Growing bodies of literature show that a controlled diet is important in controlling the symptoms of Inflammatory Bowel Diseases (IBD). This leads patients to avoid foods considered potentially harmful. However, food is not just a nutrient but entails a series of hedonistic, cultural and social values. Thus, there is the concern that having to renounce certain foods might exert an impact on patients’ psychosocial quality of life, particularly in younger patients. The aim of this paper is to review the existing literature to address which aspects of the patients’ quality of life are affected by food restrictions. A scoping review was carried out. Five different databases were searched in January 2021. Retrieved papers were then screened to only include the relevant studies. Data were extracted and the main results of the studies were charted. A thematic analysis was carried out on the main results to identify the areas of psychosocial quality of life more often impacted by the food restrictions. From the initially identified 1967 unique entries, 14 studies were included. Results show that the perceived importance of food in controlling symptoms is confirmed by patients’ accounts. The most common strategy adopted was, thus, the avoidance of trigger foods. The thematic analysis revealed three domains that are impacted by these restrictions: psychological quality of life, social life, family sphere. This study highlights the impact that food restrictions exert on IBD patients’ quality of life, and warrants further studies to fill existing gaps, in particular regarding younger patients.

Summary: Randomized clinical trials and observational studies on the implementation of clinical governance models, in patients who had experienced a fragility fracture, were examined. Literature was systematically reviewed and summarized by a panel of experts who formulated recommendations for the Italian guideline. Purpose: After experiencing a fracture, several strategies may be adopted to reduce the risk of recurrent fragility fractures and associated morbidity and mortality. Clinical governance models, such as the fracture liaison service (FLS), have been introduced for the identification, treatment, and monitoring of patients with secondary fragility fractures. A systematic review was conducted to evaluate the association between multidisciplinary care systems and several outcomes in patients with a fragility fracture in the context of the development of the Italian Guidelines. Methods: PubMed, Embase, and the Cochrane Library were investigated up to December 2020 to update the search of the Scottish Intercollegiate Guidelines Network. Randomized clinical trials (RCTs) and observational studies that analyzed clinical governance models in patients who had experienced a fragility fracture were eligible. Three authors independently extracted data and appraised the risk of bias in the included studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Effect sizes were pooled in a meta-analysis using random-effects models. Primary outcomes were bone mineral density values, antiosteoporotic therapy initiation, adherence to antiosteoporotic medications, subsequent fracture, and mortality risk, while secondary outcomes were quality of life and physical performance. Results: Fifteen RCTs and 62 observational studies, ranging from very low to low quality for bone mineral density values, antiosteoporotic initiation, adherence to antiosteoporotic medications, subsequent fracture, mortality, met our inclusion criteria. The implementation of clinical governance models compared to their pre-implementation or standard care/non-attenders significantly improved BMD testing rate, and increased the number of patients who initiated antiosteoporotic therapy and enhanced their adherence to the medications. Moreover, the treatment by clinical governance model respect to standard care/non-attenders significantly reduced the risk of subsequent fracture and mortality. The integrated structure of care enhanced the quality of life and physical function among patients with fragility fractures. Conclusions: Based on our findings, clinicians should promote the management of patients experiencing a fragility fracture through structured and integrated models of care. The task force has formulated appropriate recommendations on the implementation of multidisciplinary care systems in patients with, or at risk of, fragility fractures.

Nutrition has been acknowledged as crucial in IBD and is relevant to patients’ motives behind food choices, which are affected by health engagement (HE) and food involvement (FI). This study aimed to profile IBD patients according to their levels of health engagement and food involvement to identify patterns of different motives behind food choices, particularly regarding the use of food to regulate mood. A cross-sectional study was conducted with 890 Italian IBD patients who completed an online survey in April 2021. We measured health engagement, food involvement, motives behind food choices, emotional states, and food-related quality of life (Fr-QoL). K-means cluster analysis was performed to identify participants with similar levels of health engagement and food involvement. Four clusters were identified: “Health-conscious (high HE, low FI)”, “Balanced (high HE, high FI)”, “Hedonist (high FI, low HE)”, and “Careless (low FI, low HE)”. Clusters with high FI are inclined toward seeking pleasurable food, but when supported with high health engagement, individuals were less prone to use food to manage mood. Groups with higher health engagement demonstrated lower hospitalization rates and relapses and better Fr-QoL. Profiling IBD patients regarding FI and HE could aid clinicians in identifying individuals at greater risk of maladaptive food-related behaviors.

Therapeutic non-adherence can significantly impair the quality of life of patients affected by inflammatory bowel disease (IBD), leading to worse treatment outcomes, more frequent hospitalizations, and increased healthcare expenses. Identifying and enhancing treatment adherence is a key goal in managing IBD. To establish a consensus on the definition of therapeutic adherence, determination of risk factors, and identify patients with IBD at higher risk of non-adherence. A modified Delphi method was employed to develop consensus statements. Initially, an extensive literature review was conducted on therapeutic adherence in patients affected by IBD, leading to the formulation of 13 statements. These statements were assessed and approved after two rounds of voting (level of agreement 1 to 9; cut-off ≥7 for approval). In the first voting round, all 13 statements achieved a mean score of ≥7. During a subsequent plenary session, 12 of the 13 statements reached positive consensus, with final cumulative agreement ranging from 80 % to 100 %. The 12 statements are intended to offer practical guidance to enhance therapeutic adherence in patients with IBD. Patients' profiles at higher risk of non-adherence need prompt recognition and implementation of appropriate strategies by dedicated physicians.