| Objective The overlap and repetition of functional gastrointestinal symptoms cause great physical and mental suffering.The study intended to design a personalized diet intervention of functional gastrointestinal disorders(FGIDs)based on computer and telecommunication technology,and evaluate the effect of the project to alleviate gastrointestinal symptoms,reduce frequent medical visits,reduce the burden of disease,and improve the quality of life of patients with FGIDs.It provides theoretical and practical basis for the extension of the individualized diet intervention and other personalized intervention of behavioral patterns.MethodsThe literature review was carried out to understand the research progress in related fields,and the systems theory,trans-theoretical model,social cognitive theory,self-determination theory,self-efficacy theory and incentive theory were used to carry out the development and organization of each stage of the personalized diet intervention program modules.Conduct Delphi method to develop intervention-related measures,intervention toolkit and the draft of related questionnaires.The pilot research was used to analyze and summarize various problems,and the relevant content and specific links of the intervention were revised and improved.Delphi method was used to finalize the intervention plan.The program editing and logic calculation were carried out by computer to assist researchers to complete the personalized diet intervention route.The project team used SQL Server database to manage various data information of patients,used Hypertext Preprocessor(PHP)programming language to develop the computer-aided system,and choosed Linux as the server operating system and Nginx as the server operating environment.A randomized controlled trial(RCT)was used to evaluate the effect of personalized diet intervention of FGIDs.Patients with gastrointestinal diseases were investigated in ten general hospitals in Anhui province.The patients who passed the qualification examination were recruited and surveyed by telephone.The main index to evaluate the intervention effect was the overall treatment effect(OTE)of gastrointestinal symptoms,and the secondary indexes included: 1)the scores of dietary behaviors(24 hours dietary review),2)Knowledge-Attitude-Practice(KAP)scores related to diet,3)Symptom manifestations(including the number,frequency and duration of symptoms),4)Quality of Life score(EQ-5D-5L),5)Evaluation of intervention compliance and satisfaction.Patients’ dietary behaviors such as regular meals,vegetables,coarse cereals,fruits,calories,fats,cured products,red meat protein and non-red meat protein were improved by short message service,feedback reports and telephone calls.Epidata 3.1 software was used for double data entry and consistency test,and SPSS 26.0software was used for statistical analysis.Cronbach’s α coefficient was used to evaluate the reliability of diet behaviors’ scores and gastrointestinal symptoms’ scores,principal component analysis and spearman correlation coefficient were used to evaluate the validity of diet behaviors’ scores,and principal component analysis was used to evaluate the validity of gastrointestinal symptoms’ scores.Frequency,rate and constituent ratio were used to describe the distribution characteristics between groups of variables for classified data,while median and inter-quartile range or mean±standard deviation were used to describe the distribution characteristics of variables between groups for continuous data.The influencing factors of various dietary behaviors were analyzed by binary Logistic regression analysis,the inter-group differences of various indicators were analyzed by t test,Chi-square test,variance analysis or Kruskal-Wallis,and the differences within each indicator group were analyzed by paired t test.ResultsIn this study,the personalized diet intervention scheme of FGIDs was generated by computer program,including the automatic mining and selection of gastrointestinal symptom-oriented diet intervention route and the design for tailoring personalized intervention.It can edit and send short messages,automatically generate personalized diet intervention plans,and generate feedback reports of gastrointestinal health management.Both reliability and validity of the gastrointestinal symptoms’ scores and diet behaviors’ scores of patients were fair ideal.A total of 679 patients were recruited and enrolled in the baseline investigation of the RCT.There were 320 males and 359 females with an average age of 47.90±13.788 years.The top five symptoms were bloating(34.8%),unformed or thin stools(26.2%),stomachache(23.9%),food reflux or acid reflux(19.9%),and hard stools or difficulty defecating(17.2%).Over half of the patients suffered from stomachache(58.0%),belching(63.4%),heartburn(69.6%),abdominal pain(57.1%),diarrhea(50.9%),unformed or thin stool(55.0%),and hard stools or difficulty defecating(90.6%),which lasted for 2-3 days.Among the three meals a day,the number of people who did not eat breakfast was the highest(5.7%)and lunch was the least(1.8%).In addition to three meals,36.1% of people had eating behaviors or extra meals.95.1%,25.2%,52.3%,100%,24.9%,17.2%,67.9% and 74.8% of patients who ate at least one meal a day of vegetables,coarse cereals,fruits,rice/noodles/starch,fats,cured products,red meat protein and non-red meat protein,respectively.The percentages of 3 or more types of vegetables,coarse cereals,fruits,rice/noodles/starch,fats,cured products,red meat protein and non-red meat protein intake were 38.6%,1.8%,1.6%,60.7%,0.4%,0.3%,0.7% and 10.6%.With the increase of age,vegetables intake showed an increasing trend(P<0.05).Compared with patients 35 years and younger,vegetables intake in patients aged 46-55,56-65 and 66-75 years old were 2.129 times,3.250 times and 2.797 times.With the increase of age,cured products intake showed an increasing trend(P<0.05).Compared with patients 35 years and younger,cured products intake in patients aged46-55,56-65 and 66-75 years old were 2.300 times,2.379 times and 2.804 times.With the increase of age,non-red meat protein intake showed an decreasing trend(P<0.05).Compared with patients 35 years and younger,non-red meat protein intake in patients aged 36-45,46-55,56-65 and 66-75 years old were 0.502 times,0.420 times,0.373 times and 0.258 times.The higher the education level,the higher the possibility of red meat protein intake,and showed an increasing relationship(P<0.05).Compared with patients with primary school education,the red meat protein intake of patients with high school/technical secondary school,junior college,bachelor’s degree or above was 1.875 times,2.362 times and 2.385 times.The higher the education level,the higher the possibility of non-red meat protein intake,and showed an increasing relationship(P<0.05).Compared with patients with primary school education,the non-red meat protein intake of patients with high school/technical secondary school,junior college,bachelor’s degree and above were 2.435 times,3.143 times and 3.913 times.After the intervention,the rate of OTE in the intervention group(76.1%)was higher than that in the control group(52.7%),P<0.001.The rate of symptom distinctly improvement in the intervention group(30.7%)was higher than that in the control group(22.4%),P<0.05.The symptom scores of stomachache,bloating,food reflux or acid reflux,belching,abdominal distension,diarrhea,unformed or thin stool,hard stools or difficulty defecating,and increased stool frequency in the intervention group were significantly lower than those in the control group(P<0.05),5.33±1.83 vs.6.92±2.03,5.89±1.55 vs.6.45±1.48,4.92±1.40 vs.6.38±1.65,5.11±1.35 vs.6.95±1.60,4.75±1.32 vs.6.91±1.89,4.04±1.59 vs.5.26±1.82,5.43±1.58 vs.6.48±1.42,5.45±1.08 vs.6.39±1.26,6.20±1.33 vs.7.50±1.62,respectively;and compared with baseline,the reduction of symptom scores in the intervention group was significantly higher than that in the control group(P<0.05).The scores of vegetables and coarse cereals intake in the intervention group were higher than those in the control group(P<0.05);and compared with baseline,the increase of vegetables and coarse cereals intake scores in the intervention group was higher than that in the control group(P<0.05).The caloric intake score of the intervention group was lower than that of the control group(P<0.05);and compared with baseline,the reduction of caloric intake score in the intervention group was higher than that in the control group(P<0.05).The scores of diet-related KAP and EQ-5D-5L utility index in the intervention group were significantly higher than those in the control group(P<0.05),1.69±1.03 vs.1.49±1.12,5.58±2.75 vs.5.04±2.73,1.97±1.33 vs.1.68±1.20,0.84±0.07 vs.0.82±0.09,respectively.Compared with baseline,KAP and EQ-5D-5L utility index scores increased significantly in the intervention group(P<0.001).72.2% of patients improved their diet habits according to the content of diet short messages.ConclusionIn the baseline of this study,the rate of high-calorie food intake such as rice and noodles in patients with FGIDs was the highest,followed by the rate of vegetables intake,and the lowest is the rate of cured products intake.These diet behaviors were affected by the patient’s gender,age,marital status,residence(urban or rural),education,occupation,visits for gastrointestinal diseases in the last three months and medication use.After three months of diet intervention,the OTE of symptoms in the intervention group was better than that in the control group.The improvement degrees of stomachache,bloating,food reflux or acid reflux,belching,abdominal distension,diarrhea,unformed or thin stool,hard stools or difficulty defecating,and increased stool frequency in the intervention group were higher than that in the control group.The intakes of vegetables,coarse cereals,fruits and non-red meat protein in the intervention group were higher than that in the control group,and the intakes of calories and fats in the intervention group were lower than that in the control group.The scores of diet-related KAP and EQ-5D-5L utility index in the intervention group were higher than those in the control group.In conclusion,after personalized diet intervention,gastrointestinal symptoms were relieved,diet-related cognition and quality of life were improved in the intervention group.This scheme is suitable for further popularization and research. |
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