Top of the pops

Here at JHND HQ I am waiting for the release of the new journal impact factors for last year. To be honest I am expecting a slight dip in JHNDs fortunes but am not desperately worried as we have a longer-term plan for improving our reputational indices. In the meantime here are our top cited papers for each of the last 4 years.


Number 1 for 2011 was:

Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome By Staudacher and colleagues. 

Background:  Emerging evidence indicates that the consumption of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) may result in symptoms in some patients with irritable bowel syndrome (IBS). The present study aimed to determine whether a low FODMAP diet is effective for symptom control in patients with IBS and to compare its effects with those of standard dietary advice based on the UK National Institute for Health and Clinical Excellence (NICE) guidelines.

Methods:  Consecutive patients with IBS who attended a follow-up dietetic outpatient visit for dietary management of their symptoms were included. Questionnaires were completed for patients who received standard (n = 39) or low FODMAP dietary advice (n = 43). Data were recorded on symptom change and comparisons were made between groups.

Results:  In total, more patients in the low FODMAP group reported satisfaction with their symptom response (76%) compared to the standard group (54%, P = 0.038). Composite symptom score data showed better overall symptom response in the low FODMAP group (86%) compared to the standard group (49%, P < 0.001). Significantly more patients in the low FODMAP group compared to the standard group reported improvements in bloating (low FODMAP 82% versus standard 49%, P = 0.002), abdominal pain (low FODMAP 85% versus standard 61%, P = 0.023) and flatulence (low FODMAP 87% versus standard 50%, P = 0.001).

Conclusions:  A low FODMAP diet appears to be more effective than standard dietary advice for symptom control in IBS.


The most cited paper for 2012 was: 

Dietary counselling with or without oral nutritional supplements in the management of malnourished patients: a systematic review and meta-analysis of randomised controlled trials by Baldwin and Weekes. 

Dietary counselling and oral nutritional supplements (ONS) are recommended for managing malnutrition. A recent systematic review demonstrated (in separate analyses) that dietary counselling and dietary counselling with ONS improved energy intake, weight and some indices of body composition, although there was considerable heterogeneity. The present analysis aimed to examine the effects on mortality and nutritional indices of dietary counselling given with or without ONS and to explore the heterogeneity in the meta-analyses aiming to characterise the groups most likely to benefit from these interventions. A systematic review and meta-analysis was performed using Cochrane methodology. Twenty-six studies were included in the analysis: 12 comparing dietary counselling with usual care and 14 comparing dietary counselling and ONS if required with usual care (2123 participants). Quality of studies varied. Dietary counselling given with or without ONS had no effect on mortality [relative risk (fixed) = 1.12; 95% confidence interval = 0.86–1.46] but was associated with significant but heterogeneous benefits to weight [mean difference (random) = 1.7 kg; 95% confidence interval = 0.86–2.55], energy intake and some aspects of body composition. Subgroup analyses taking into account clinical background, age, nutritional status, type and length of intervention failed to reveal any differences in mortality, weight change and energy intake between groups. There were insufficient data on functional outcomes to explore these findings. Dietary counselling given with or without ONS is effective at increasing nutritional intake and weight but adequately-powered studies in similar patient populations and standardised for factors that might account for variations in response are required.


Number 1 for 2013 was: 

Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease by Shepherd and Gibson. 


Life-long gluten-free diet (GFD) is the only recognised treatment for coeliac disease (CD). The present study aimed to determine the nutritional adequacy of the ‘no detectable gluten’ diet.


Seven-day prospective food intake was assessed in 55 patients who were adherent to a GFD for more than 2 years and in 50 newly-diagnosed age- and sex-matched patients (18–71 years, 24% male) studied prospectively over 12 months on GFD. Historical precoeliac intake was also assessed in the latter group. Intake was compared with Australian Nutritional Recommendations and the Australian population data.


Nutritional intake was similar between groups. Of macronutrients, only starch intake fell over 12 months (26% to 23%, P = 0.04). Fibre intake was inadequate for all except in diet-experienced men. More than one in 10 of both newly-diagnosed and experienced women had inadequate thiamin, folate, vitamin A, magnesium, calcium and iron intakes. More than one in 10 newly-diagnosed men had inadequate thiamin, folate, magnesium, calcium and zinc intakes. Inadequate intake did not relate to nutrient density of the GFD. Inadequacies of folate, calcium, iron and zinc occurred more frequently than in the Australian population. The frequency of inadequacies was similar pre- and post-diagnosis, except for thiamin and vitamin A, where inadequacies were more common after GFD implementation.


Dietary intake patterns at 12 months on a GFD are similar to longer-term intake. Dietary inadequacies are common and may relate to habitual poor food choices in addition to inherent deficiencies in the GFD. Dietary education should also address the achievement of adequate micronutrient intake. Fortification of GF foods also need to be considered.


And the top cited paper  from 2014 is:

Nutrient intake in adolescent girls and boys diagnosed with coeliac disease at an early age is mostly comparable to their non-coeliac contemporaries by Kautto et al.


Food habits, nutrient needs and intakes differ between males and females, although few nutritional studies on patients with coeliac disease (CD) have reported results stratified by gender.


To compare energy and nutrient intakes among 13-year olds diagnosed with CD in early childhood with those of a non-coeliac (NC) age- and gender-matched control group, and also with estimated average requirements (EAR).


A case–control study was conducted in Sweden 2006–2007 within the coeliac screening study ETICS (Exploring The Iceberg of Coeliacs in Sweden). Dietary intake was assessed among 37 adolescents (23 girls) diagnosed with CD at median age 1.7 years (CD group) and 805 (430 girls) NC controls (NC group) using a food-frequency questionnaire covering 4 weeks. Reported energy intake was validated by comparison with the calculated physical activity level (PAL).


Regardless of CD status, most adolescents reported an intake above EAR for most nutrients. However, both groups had a low intake of vitamin C, with 13% in the CD-group and 25% in the NC-group below EAR, and 21% of boys in the CD-group below EAR for thiamine. The intake of fatty acids was unbalanced, with a high intake of saturated and a low intake of unsaturated fats. Girls and boys in the CD-group had an overall lower nutrient density in reported food intake compared to girls and boys in the NC-group.


Nutrient intake of adolescent girls and boys with CD was mostly comparable to intakes of NC controls. Dietitians should take the opportunity to reinforce a generally healthy diet when providing information about the gluten-free diet.

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