Waterloo)
    • Yap, Jason (Department of Pediatrics Division of Pediatric Gastroenterology