Habitual Dietary Intake and Adherence to Dietary Guidelines of Patients with Inflammatory Bowel Diseases

Round 1

Reviewer 1 Report

1. Adding some context regarding the selection of patients could be relevant and should be detailed (Row 97-98)
2. A comment should be made if the patients were taking oral supplements or not (vitamin complex, minerals, etc) which are relevant to their diet
3. When did the assessment happen? Diet, appetite and metabolism changes according to the seasons. Were any of the patients hospitalised during the assessment? This can also influence intake. 
4. Did these patients have nutritional deficiencies confirmed by blood tests? Do you perform regular diet evaluations or consultations in the clinic? This information could help the reader understand whether or not the patients were previously informed towards the importance of nutrition as part of their disease management program

1. The article should be slightly revised from the grammar point of view. For example, there are some awkward repetitions (similar in row 280, 281 and 283)

Author Response

Dear Reviewer,
We greatly appreciate your valuable suggestions, which have significantly enhanced the quality of our article. We included the suggestions of the reviewers as is explained below. Thank you once again for your guidance and expertise.

The article is well structured and written, the conclusions are supported by the data analysis and therefore it can be accepted for publication after revision.  Some of my comments are the following:

1. Adding some context regarding the selection of patients could be relevant and should be detailed (Row 97-98)
   
   We added more detailed information about selection of patients.
   
   
2. A comment should be made if the patients were taking oral supplements or not (vitamin complex, minerals, etc) which are relevant to their diet
   
   We added the information about vitamins and minerals supplementation in table 1 and in the main text.
   
   
3. When did the assessment happen? Diet, appetite and metabolism changes according to the seasons. Were any of the patients hospitalised during the assessment? This can also influence intake. 
   
   We added the information about time of the assessment.
   
   
   
4. Did these patients have nutritional deficiencies confirmed by blood tests? Do you perform regular diet evaluations or consultations in the clinic? This information could help the reader understand whether or not the patients were previously informed towards the importance of nutrition as part of their disease management program
   
   We added the explaination about diet evaluation previously the assessment. We also added the information about lacking of blood tests in limitations of our study.

Reviewer 2 Report

This study assesses dietary intake for energy and nutrients requirements in IBD patients. The results showed inadequate intake in these patient populations due to several factors. Though there are several existing similar studies, the study underlies the need for routine dietary intake in IBD patient populations whether in active disease or remission. A flaw of the study design is the single point of data collection as dietary interests and preferences change based on different reasons and seasons. However, this limitation has been acknowledged by the authors. A longer study with multiple data collection points would have been more reflective of the realities in this case. 

Author Response

Dear Reviewer,
We greatly appreciate your valuable suggestions, which have significantly enhanced the quality of our article. We included the suggestions of the reviewers as is explained below. Thank you once again for your guidance and expertise.

This study assesses dietary intake for energy and nutrients requirements in IBD patients. The results showed inadequate intake in these patient populations due to several factors. Though there are several existing similar studies, the study underlies the need for routine dietary intake in IBD patient populations whether in active disease or remission. A flaw of the study design is the single point of data collection as dietary interests and preferences change based on different reasons and seasons. However, this limitation has been acknowledged by the authors. A longer study with multiple data collection points would have been more reflective of the realities in this case. 

We added information about lacking blood tests in limitations section.

Reviewer 3 Report

The study entitled “” aims to quantitatively and qualitatively evaluate the diet of IBD patients to identify dietary errors and possible nutrient deficiencies.

The authors base their results on questionaries filled in by fairly big group of patients 82 Caucasians patients with IBD, including 48 patients with CD and 34 patients with UC. The results indicated inadequate intake of energy and most nutrients and fiber in IBD patients, and highlight the influence of disease activity as the main factor influencing it. Also they indicate the need for routine assessment dietary intake and  nutrition among IBD patients, as well as potential dietary interventions aimed at  improving the energy and nutritional quality of diet in order to optimize treatment  outcomes, and prevent the development of accompanying diseases.

The study is interesting and the results are convincing however, it is rather qualitative than quantitative study. My major concerns include:

The authors should add more information to the limitation to the study. For instance, their work was based on questionaries and the mean value of nutrients and vitamins was calculated basing on questionaries not measured parameters e.g. in blood.

It would also be valuable if the authors add some information on how the results from questionaries are mirrored by the real assay in human body e.g. blood, urine etc. This information could be added to the discussion of limitation part.

The authors could also highlight the influence of sex on the following on diet regime which could also be different in men and women.

Minor points:

Table 1 „Waist circumference [cm]” commas should be replaced with dots.

Author Response

Dear Reviewer,
We greatly appreciate your valuable suggestions, which have significantly enhanced the quality of our article. We included the suggestions of the reviewers as is explained below. Thank you once again for your guidance and expertise.

The study aims to quantitatively and qualitatively evaluate the diet of IBD patients to identify dietary errors and possible nutrient deficiencies.

The authors base their results on questionaries filled in by fairly big group of patients 82 Caucasians patients with IBD, including 48 patients with CD and 34 patients with UC. The results indicated inadequate intake of energy and most nutrients and fiber in IBD patients, and highlight the influence of disease activity as the main factor influencing it. Also they indicate the need for routine assessment dietary intake and  nutrition among IBD patients, as well as potential dietary interventions aimed at  improving the energy and nutritional quality of diet in order to optimize treatment  outcomes, and prevent the development of accompanying diseases.

The study is interesting and the results are convincing however, it is rather qualitative than quantitative study. My major concerns include:

The authors should add more information to the limitation to the study. For instance, their work was based on questionaries and the mean value of nutrients and vitamins was calculated basing on questionaries not measured parameters e.g. in blood.

It would also be valuable if the authors add some information on how the results from questionaries are mirrored by the real assay in human body e.g. blood, urine etc. This information could be added to the discussion of limitation part.

The authors could also highlight the influence of sex on the following on diet regime which could also be different in men and women.

We added the information about lacking blood tests in limitations of the study. We checked influence of sex but we did not find any important influence.

Minor points:

Table 1 „Waist circumference [cm]” commas should be replaced with dots.

Corrected.

Round 2

Reviewer 1 Report

Recommended changes have been made The paper looks fine