Clinical nutrition knowledge lacking in some paediatricians

Physicians in a tertiary paediatric specialist hospital in Singapore report gaps in their nutritional knowledge, particularly regarding special diet, inflammatory bowel disease (IBD), and gastrointestinal allergy, according to a recent study.

“Topics relating to nutrition and growth are an integral part of paediatric training,” said the researchers, led by Sudipta Roy Chowdhury, Department of Pediatrics, KK Women’s and Children’s Hospital (KKWCH), Singapore. “Paediatricians need to recognize the importance of effective nutrition counseling, and this requires a solid nutritional knowledge base and training.”

Chowdhury and colleagues sent out a survey questionnaire to physicians at KKWCH to evaluate general nutrition education via self-assessment of current nutritional knowledge across 12 distinct topics, to assess the importance of teaching among these topics, and to determine the preferred teaching method.

Of the physicians who received the survey, 64 completed the questionnaire (response rate, 88 percent). Majority of the responders were found to have average or above-average knowledge base in all nutritional topics, except for nutritional aspects of special diets. [Proc Singap Healthc 2024;doi:10.1177/20101058241236988]

Knowledge base was poorest (either below average or poor) in the following domains: special diet (n=38, 59.4 percent), IBD (n=17, 26.6 percent), and gastrointestinal allergy (n=16, 25.0 percent).

“These findings are concerning as being in a teaching hospital, paediatricians in-training should possess an above-average knowledge base in these topics as it is part of the residency curriculum,” the researchers said.

“Furthermore, there is increasing prevalence of allergic disorders and IBD in the paediatric population compared to past decades, and thus it is even more critical for every resident to be confident and well-versed in these topics,” they added. [Annu Rev Cell Dev Biol 2020;36:511-528; J Pediatr 2005;146:35-40]

On the other hand, physicians expressed strong interest in additional teaching needs for the following topics: failure to thrive (FTT; n=38, 59.4 percent), nutritional assessment (n=34, 53.1 percent), and infant feeding (n=31, 48.4 percent). The most popular methods of teaching included clinical case review (31.7 percent) and didactic lecture (29.8 percent) for overall clinical nutritional education.

Dietary preference

Modernity has introduced a variety of special dietary preferences to families, resulting in more children having specialized meal plans with its associated nutritional complications, according to the researchers.

“It is vital for all trainees to be aware of such possibilities and to actively look out for complications when handling such patients,” they added.

There is increasing prevalence of vegan or vegetarian diet in children, and such dietary patterns often lead to vitamin D and vitamin B12 deficiency. [Nestle Nutr Inst Workshop Ser 2020;93:103-110; Am J Clin Nutr 2021;113:1565-1577]

In addition, interest in gluten-free diet is also growing due to its supposed benefits, but such diet may put children at risk of excessive fat intake, insufficient fibre consumption, lack of iron and vitamin D intake with increased glycaemic index. [Nutrients 2019;11:1588; Nutrients 2020;12:143; Clin Nutr 2016;35:1236-1241]

“These are important factors to consider when reviewing patients with such restricted diets,” according to Chowdhury and colleagues.

“[T]he relative importance of nutritional clinical topics should be reassessed on a regular basis to be updated on prevailing trends and knowledge gaps to ensure a robust curriculum,” they said.