# Practices, Attitudes, Perceived Knowledge, and Intentions Underlying Low‐Fat Dietary Behaviours in Adults Living With Bile Acid Diarrhoea: A Cross‐Sectional Study

## TL;DR

This study explores why people with bile acid diarrhoea follow low-fat diets and finds that health beliefs and symptom improvement are key factors.

## Contribution

The study identifies specific predictors of dietary behavior in managing bile acid diarrhoea using the Theory of Planned Behaviour.

## Key findings

- Many individuals with bile acid diarrhoea continue to experience symptoms despite using low-fat diets and bile acid sequestrants.
- Perceived necessity for health and symptom improvement are strong predictors of intention to reduce fat intake.
- Dietary modifications beyond fat reduction may be needed for effective symptom and weight management in bile acid diarrhoea.

## Abstract

The effectiveness of low‐fats diet for managing bile acid diarrhoea (BAD) is unclear, yet many individuals may restrict fat intake. This study aims to explore factors associated with reducing fat intake.

Cross‐sectional survey using convenience sampling recruited adults from the United Kingdom with a self‐reported diagnosis of BAD via online platforms (April to May 2021). Demographics, clinical characteristics, and low‐fat diet follower status data were collected. Potential predictors of intention to reduce fat intake were assessed using a modified validated questionnaire framed on the Theory of Planned Behaviour. Multinomial logistic regression was performed.

Of 434 respondents, current, past and non‐followers of low‐fat diets were 49%, 34% and 17%, whilst 79%, 83% and 78% reported chronic diarrhoea, respectively. Intention to reduce fat intake was associated with higher odds for six out of 20 predictor variables: current versus past‐followers, for its necessity for health (odds ratio [OR] = 1.4, 95% confidence interval [CI] 1.2 to 1.7), improving diarrhoea (OR = 1.5, 95% CI 1.3 to 1.7), abdominal pain (OR = 1.4, 95% CI: 1.3 to 1.7), bloating (OR = 1.4, 95% CI 1.2 to 1.6), flatulence (OR = 1.4, 95% CI 1.4 to 1.7), controlling gut symptoms (OR = 1.3, 95% CI 1.2 to 1.5); current versus non‐followers, for its necessary for health (OR = 1.3, 95% CI 1.1 to 1.5).

Addressing the association between fat intake and an individual's attitude about its necessity for health and beliefs about controlling diarrhoeal symptoms may improve BAD management. For developing new therapies for symptom and body weight management, dietary behaviour components additional to fat intake warrant investigation.

This study found that many people living with bile acid diarrhoea continue to have diarrhoea despite treatment by bile acid sequestrants and low‐fat diets.Important predictors of intention to reduce fat intake were its necessity for health and improving diarrhoea, abdominal pain, bloating, flatulence, and controlling gut symptoms.In developing novel diet therapies for bile acid diarrhoea, aside from dietary fat intake reduction, other dietary modifications should be explored. Dietary modification to improve symptoms may differ from that to manage body weight.

This study found that many people living with bile acid diarrhoea continue to have diarrhoea despite treatment by bile acid sequestrants and low‐fat diets.

Important predictors of intention to reduce fat intake were its necessity for health and improving diarrhoea, abdominal pain, bloating, flatulence, and controlling gut symptoms.

In developing novel diet therapies for bile acid diarrhoea, aside from dietary fat intake reduction, other dietary modifications should be explored. Dietary modification to improve symptoms may differ from that to manage body weight.