Hamish Osborne’s research while affiliated with University of Otago and other places

Aims To describe (1) dietary intake, food avoidance and adequacy, and (2) physical activity levels and barriers among New Zealand adults with inflammatory bowel disease. Methods A cross‐sectional online survey comprising four questionnaires collecting data on demographics, disease activity index, dietary intake and physical activity levels was distributed. Exclusion criteria applied to those who were pregnant/lactating, with a stoma or pouch, or on enteral/parenteral nutrition. Descriptive analyses were performed, and dietary intakes were compared to established references. T ‐tests, equality‐of‐medians tests and two‐sample proportion tests investigated differences between disease types. Results Two hundred and thirteen adults with mostly quiescent or mildly active inflammatory bowel disease (53% Crohn's disease) completed at least one questionnaire. Participants were predominantly female (70%), New Zealand European (89%) with a median age of 37 years. Discretionary food intake was high, while fruit and vegetable consumption was generally suboptimal. Food avoidances were reported by 69% of participants, primarily dairy and vegetables. A higher proportion of participants with ulcerative colitis or inflammatory bowel disease‐unspecified avoided gluten and unprocessed red meat. Inadequate intakes of calcium (69%), selenium (40%) and magnesium (26%) were common. Most participants limited vigorous physical activity, but 67% met the physical activity guidelines. Barriers to physical activity were reported by 63% of participants, where fatigue (54%) and abdominal cramps (26%) were common barriers. Conclusion Our findings demonstrate that New Zealand adults with inflammatory bowel disease had inadequate dietary intake and faced several barriers to physical activity, even when in remission.

Background People with inflammatory bowel disease (IBD) are at higher risk of metabolic diseases that may respond to changes in diet and physical activity. Whether these lifestyle changes are possible and effective in IBD is unclear. This study aims to investigate the effectiveness of personalised diet and physical activity advice on metabolic disease risk factors in adults with inactive IBD. Methods A randomised controlled trial was conducted at three hospitals in New Zealand (NZ) from May 23 to August 24. Eligible participants (aged >18 years, body mass index (BMI) ≥ 25 kg/m2, low fibre intake (<25g/day), stable medical therapy, and could exercise) were randomised to one of two 6-month interventions: dietitian-delivered generic or personalised physical activity and heart-healthy diet advice. The primary outcome was body fat change and secondary outcomes included disease activity, faecal calprotectin, self-reported physical activity, and dietary intake (3-day food diaries). Multivariable regression models investigated between group differences adjusted for age, sex, and baseline values (significance p<0.05). Dietary intake and physical activity were adjusted for seasonality and disease activity. The study was approved by the NZ Health and Disability Ethics Committee (ref 2022 EXP 13602). Results A total of 64 participants were randomised and 51 (80%) completed the 6-month intervention and had complete datasets. Participants were median age 47 (LQ, UQ 37, 55), 59% female, 91% NZ European ethnicity, 61% had Crohn’s disease, 75% had faecal calprotectin < 100µg/g, 80% were non-smokers, and 81% on maintenance medical therapy including 44% on biologics. The intervention group had a non-significant decrease in fat mass (-188g; 95%CI: -1606, 1230) compared to the control group and statistically significant changes in dietary intake: increased fruit (0.5 serves/day; 95%CI: 0.1, 1.0) and dietary fibre (3.1 g/1000kcal/day; 95%CI: 1.1, 5.1), and reduced discretionary food and drink (-1.7 serves/day; 95%CI: -3.0, -0.3) and sodium (-911 mg/day; 95%CI: -1783, -40). Physical activity increased non-significantly by 188 total MET-mins/week (95%CI: -3336, 3711). Disease activity indices and faecal calprotectin did not significantly alter. Conclusion Dietitian-delivered personalised compared to generic advice, led to significant changes in dietary intake associated with reduced metabolic disease risk in patients with inactive IBD. However, the lack of significant changes in fat mass between groups is likely due to the absence of increased physical activity or reduced energy intake. Nonetheless, this study shows that adults with inactive IBD can make lifestyle changes without worsening disease activity.

This review aims to highlight the relative importance of cardiovascular disease (CVD) lifestyle-associated risk factors among individuals with inflammatory bowel disease (IBD) and examine the effectiveness of lifestyle interventions to improve these CVD risk factors. Adults with IBD are at higher risk of CVD due to systemic and gut inflammation. Besides that, tobacco smoking, dyslipidaemia, hypertension, obesity, physical inactivity, and poor diet can also increase CVD risk. Typical IBD behavioural modification including food avoidance and reduced physical activity, as well as frequent corticosteroid use can further increase CVD risk. We reviewed seven studies and found that there is insufficient evidence to conclude the effects of diet and/or physical activity interventions on CVD risk outcomes among populations with IBD. However, the limited findings suggest that people with IBD can adhere to a healthy diet or Mediterranean diet (for which there is most evidence) and safely participate in moderately intense aerobic and resistance training to potentially improve anthropometric risk factors. This review highlights the need for more robust controlled trials with larger sample sizes to assess and confirm the effects of lifestyle interventions to mitigate modifiable CVD risk factors among the IBD population.

Patients with inflammatory bowel disease (IBD) have higher risk of developing cardiometabolic diseases due to chronic gut and systemic inflammation which promotes atherogenesis. Adopting healthy lifestyle habits can prevent development of cardiometabolic diseases, but can be challenging for people with IBD. The IBD exercise and diet (IBDeat) habits study describes the lifestyle habits and cardiometabolic disease risk factors of adults with IBD in Aotearoa, New Zealand (NZ). This is a cross-sectional study including adult NZ IBD patients recruited online via Crohn’s and Colitis NZ and Dunedin hospital from 2021 to 2022. An online questionnaire collected demographics, smoking status, comorbidities, medications, disease severity scores, quality of life, physical activity, and dietary intake. The Dunedin cohort had physical measurements taken including anthropometrics, handgrip strength, blood pressure, body composition (bioelectrical impedance), blood nutritional markers, and faecal calprotectin. Data were compared to established reference values and linear regression analysis investigated associations between lifestyle habits and cardiometabolic risk factors. The study received University of Otago ethical approval (reference: H21/135). A total of 213 adults with IBD (54% Crohn’s disease; 46% ulcerative colitis) completed the online questionnaire and a subset of 102 from Dunedin provided physical measurements. Participants characteristics were: median age 37 (IQR 25, 51) years, 71% female, 82% NZ European, 4% smokers, and 1.4% had active IBD. Thirty-five percent of participants had at least one comorbidity and 34% of participants had poor quality of life. Known dietary risk factors associated with cardiometabolic diseases were common: low intakes of vegetables (77%), fruit (51%), fibre (35%) and high intakes of total fat (84%) and saturated fat (98%). Physical activity recommendations were met by 61% of participants and 63% reported barriers to being more active from fatigue (63%) and joint pain (54%). Other cardiometabolic risk factors were common in the Dunedin cohort: high LDL (79%) and total cholesterol (76%), central adiposity (64%), high body fat percentage (44%), high blood pressure (26%), and low handgrip strength (25%). Regression analysis showed that vegetable (per serve) and carbohydrate (per 5% of total daily energy intake (TE)) were associated with 0.22 mmol/L (95%CI 0.43, 0.013) and 0.20 mmol/L (95%CI 0.34, 0.057) lower LDL cholesterol. Discretionary food items were associated with higher LDL cholesterol, 0.11 mmol/L per daily serve (95%CI 0.028, 0.19). A 5% difference in TE intake from carbohydrate was associated with 1.11% (95%CI 2.22%, 0.0038%) lower body fat percentage while protein was associated with 3.1% (95%CI 0.81%, 5.39%) higher body fat percentage. Physical activity had weak associations with cardiometabolic disease risk factors. Adults with IBD have multiple modifiable risk factors for cardiometabolic diseases. Vegetable and carbohydrate intake were associated with lower LDL cholesterol concentration while discretionary food items showed otherwise. Protein intake was associated with higher body fat percentage.

Background Recent literature shows that patients with inflammatory bowel disease (IBD) are at higher risk of developing chronic metabolic diseases which may be amenable to a healthy lifestyle. However, this may be challenging for IBD patients as disease symptoms may result in unfavourable lifestyle habits such as avoidance of healthy foods and reduced physical activity. In this study, we aim to describe the nutritional status and lifestyle habits of adults with IBD in New Zealand (NZ). Methods A cross-sectional nationwide study was undertaken from December 2021 to October 2022 in NZ. Participants were recruited through social media and the Dunedin public hospital patient database. An online questionnaire collected demographics, disease severity scores (harvey-bradshaw index and simple clinical colitis activity index), quality of life (QoL), physical activity, and dietary intake data. A subset of patients living in Dunedin had anthropometrics, handgrip strength, blood pressure, body composition (bioelectrical impedance), blood nutritional markers (lipid profile, iron studies, vitamin D, vitamin B12, folate) and faecal calprotectin measured. Descriptive analysis was conducted and data were compared to population reference values. The study received University of Otago, Dunedin, NZ ethical approval (reference: H21/135). Results The questionnaire was completed by 197 adults, median age 37 (IQR 25, 51) of which 72% were female and predominantly NZ European ethnicity (82.4%). In this IBD cohort, 54% had Crohn’s disease and 46% had ulcerative colitis or IBD-unspecified with quiescent-mild disease activity. Two-thirds of patients had at least one comorbidity aside from IBD and one-third of patients had impaired QoL (defined by a score <45). Most patients had nutritional risk factors including low intakes of fruits (91.3%), vegetables (94.4%), fibre (38.3%), and excessive intakes of fat (73.2%) and saturated fat (98.0%). Two-thirds of patients reported IBD-related barriers to exercise mainly due to fatigue (53.9%), abdominal pain (25.7%), bowel incontinence (23.3%), and joint pain (22.3%) in which only 59.7% met national physical activity recommendations. The Dunedin cohort (n=102) had further chronic metabolic disease risk factors such as central adiposity (63.7%), high body fat percentage (43.9%), high cholesterol/HDL ratio (29.3%), high blood pressure (26.5%), and poor handgrip strength (43.9%). Conclusion Findings suggest that NZ adults with IBD have multiple risk factors for chronic metabolic diseases that could be amendable to lifestyle interventions. Future studies should explore the feasibility and efficacy of nutrition and exercise lifestyle interventions to mitigate these risk factors.

Introduction and objective: Despite the known benefits of physical activity in the management of chronic diseases, the use of exercise as a treatment is relatively underemployed, with many patients reporting their disease to be a barrier. This study aimed to assess physical activity levels, attitudes, and barriers towards exercise in a cohort of patients with inflammatory bowel disease (IBD). In addition, this study aimed to assess possible relationships between physical well-being, psychological well-being, and sociodemographic factors. Methods: 306 patients >18 years with diagnosed IBD in Dunedin, New Zealand, were approached to participate in this study. Participants who consented completed questionnaires regarding exercise preferences and attitudes, physical activity levels, and psychological well-being. Results: Seventy-seven patients participated in the study (77/308 = 25%). Sixty-six percent of participants met physical activity guidelines and the median metabolic equivalent minutes/week of 1,027.5 (505.5-2,339.5). Walking was the most preferred activity (30%) followed by water-based exercise (20%). Two-thirds of participants reported their disease limited the amount of physical activity undertaken. Common barriers to participating in physical activity included fatigue (34%) and abdominal pain (20%). Patients with active disease reported higher levels of barriers than those in remission (80 vs. 54%, p = 0.018). Higher physical activity levels were correlated with lower levels of fatigue (p = 0.022-0.046). Conclusions: While patients with IBD in Dunedin, New Zealand, are physically active, reducing real and perceived barriers is crucial to further increase physical activity in patients with IBD who are in remission or with active disease.