P0508 Food-related quality of life is worse in Crohn’s disease, stricturing disease and those with a surgical history: development and validation of the FR-QoL-29-Dutch (Flemish) questionnaire
Authors: Wellens J , Guadagnoli L , Vanderstappen J , Hoekx S , Vandaele J , Ferrante M , Verstockt B , Vermeire S , Whelan K , Sabino J 
Published: January 2025

Abstract

Background
The food-related quality of life (FRQoL) questionnaire was developed in inflammatory bowel disease (IBD) to evaluate the impact of diet on a person’s quality of life (1-3). FRQoL is reduced in IBD and associates with a reduced intake of key nutrients (1). Since Belgian studies are lacking, we aimed to translate and validate the FR-QoL-29 into Dutch and to investigate FRQoL and factors associated with it in a Belgian IBD population.

Methods
The original FR-QoL-29 was translated from English to Dutch and adapted to the Flemish setting using the forward-backward method. The translated instrument was reviewed by the Flemish patient organisation to produce the final FR-QoL-29-Dutch (Flemish) questionnaire. All IBD patients in an outpatient setting were eligible and recruited from October 2023 to July 2024. The FR-QoL-29 Dutch (Flemish) was completed alongside symptoms and disease-specific QoL questionnaires, and routine clinical and biochemical data were collected. Exploratory factor analysis (EFA) with promax rotation assessed the underlying factor structure. Reliability measures (internal consistency, test-retest reliability) were evaluated. Pearson correlations examined relationships between FR-QoL-29 scores and disease severity (PRO-2, Manitoba IBD Index) and IBD-related disability (IBD-disk). Correlation between FR-QoL-29 scores and clinical parameters were analysed using independent samples t-tests and Welch’s ANOVA with Tukey post-hoc tests as appropriate.

Results
312 participants completed the FR-QoL-29-Dutch (Flemish), with 31 (9.9%) undertaking a retest within two weeks (Table 1). EFA revealed a one-factor structure explaining 55% of the variance. The FR-QoL-29-Dutch (Flemish) showed excellent internal consistency (Cronbach’s α = 0.97) and very good test-retest reliability (intraclass correlation = 0.94 [95% CI: 0.88-0.97]). Mean (SD) scores were 86.34 (24.6). Lower FR-QoL-29 scores were significantly correlated with increased disease activity (Manitoba: r=−0.49; PRO-2 for Crohn’s disease (CD): r=−0.48; PRO-2 for UC: r=−0.38) and IBD-related disability (r=−0.54; all p&lt;0.001). FR-QoL-29 scores were lower in CD (p=0.01) and those who previously received surgery (p&lt;0.0001, Figure 1). Likewise, patients with stricturing CD (Montreal B2) had significantly lower FR-QoL-29 scores compared to B1 and B3 (all p&lt;0.01). There were no differences when using advanced treatments or neuromodulators.

Conclusion
The FR-QoL-29-Dutch (Flemish) is a valid and reliable tool to assess FRQoL in IBD patients in the Flemish setting. FR-QoL-29 correlates with disease activity and IBD-related disability. CD patients, those with stricturing disease and those who underwent surgery have significantly lower FRQoL and should be targeted for support.

References
1.Whelan K, Murrells T, Morgan M, et al. Food-related quality of life is impaired in inflammatory bowel disease and associated with reduced intake of key nutrients. Am J Clin Nutr. 2021;113(4):832-844. doi:10.1093/ajcn/nqaa3952. Hughes LD, King L, Morgan M, et al. Food-related quality of life in inflammatory bowel disease: Development and validation of a questionnaire. J Crohn’s Colitis. 2016;10(2):194-201.
2.Hughes LD, King L, Morgan M, et al. Food-related quality of life in inflammatory bowel disease: Development and validation of a questionnaire. J Crohn’s Colitis. 2016;10(2):194-201.
3.Czuber-Dochan W, Morgan M, Hughes LD, Lomer MCE, Lindsay JO, Whelan K. Perceptions and psychosocial impact of food, nutrition, eating and drinking in people with inflammatory bowel disease: a qualitative investigation of food-related quality of life. J Hum Nutr Diet. 2020;33(1):115-127.