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18 OSTOMY WOUND MANAGEMENT® MAY 2018 www.o-wm.com
FEATURE
A Cross-sectional Study of Nutritional
Status, Diet, and Dietary Restrictions
Among Persons With an Ileostomy
or Colostomy
Ana Lívia de Oliveira, DSc; Ana Paula Boroni Moreira, DSc; Michele Pereira Netto, DSc; and
Isabel Cristina Gonçalves Leite, DSc
Abstract
Little is known about the nutritional status and dietar y habits of persons with an intestinal stoma, and no specifi c di-
etary guidelines have been established. A cross-sectional study was conducted among patients of a Stoma Patient
Health Care Service in Juiz de Fora, Brazil, to compare the nutritional status of persons with an ileostomy or colostomy
and to evaluate which foods are avoided most frequently and why. Anthropometric measurements (weight, height, arm
circumference, and triceps and subscapular skinfold thickness) and body fat were assessed. Habitual dietary intake
(energy, protein, carbohydrate, fi ber, fat, calcium, iron, sodium, potassium, thiamin, ribofl avin, vitamin B6, vitamin B3
[niacin], and vitamin B12) was assessed using a validated quantitative food frequency questionnaire. Foods avoided and
reasons for avoidance (increased odor, increased gas, increased output, constipation, appliance leakage, and feelings
regarding leaving home) were assessed. All data were collected without personal identifi ers and stored in electronic fi les.
Data were analyzed descriptively, and the Student’s t test or Mann-Whitney test was used to compare the groups. Chi-
squared analysis with Yates’ continuity correction or Fisher’s exact test was employed to examine the differences in the
frequency of avoided foods by reasons for avoidance between the 2 groups. Of the 103 participants (52 [50.5%] men,
51 [49.5%] women; mean age 60.5 ± 12.9 years); 63 (61.2%) had a colostomy and 40 (38.8%) had an ileostomy. For both
groups combined, time since surgery ranged from 1 to 360 months. Anthropometric measurements and body composi-
tion did not suggest nutritional defi ciencies and did not differ signifi cantly between groups. Persons with an ileostomy
had a signifi cantly lower fat and niacin intake than persons with a colostomy (P <.05). No other dietary intake differences
were observed. Avoiding foods due to appliance leakage was more common among participants with an ileostomy (8,
20%) than a colostomy (3, 4.8%), and vegetables and fruits were reported as the most problematic foods. None of the
other cited reasons was signifi cantly different. The results of this study confi rm that many persons with a stoma adjust
their dietar y intake and avoid certain foods which, especially in persons with an ileostomy, may increase their risk for
nutritional defi ciencies. Additional research to assess dietary intake and nutritional status variables as well as patient
needs is needed to facilitate the development of specifi c nutritional status monitoring and dietary recommendations for
persons with an ileostomy or colostomy.
Keywords: cross-sectional study, colostomy, ileostomy, nutritional status, food preferences
Index: Ostomy Wound Management 2018;6 4(5 ):18–2 9 doi: 10. 25270/owm. 2018.5 .1829
Potential Confl icts of Interest: The study was supported by a Brazilian government organization (FAPEMIG; APQ
03 502 /13).
Dr. Oliveira, Dr. Moreira, and Dr. Netto are Adjunct Professors, Department of Nutrition; and Dr. Leite is a CNPq Productivity Sponsorship (Process 301101/2016-7)
and an Associate Professor, School of Medicine, Department of Public Health, Federal University of Juiz de Fora, Minas Gerais, Brazil. Please address correspon-
dence to: Ana Lívia de Oliveira, Department of Nutrition, Federal University of Juiz de Fora – UFJF, José Lourenço Kelmer, s/n Campus Universitário, CEP 36036-330,
Juiz de Fora, Minas Gerais, Brazil; email: analivia.oliveira@ufjf.edu.br.
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NUTRITION AND ILEOSTOMY/COLOSTOMY
The Greek word stoma describes a surgically created open-
ing that allows externalization of digestive, respiratory,
and urinary system functions. In the digestive system, a sto-
ma is created when it is necessary to deviate (temporarily or
permanently) the normal transit of food and/or elimination
of stool.1-3 Patients are provided an ileostomy or colostomy as
a result of a variety of medical conditions, including colorec-
tal cancer, congenital disorders, trauma, infl ammatory bowel
disease, intestinal obstruction, diverticulitis, and trauma.
Among the clinical situations mentioned, colorectal cancer is
the most prevalent.4,5
The intestinal stoma negates voluntary control of physi-
ological elimination,6 making the person with a stoma de-
pendent on an external collection device (stoma pouch) that
can affect body image and self-esteem as well as social activity
and employment capability and productivity. According to a
prospective study,7 persons with stomas may face problems
adapting to and learning how to manage their new anatomy.
The stoma interrupts the absorptive process at the point
where it is created, affecting the nature of output and the
individual’s ability to absorb nutrients from food. It is nec-
essary to evaluate the patient’s eating behavior because the
stoma can bring specifi c changes depending on the intestinal
region where it is formed (ileum or colon).8 An ileostomy is
placed in the small intestine where nutrients are absorbed,
resulting in liquid to semi-liquid stools with abundant diges-
tive enzymes that continuously exit the body. According to
an intervention study,9 a literature review,10 and a nutrition
guide,11 persons with an ileostomy may incur nutritional
losses of calcium; magnesium; iron; vitamins B12, A, D, E, and
K; folic acid; water; protein; fat; and bile salts.9-11 A colostomy
is placed in the colon region (sigmoid colon, ascending, de-
scending, or transverse), and fecal formation is intermittent,
with near normal defecation ranging from semi-liquid or
hard stools with little or no nutritional loss.9-11
Eating habits can signifi cantly affect the lives of ostomates,
positively or negatively infl uencing the process of adaptation
to a stoma. A qualitative, descriptive, exploratory study12 re-
vealed it is common for persons with a stoma to stop eating
or to stop eating foods essential to maintaining proper nutri-
tional support in order to resume their social life. According
to a review by Cronin,13 dietary advice provided to patients
before and after stoma surgery, especially in the fi rst month,
is important for their rehabilitation. A cross-sectional study14
has shown patients with a colostomy or ileostomy need in-
dividualized nutritional guidance to make appropriate food
choices over time.
The literature contains little information regarding nu-
tritional status and dietary habits and does not put forth
specifi c dietary recommendations for persons with a stoma.
Within this context, the purpose of this study was to compare
the nutritional status of patients with an ileostomy or colos-
tomy and evaluate the foods they avoid most frequently and
their reasons for doing so.
Methods and Procedures
Study design and sample. This was a cross-sectional study
of patients served by the Stoma Patient Health Care Service
in Juiz de Fora, a city of approximately 564 000 inhabitants
in southeastern Brazil. This Service provided care for 428 pa-
tients monthly. The study was conducted between September
2014 and August 2015. All patients were contacted by tele-
phone and invited to participate as volunteers in the research.
The inclusion criteria stipulated participants must have an
intestinal stoma (ileostomy or colostomy), be at least 18 years
of age, and be physically and mentally capable of completing
the interview. All volunteers gave their written informed con-
sent after being provided with oral and written information
about the study aims and protocol.
The study was approved by the Human Research Eth-
ics Committee, Federal University of Juiz de Fora (protocol
number 516.306).
Anthropometrics and body composition. Weight, height,
arm circumference, and triceps and subscapular skinfold
thickness were assessed by trained research personnel. Par-
ticipants were instructed to wear light clothing and to remove
any heavy objects before measurement sessions. Weight was
measured using a digital weighing scale, and height was mea-
sured using a wall-mounted stadiometer. Body mass index
(BMI) was calculated from weight and height measurements.
Arm circumference was measured with a fl exible measuring
tape. Triceps and subscapular skinfold were measured using
the Lange skinfold caliper. Body fat was measured via bio-
impedance (Tanita Corporation, Tokyo, Japan).
Key Points
• Information about the dietary needs and practices of
persons with an ileostomy or colostomy is limited.
• The authors conducted a study among 103 persons
with an ileostomy or colostomy to assess their nutri-
tional status and dietary intake and to evaluate food
avoidance practices.
• Anthropometric measurements and dietary intake re-
ports did not indicate nutritional defi ciencies, although
persons with an ileostomy consumed signifi cantly less
fat and niacin than persons with a colostomy.
• Many patients reported avoiding a variety of foods to
reduce the risk of increased gas, odor, stoma output,
constipation, or appliance leakage, with the latter be-
ing signifi cantly more likely to be reported by persons
with an ileostomy.
• Additional studies to increase knowledge about the
nutritional status, dietary requirements, and limita-
tions of persons with a gastrointestinal stoma are
needed to develop monitoring and dietary guidelines.
Ostomy Wound Management 2018;64(5):18–29
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FEATURE
Dietary intake assessment. Dietary intake was assessed
using the quantitative Food Frequency Questionnaire (FFQ)
adapted from the questionnaire developed by Ribeiro and
Cardoso,15 which was previously validated for use in studies
involving chronic diseases. Each patient completed the FFQ
with the assistance of a trained researcher. Participants were
asked to report their usual frequency of consumption of spe-
cifi c foods. The FFQ used for this study was composed of 106
items that focused on 11 food groups (dairy products, meats
and by-products, cereals, breads, fruits, vegetables, legumes,
nuts and oilseed, sweets, fats, and drinks). Portion size was
assessed using standard food measurement utensils. FFQ
data were analyzed using food composition tables.16-18 Addi-
tional information on nutritional composition was collected
from food labels where applicable.
A questionnaire was developed to ascertain whether
stoma patients excluded some food from their eating rou-
tine and the reasons for avoidance. The effects of food on
the stoma were grouped into 6 possible reasons/responses:
increased odor, increased gas, increased output, constipation,
appliance leakage, and leaving home. Appliance leakage re-
ferred to the displacement of the collector pouch affi xed to
the abdomen. Leaving home referred to foods patients avoid
consuming before leaving home to offset possible discom-
fort. Patients could choose more than 1 response, and they
were asked to list such foods and highlight those that were
the most problematic.
Data collection. The first author trained a team of nu-
trition students to participate in patient assessment on the
selected measurement day. All data were collected using
a standardized form developed for the study and stored
electronically. Researchers completed the paper-and-pencil
FFQ by individually asking patients the questions when
they visited the Service for care. Information such as gen-
der, age, type of ostomy, and duration of the stoma were
obtained directly from medical records. Patient identity was
kept anonymous, and patients had the option to refuse to
participate with no repercussions.
Statistical analysis. Results from the anthropometrics
and body composition data and dietary intake were entered,
processed, and analyzed using SigmaPlot, version 12.0 (Sy-
stat Software, Inc, San Jose, CA). Demographic and clini-
cal variables were descriptively analyzed. Parametric and
nonparametric tests were used based on normality testing
(Shapiro-Wilk) and variance homogeneity (Levene) tests.
Data are represented as mean ± standard deviation (SD).
The Student’s t test or Mann-Whitney test was used to com-
pare the groups (patients with an ileostomy versus those
with a colostomy). Chi-squared analysis with Yates’ conti-
nuity correction or Fisher’s exact test, where appropriate,
was employed to examine the differences in the frequency
of avoided foods according to the reason for ileostomy and
colostomy patients. A 5% signifi cance level was considered
for analysis.
Results
Of the 428 intestinal ostomy patients in the service, 103
met the inclusion/exclusion criteria and/or agreed to partici-
pate in the study; 51 (49.5%) were women, 52 (50.5%) were
men, 40 (38.8%) had an ileostomy, and 63 (61.2%) had a co-
lostomy. Mean patient age mean age was 60.5 ± 12.9 (range
25–94) years. Time living with the stoma varied greatly
among patients (range 1–360 months). Most patients with
ileostomy (23 [57.5%]) and colostomy (42 [66.7%]) had the
stoma >1 year.
Anthropometric (weight, BMI, arm circumference, triceps
and subscapular skinfold) and body composition (body fat)
measurements did not differ signifi cantly between groups
(see Table 1). Eleven (11) patients (2 with an ileostomy and
9 with a colostomy) refrained from having their triceps, sub-
scapular skinfold, and body fat measurements taken. The
dietary data from the FFQ showed habitual dietary intake
(energy, protein, carbohydrate, fi ber, calcium, iron, sodium,
potassium, thiamin, ribofl avin, vitamin B6, and vitamin B12)
was not different between groups, except for fat and niacin.
In the present study, patients with an ileostomy had signifi -
cantly lower fat intake (58.5 ± 38.5 g and 24.3% ± 7.9%) and
niacin levels (13.7 ± 9.2 mg) compared to patients with a co-
lostomy (fat: 82.5 ± 62.8 g and 27.9% ± 6.6%; niacin: 17.9 ±
12.4 mg) (see Table 2).
As might be expected, signifi cantly more ileostomy pa-
tients (20%) avoided foods for fear of appliance leakage com-
pared with colostomy patients (4.8%), and vegetables and
fruits were reported as the most problematic (see Table 3).
The other reasons (increased odor, increased gas, increased
Table 1. Anthropometric and body composition
characteristics of persons with an ileostomy or
colostomy
Ileostomy
(n=40)
Colostomy
(n=63) Pa
Age (years) 60.1±12.9 6 0.8±13 .0 .781
Weight (kg) 68 . 9 ±16 .1 6 9 . 5 ±16 .7 .997
BMI (kg/m2)26.5±5.4 27.0±6.3 .842
AC (cm) 30.1± 4 . 7 30.2±5.9 .704
Ileostomy
(n=38)
Colostomy
(n=54) Pa
TS (mm)b18.7±8.8 20.4±10.8 .689
SS (mm)b19.5±9.2 23.1±10.3 .089
Body fat (%)b28 .1±10. 2 2 7. 8 ±11. 3 .837
Data ar e repre sente d as mea n ± SD; aStude nts t test o r Mann-Whitney
test; b11 patients refrained from measurement
BMI=bo dy mass index; AC= arm circumferen ce; TS= triceps skinfold;
SS=subscapular skinfold
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FEATURE
output, constipation, and leaving home) reported for avoid-
ing food consumption were similar between groups.
Discussion
Whether temporary or permanent, stomas result in physi-
cal changes and may result in dietary restrictions on patients.
The amount of intestine remaining after an intestinal stoma
is created will determine the individual’s capacity for normal
nutritional absorption from food and beverages, making it
crucial for health care professionals involved in caring for
persons with a stoma to be aware of the type of stoma cre-
ated, the length of proximal bowel remaining, and the impli-
cations for absorption of nutrients to provide optimal nutri-
tional advice and support.19 To the authors’ knowledge, this
is the fi rst time the nutritional status, diet, and foods most
frequently avoided have been compared between ileostomy
and colostomy patients.
In the present research, the study population had an aver-
age age of 60.5 years, similar to other cross-sectional stud-
ies involving Italian20 and Brazilian21 patients with a stoma.
Many patients undergoing stoma surgery are older and have
colorectal cancer as the cause of the ostomy, which has a posi-
tive association with age, as shown in qualitative22 and pro-
spective23 studies. In this study, anthropometric character-
istics and body composition did not differ between persons
with an ileostomy and those with a colostomy. Cross-section-
al study data24 suggest that, based on the reported mean BMI
(26.8 kg/m2) and body fat (33.8% for women and 21.5% for
men), participants in this study did not have nutritional defi -
cits. A BMI of 18.5 to 24.9 kg/m2 is generally accepted as the
optimal range, although there is some debate about the ideal
reference range for older adults. According to a cross-sectional
study by Bahat et al,25 a BMI cutoff point of 25 kg/m2 may be
restrictive for older adults. In fact, the patients in the present
study must have a body reserve, considering their age. Ac-
cording to a review by Gary and Fleury,26 older patients often
are unable to maintain a nutrient intake adequate to meet
their rising metabolic demands when physiological demands
increase, such as during an acute illness. As a result, protein
and energy stores may be depleted, exacerbating weaknesses
and contributing to a decline in functional status.26 Addition-
ally, most persons with a stoma have an underlying disease
with an impact on nutritional status.14
The authors used arm circumference, triceps, and sub-
scapular skinfold measurements because of the diffi culty of
assessing any measure in the abdominal area due to the pres-
ence of the stoma itself, the collection pouch, and the poten-
tial presence of complications such as parastomal hernia.27
Despite not having specifi c anthropometric recommenda-
tions for this population, the measures assessed in this study
are valid for monitoring nutritional status.
Energy intake was similar between the groups, although
ileostomy patients had an energy intake approximately 20%
lower than colostomy patients, owing to lower fat intake. Al-
though no specifi c energy recommendations exist for stoma
patients, daily energy intake of ileostomy patients (2046 kcal,
on average, for men and women) was similar to World Health
Organization28 (WHO) recommendations (2090 kcal, on
average, for men and women). The mean energy intake of
colostomy patients was 2579 kcal and the WHO recommen-
dation28 was 2088 kcal — the usual intake was 23.5% higher
than the recommendation. In fact, the anthropometric as-
sessment showed no depletion of nutritional status or body
weight as a result of energy intake.
Decreased fat consumption in the ileostomy group occurs
because intestinal transit is faster and effl uent are more liq-
uid having not passed through the colon. As a result, persons
with an ileostomy produce a higher volume of effl uent.19 Fat
Table 2. Energy, macronutrients (g and percenage
of total energy intake), fi ber, and micronutrient
consumption of patients with ileostomy or
colostomy
Ileostomy
(n=40)
Colostomy
(n=63) Pa
Energy (kcal) 2046.6±938.2 2579.4± 697.4 .293
Protein (g) 91.6±56.1 101.8±66.4 .605
Protein (%) 17. 4 ± 5.1 16.6±5.4 .261
Carbohydrate
(g) 288.2±9.0 3 5 7. 2 ± 24 0 . 4 .407
Carbohydrate
(%) 58 .4 ±1.1 55.4±8.5 .131
Dietary fi ber
(g/day) 2 7. 2 ±13 . 7 2 8. 5 ±1 7. 2 .763
Fat (g) 58.5±38.5 82.5±62.8 .0 41
Fat (%) 24. 3 ± 7. 9 27. 9± 6 . 6 .012
Calcium (mg) 6 77. 1± 5 4 2 . 5 782.9± 72.7 .266
Iron (mg) 9.9±5.7 12.2±11.2 .509
Sodium (mg) 1743.5±1336.0 2197.8±1880.8 .18 1
Potassium
(mg) 2519.6±1154.5 2725.4±1404.4 .591
Thiamin (mg) 4.3±3.7 6.0±5.4 .098
R i b o fl a v i n
(mg) 1.0±0.4 1.2±0. 9 .697
Vitamin B6
(mg) 0.9±0.4 1.0±0.7 .933
Niacin (mg) 13.7±9.2 17. 9 ±12 . 4 .045
Vitamin B12
(µg) 0.1±0.2 0.2±0.5 .414
Data ar e repre sente d as mea n ± SD; aStude nts t test o r Mann-Whitney test
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FEATURE
may facilitate the stool movement, so ile-
ostomy patients may consume less fat for
fear of increased intestinal output. The
potential consequences are defi ciencies
in calories, essential fatty acids, and fat-
soluble vitamins.
The consumption of niacin (vita-
min B3) also was lower in the ileostomy
group. Due to the wide distribution of
this vitamin in the food supply, niacin
defi ciencies are rare, but minor defi -
ciencies of niacin can occur in chronic
gastrointestinal disorders that lead to
malabsorption.29 Because persons with
a stoma (especially an ileostomy) have
accelerated intestinal transit and may
have malabsorption as a result of bowel
resection,23,30 it is possible they have a
loss of niacin absorption in addition to
possible reduced intake shown in this
study. Therefore, it is essential to moni-
tor blood levels of this vitamin.
The intake of fi ber and other nutrients
did not differ between groups. Because
no specifi c dietary recommendations
exist for persons with a stoma, compari-
sons were not possible. However, it is
essential for the nutritionist to be aware
of possible nutritional defi ciencies. For
example, without a functioning colon,
patients with ileostomy will lose 50 to 80
mmols of sodium daily.31 According to
a review by Fulham,19 this generally can
be replaced by adding the equivalent of
an extra teaspoonful of salt daily to food.
Screening and monitoring the nutritional
status of individuals with a stoma should
be an ongoing process, beginning preop-
eratively and continuing after discharge
from hospital.
Because they fear leaking of effluent
and injuries to peristomal skin, stoma
patients have strong concerns about
appliance leakage. These patients have
a high-output stoma with a higher
concentration of digestive enzymes
that can dissolve the hydrocolloid and
erode the skin.32 In this study, patients
with an ileostomy showed greater fear
of appliance leakage and subsequently
avoided more foods, especially veg-
etables and fruits. From the nutritional
point of view, maintenance of healthy
peristomal skin is vital because it allows
Table 3. Foods that patients with an ileostomy (n=40) or colostomy
(n=63) said they avoid most frequently and reasons
Ileostomy
n (%)
Colostomy
n (%)
Pa
Increased odor 11 ( 2 7. 5) 8 (12.7) .1 0 4
Vegetables (garlic, onion, cabbage,
chili, collard greens, caulifl ower)
8 (20) 6 (9.5)
Fruits (orange) 0 (0) 1 (1.6)
Legumes (bean) 1 (2.5) 1 (1.6)
Meat (pork, chicken, fi sh) 2 (5) 3 (4.8)
Eggs 4 (10) 0 (0)
Dairy (milk) 0 (0) 1 (1.6)
Condiments (unspecifi ed) 0 (0) 1 (1.6)
Increased gas 16 (4 0) 32 (50.8) .386
Cereals (corn, pasta) 0 2
Vegetables (garlic, onion, lettuce,
cabbage, chili, collard greens,
caulifl ower, broccoli, okra, potatoes,
sweet potatoes)
11 19
Fruits (plum, banana, orange, papaya,
persimmon, coconut)
2 5
Nuts (peanut) 1 0
Legumes (bean, lentil, chickpea) 6 9
Meat (beef, chicken, sausage) 0 4
Eggs 2 0
Dairy (milk, cheese) 2 5
Fatty foods (unspecifi ed, butter) 0 2
Beverages (soft drink) 4 5
Increased output 13 (32.5) 26 (41.3 ) .493
Cereals (high-fi ber cereal, corn,
cake, bread)
1 2
Vegetables (lettuce, cabbage, collard
greens, green bean, beet, carrot, okra,
tomato, potato)
5 6
Fruits (orange, papaya, pineapple) 613
Legumes (bean) 1 3
Meat (codfi sh, sausage) 1 1
Dairy (milk, cheese, cream, yogurt) 7 (17. 5) 8 (12.7)
Fatty foods (unspecifi ed, mayonnaise,
sauce, ice cream)
2 3
Beverages (coffee, alcohol) 0 2
Constipation 3 ( 7. 5) 13 (20.6) .13 0
Cereals (corn, rice, grain, pasta, fl our) 3 6
Vegetables (potato) 1 0
continued on next page
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FEATURE
good stoma pouch adhesion.33 Accordingly, dietary guid-
ance is required because it influences wound healing and
alters stool quantity, frequency, and consistency.2
On average, ileostomy output consists of 600 mL to
800 mL liquid or very soft effl uent per 24 hours, with little
odor.32 The person with a colostomy naturally produces
formed stools with a characteristic smell and tends to im-
pose dietary restrictions for fear of odor.34 However, in this
study no difference regarding fear of increased odor was
noted between groups, suggesting that persons with an il-
eostomy are just as fearful of odor as persons with a colos-
tomy. Dietary guidelines may increase patient confi dence
in food choices, including suggestions
about foods that can control odor,
such as buttermilk, yogurt, cranberry
juice, parsley, and tomato juice.2 In
addition, products such as activated
charcoal added to the stoma pouch
can help reduce odor.35
Fear of increasing stoma output
was described as a reason for dietary
restrictions by both study groups.
It is not known whether the fear of
increasing stoma output is related
to a fear of loose stools or not. If
loose stools are a problem that can-
not be resolved with medication or
dietary changes, a stoma special-
ist nurse should be consulted or the
patient can try a binding agent such
as loperamide under medical super-
vision.36 It is important to consider
that often in the context of care for
persons with a stoma, it is observed
that eating habits are associated with
various myths, and while some be-
liefs with no scientific basis on diet
may be harmless, others may have
serious implications for health and
well-being.12 Fear of constipation
was reported less frequently by study
participants. Although a review of
the literature36 found constipation
is more common in colostomy pa-
tients, differences in the fear of this
occurrence were not observed be-
tween groups in this study. If the
person with a colostomy was prone
to constipation or loose stool before
the stoma-forming surgery, this is-
sue will likely endure long-term.36,37
To prevent constipation, patients
should be advised to consume ad-
equate amounts of fluids and fiber,
especially fruit and vegetables.36,37
In a cross-sectional study by Floruta,34 increased gas
was among the main problems reported by both colosto-
my and ileostomy patients. This also was observed in the
current study as the most reported fear, with no difference
between the groups. Avoidance of certain foods such as
green vegetables, onions, beans, and carbonated beverages
might be useful. Moreover, it is beneficial to guide the pa-
tient to refrain from talking while eating to avoid swallow-
ing air.1 However, the nutritionist should assess each pa-
tient individually so dietary self-restrictions do not harm
nutritional status.
Table 3. Foods that patients with an ileostomy (n=40) or colostomy
(n=63) said they avoid most frequently and reasons
Ileostomy
n (%)
Colostomy
n (%)
Pa
Fruits (banana, apple, guava) 2 8
Eggs 0 2
Dairy (cheese) 0 1
Fatty foods (unspecifi ed) 0 1
Appliance leakage 8 (20) 3 (4.8) .035
Cereals (corn) 1 0
Vegetables (leafy unspecifi ed) 2 0
Fruits (orange, pineapple, guava) 2 0
Nuts (unspecifi ed) 1 0
Legumes (lentil) 0 1
Fatty foods (sauce) 1 0
Beverages (coffee, alcohol) 1 1
Flatulent foods (unspecifi ed) 1 0
Leaving home 7 (17. 5 ) 2 0 (31.7) .170
Cereals (high-fi ber cereal, rice, noodle,
bread, biscuit)
1 (2.5) 3 (4.8)
Vegetables (leafy unspecifi ed,
cabbage, caulifl ower, broccoli)
2 (5) 4 (6.4)
Fruits (banana, orange, papaya) 1 (2.5) 3 (4.8)
Legumes (bean) 1 (2.5) 2 (3.2)
Meat (unspecifi ed) 0 (0) 2 (3.2)
Eggs 1 (2.5) 0 (0)
Dairy (unspecifi ed) 0 (0) 2 (3.2)
Fatty foods (unspecifi ed, pudding,
ice cream)
0 (0) 4 (6.4)
Beverages and liquids (unspecifi ed,
coffee, juice)
0 (0) 3 (4.8)
Flatulent foods (unspecifi ed) 1 (2.5) 0 (0)
aChi-squared analysis was used to examine the differences between groups.
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Several patients in both groups reported avoiding con-
suming food before leaving home. It is common to find
that ostomy patients stop eating, influenced by feelings
provided by their current condition.12,14 Anxiety, insecu-
rity, fear, and doubt may negatively affect eating itself, an
event that should be enjoyable.
Limitations
The current study has limitations. The group was not
heterogeneous in terms of the duration of the stoma, the
reason for its creation, and nutritional status, which may
affect the external validity of the results vis-à-vis all per-
sons with an ileostomy or colostomy. The wide range in
stoma history (1 to 360 months) may have affected the
results and is a consequence of the various reasons for
creating a stoma, as well as the patient’s previous nutri-
tional status. Additionally, the absence of specific dietary
recommendations and anthropometric measures for per-
sons with a stoma as well as the absence of studies on this
topic did not allow comparisons between the published
literature and current results. Finally, an inevitable limi-
tation of the FFQ is that all information depends on the
respondents’ memory.
Conclusion
The results of this cross-sectional study involving 40
persons with an ileostomy and 63 with a colostomy sug-
gest that, based on anthropometric characteristics, study
participants did not have nutritional deficits. However,
FFQ results showed persons with an ileostomy had sig-
nificantly lower fat (g and percent) and niacin (mg) intake
than persons with a colostomy. The study also confirmed
both groups implement many dietary restrictions to re-
duce the risk of appliance loosening, increased odor, gas,
stoma output, or constipation. Leaving home was also fre-
quently cited as a reason for avoiding certain foods. Veg-
etables and fruits were included as foods avoided for every
risk cited.
Living with a stoma can be challenging and patients
need to learn what does and does not work for them to
manage the side effects of food on the ostomy, including
odor, gas, effluent, constipation, and leakage. Few stud-
ies have examined the nutritional status of persons with a
stoma and the effects of diet on ostomy function. Longi-
tudinal studies to assess these variables and patient needs
are necessary to facilitate the development of specific nu-
tritional recommendations for persons with an ileostomy
or colostomy. ■
Acknowledgments
The authors thank the nurse responsible for the service
(Alfeu Gomes de Oliveira Júnior) and his entire team, which
provided all the technical assistance with data collection.
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NUTRITION AND ILEOSTOMY/COLOSTOMY
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