Dietary Intake and Nutritional Deficiencies in Patients With Diabetic or Idiopathic Gastroparesis
Open accessAbstract
Background & aims Gastroparesis can lead to food aversion, poor oral intake, and subsequent malnutrition. We characterized dietary intake and nutritional deficiencies in patients with diabetic and idiopathic gastroparesis. Methods Patients with gastroparesis on oral intake (N = 305) were enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Registry and completed diet questionnaires at 7 centers. Medical history, gastroparesis symptoms, answers to the Block Food Frequency Questionnaire, and gastric emptying scintigraphy results were analyzed. Results Caloric intake averaged 1168 ± 801 kcal/day, amounting to 58% ± 39% of daily total energy requirements (TER). A total of 194 patients (64%) reported caloric-deficient diets, defined as <60% of estimated TER. Only 5 patients (2%) followed a diet suggested for patients with gastroparesis. Deficiencies were present in several vitamins and minerals; patients with idiopathic disorders were more likely to have diets with estimated deficiencies in vitamins A, B(6), C, K, iron, potassium, and zinc than diabetic patients. Only one-third of patients were taking multivitamin supplements. More severe symptoms (bloating and constipation) were characteristic of patients who reported an energy-deficient diet. Overall, 32% of patients had nutritional consultation after the onset of gastroparesis; consultation was more likely among patients with longer duration of symptoms and more hospitalizations and patients with diabetes. Multivariable logistic regression analysis indicated that nutritional consultation increased the chances that daily TER were met (odds ratio, 1.51; P = .08). Conclusions Many patients with gastroparesis have diets deficient in calories, vitamins, and minerals. Nutritional consultation is obtained infrequently but is suggested for dietary therapy and to address nutritional deficiencies.
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Nutritional morbidities are common in DGP: nausea, vomiting, early satiety, and postprandial fullness limit food intake and often lead to involuntary weight loss, micronutrient deficiencies (particularly iron, vitamin B12, vitamin D, and fat-soluble vitamins), reduced protein intake, sarcopenia, increased risk of dehydration and hospitalization.
“Nutritional morbidities are also common: nausea, vomiting, early satiety, and postprandial fullness limit food intake and often lead to involuntary weight loss, micronutrient deficiencies (particularly iron, vitamin B12, vitamin D, and fat-soluble vitamins), reduced protein intake, sarcopenia, increased risk of dehydration and hospitalization [105–108].”
From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [106]
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Tack, J. F., Törnblom, H., Tan, V. P. Y., & Carbone, F. (2022) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000001780 · Cited by 28 · see citing works
Nutritional Considerations in the Patient with Gastroparesis
Parrish, C. R. (2014) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2014.11.007 · Cited by 27 · see citing works
Self-citationSato, H., & Grover, M. (2022) · Gastro Hep Advances · doi:10.1016/j.gastha.2022.10.005 · Cited by 26 · see citing works
“In a study done by the gastroparesis consortium, 64% of gastroparesis patients reported caloric-deficient diets and often lacked nutritional counselling.(85) In a subset of patients with refractory gastroparesis with associated malnutrition (usually defined by ≥10% weight loss over 6 months), nutritional support often…”
BackgroundDashti, H. S., & Mogensen, K. M. (2016) · Nutrition in Clinical Practice · doi:10.1177/0884533616662995 · Cited by 27 · see citing works
Body weight in patients with idiopathic gastroparesis
Parkman, H. P., Natta, M. L. V., Yamada, G., Grover, M., McCallum, R. W., Sarosiek, I., Farrugia, G., Koch, K. L., Abell, T. L., Kuo, B., et al. (2020) · Neurogastroenterology & Motility · doi:10.1111/nmo.13974 · Cited by 26 · see citing works
Self-citationRelamorelin for the treatment of gastrointestinal motility disorders
Chedid, V. G., & Camilleri, M. (2017) · Expert Opinion on Investigational Drugs · doi:10.1080/13543784.2017.1373088 · Cited by 26 · see citing works
Parkinson’s Disease and Current Treatments for Its Gastrointestinal Neurogastromotility Effects
Ramprasad, C., Douglas, J. Y., & Moshiree, B. (2018) · Current Treatment Options in Gastroenterology · doi:10.1007/s11938-018-0201-3 · Cited by 27 · see citing works
Botulinum Toxin A Improves Symptoms of Gastroparesis
Reichenbach, Z. W., Stanek, S., Patel, S., Ward, S. J., Malik, Z. A., Parkman, H. P., & Schey, R. (2019) · Digestive Diseases and Sciences · doi:10.1007/s10620-019-05885-z · Cited by 27 · see citing works
Self-citationColeski, R., Wilding, G. E., Semler, J. R., & Hasler, W. L. (2015) · PLoS ONE · doi:10.1371/journal.pone.0141183 · Cited by 25 · see citing works
“It is well established that nutrient intake in gastroparesis patients is significantly impaired [37].”
Self-citationTaste and Smell Disturbances in Patients with Gastroparesis and Gastroesophageal Reflux Disease
Kabadi, A. A., Saadi, M., Schey, R., & Parkman, H. P. (2017) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm16132 · Cited by 24 · see citing works
“Gender Male (n [%)) 8 (11) 2 (15) 2 (7) 0 (0) 4 (40) Female (n [%)) 68 (89) 11 (85) 28 (93) 23 (100) 6 (60) Age (mean [SD], yr) 45 (15) 39 (14) 44 (16) 46 (16) 53 (11) Race White (n [%]) 59 (78) 7 (54) 26 (86) 20 (87) 6 (60) African American (n [%]) 11 (14) 5 (38) 2 (7) 2 (9) 2 (20) Other (n [%]) 6 (8) 1 (8) 2 (7) 1 (…”
BackgroundSelf-citationDiabetic gastroenteropathy: a pan-alimentary complication
Kornum, D. S., Krogh, K., Keller, J., Malagelada, C., Drewes, A. M., & Brock, C. (2025) · Diabetologia · doi:10.1007/s00125-025-06365-y · Cited by 23 · see citing works
Suresh, H., Zhou, J., & Ho, V. (2021) · Nutrients · doi:10.3390/nu13124298 · Cited by 22 · see citing works
“Despite the known benefits, the current dietary recommendations for gastroparesis patients suggests the avoidance or minimisation of all forms dietary fibre [26].”
BackgroundBouras, E. P., Roque, M. I. V., & Aranda‐Michel, J. (2013) · Nutrition in Clinical Practice · doi:10.1177/0884533613491982 · Cited by 21 · see citing works
Wieck, M. M., El-Nachef, W. N., Hou, X., Spurrier, R. G., Holoyda, K. A., Schall, K. A., Mojica, S. G., Collins, M. K., Trecartin, A., Cheng, Z., et al. (2015) · Tissue Engineering Part A · doi:10.1089/ten.tea.2015.0120 · Cited by 20 · see citing works
Methodologic considerations for studies of chronic nausea and vomiting in adults and children
Hasler, W. L., Li, B. U. K., Koch, K. L., Parkman, H. P., Kovacic, K. K., & McCallum, R. W. (2016) · Autonomic Neuroscience · doi:10.1016/j.autneu.2016.08.001 · Cited by 19 · see citing works
Self-citationAttaar, M., Su, B., Wong, H. J., Kuchta, K. M., Denham, W., Haggerty, S. P., Linn, J. G., & Ujiki, M. B. (2021) · Surgical Endoscopy · doi:10.1007/s00464-021-08441-x · Cited by 19 · see citing works
Treatment of gastrointestinal autonomic neuropathy
Törnblom, H. (2015) · Diabetologia · doi:10.1007/s00125-015-3828-9 · Cited by 21 · see citing works
“Indeed, there appears to be a great need for this support since most patients experience difficulties following dietary advice [5].”
BackgroundGastric Dysmotility and Low Serum Vitamin D Levels in Patients with Gastroparesis
Kedar, A., Nikitina, Y., Abell, K. B., Vedanarayanan, V., Griswold, M. E., Subramony, C., & Abell, T. L. (2012) · Hormone and Metabolic Research · doi:10.1055/s-0032-1323689 · Cited by 18 · see citing works
Self-citationJehangir, A., Abdallah, R. T., & Parkman, H. (2019) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000001059 · Cited by 13 · see citing works
Self-citationLu, D., Altieri, M. S., Yang, J., Yin, D., Obeid, N. R., Spaniolas, K., Talamini, M. A., & Pryor, A. D. (2018) · Surgical Endoscopy · doi:10.1007/s00464-018-6588-z · Cited by 18 · see citing works
Understanding Cystic Fibrosis Comorbidities and Their Impact on Nutritional Management
Patel, D. R., Shan, A., Mathews, S. K., & Sathe, M. (2022) · Nutrients · doi:10.3390/nu14051028 · Cited by 17 · see citing works
“A large proportion of patients consumed less than 60% of their daily energy requirements [50].”
BackgroundDiabetic Gastroparesis: Navigating Pathophysiology and Nutritional Interventions
Caturano, A., Cavallo, M., Nilo, D., Vaudo, G., Russo, V., Galiero, R., Rinaldi, L., Marfella, R., Monda, M., Luca, G., et al. (2024) · Gastrointestinal Disorders · doi:10.3390/gidisord6010016 · Cited by 17 · see citing works
“According to the study results, only a very small percentage of gastroparetic patients received nutrition counseling from a qualified dietitian or followed a suggested diet to minimize gastrointestinal discomfort [99].”
BackgroundResultMacGibbon, K. (2020) · Journal of Infusion Nursing · doi:10.1097/nan.0000000000000363 · Cited by 18 · see citing works
Nutritional deficiencies and predictors of mortality in diabetic and nondiabetic gastroparesis
Amjad, W. (2021) · Annals of Gastroenterology · doi:10.20524/aog.2021.0660 · Cited by 16 · see citing works
Novel insights into the effects of diabetes on gastric motility
Marathe, C. S., Rayner, C. K., Jones, K. L., & Horowitz, M. (2015) · Expert Review of Gastroenterology & Hepatology · doi:10.1586/17474124.2016.1129898 · Cited by 16 · see citing works
“cies (vitamins A, B6, C and K, iron, potassium and zinc) are common in patients with diabetic gastroparesis and need to be addressed.[39] Unfortunately, a diet high in fiber and raw vegetables and low in processed carbo-”
BackgroundApproach to the Patient with Nausea and Vomiting
Hasler, W. L. (2015) · Wiley eBooks · doi:10.1002/9781118512074.ch38 · Cited by 16 · see citing works
Self-citationEndoscopic Therapies for Gastroparesis
Su, A., Conklin, J. L., & Sedarat, A. (2018) · Current Gastroenterology Reports · doi:10.1007/s11894-018-0630-0 · Cited by 15 · see citing works
Pathogenesis and management of diabetic gastroparesis: An updated clinically oriented review
Uppaluri, S., Jain, M. A., Ali, H., Shingala, J., Amin, D., Ajwani, T., Fatima, I., Patel, N., Kaka, N., Sethi, Y., et al. (2024) · Diabetes & Metabolic Syndrome: Clinical Research & Reviews · doi:10.1016/j.dsx.2024.102994 · Cited by 14 · see citing works
Pharmacologic treatments for gastroparesis
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Broekaert, I. J., Assa, A., Borrelli, O., Saccomani, M. D., Homan, M., de Carpi, J. M., Mas, E., Miele, E., Mišak, Z., Sila, S., et al. (2025) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1002/jpn3.12454 · Cited by 14 · see citing works
Upper GI Disorders: Pathophysiology and Current Therapeutic Approaches.
Parkman, H. (2017) · Handbook of Experimental Pharmacology · doi:10.1007/164_2016_114 · Cited by 9 · see citing works
“Unfortunately, nutritional consultation is obtained infrequently but this is suggested for dietary therapy and to address nutritional deficiencies (Parkman et al. 2011).”
BackgroundSelf-citationGastroparesis: Myths, Misconceptions, and Management
Cangemi, D. J., & Lacy, B. E. (2023) · Clinical and Experimental Gastroenterology · doi:10.2147/ceg.s362879 · Cited by 13 · see citing works
Lee, A. A., & Hasler, W. L. (2017) · Current Treatment Options in Gastroenterology · doi:10.1007/s11938-017-0146-y · Cited by 12 · see citing works
Self-citationHomko, C. J., Zamora, L. C., Boden, G., & Parkman, H. P. (2013) · Neurogastroenterology & Motility · doi:10.1111/nmo.12263 · Cited by 12 · see citing works
Self-citationMedical Nutrition Therapy for Youth with Type 1 Diabetes Mellitus: More than Carbohydrate Counting
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Emerging drugs for the treatment of gastroparesis
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“Nearly two-thirds of patients ingest caloriedeficient diets (< 75% of recommended intake), and deficiencies in vitamins A, B6, C and K, as well as iron, potassium and zinc are prevalent [8].”
BackgroundSelf-citationMeal Eating Characteristics of Patients with Gastroparesis
Hagopian, G. G., Johnson, K. P., Shahsavari, D., & Parkman, H. P. (2021) · Digestive Diseases and Sciences · doi:10.1007/s10620-021-07190-0 · Cited by 12 · see citing works
Self-citationOptimizing nutrition in pediatric intestinal pseudo‐obstruction syndrome
Pescarin, M., Day, H., Thapar, N., Jackman, L., Saliakellis, E., Lindley, K. J., Nikaki, K., Hill, S. M., Köglmeier, J., Rybak, A., et al. (2023) · Neurogastroenterology & Motility · doi:10.1111/nmo.14562 · Cited by 12 · see citing works
Suresh, H., Mikhael, M., Ho, V., & Zhou, J. (2022) · International Journal of Food Properties · doi:10.1080/10942912.2022.2096064 · Cited by 11 · see citing works
“1%), but these patients avoid consuming dietary fibres due to detrimental symptom effects.([25,26]) In order to find possible solutions for this situation, the rheological characteristics and the clinical suitability of certain soluble fibres such as the “low-viscosity” type partially hydrolysed guar gum (PHGG) and gu…”
BackgroundChronic nausea and vomiting: insights into underlying mechanisms
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Mao, C., Liu, X., Huang, Y., Shi, M., Meng, W., Xu, L., Chen, W., Hu, Y., Yang, X., Chen, X., et al. (2020) · Journal of Diabetes Research · doi:10.1155/2020/7058145 · Cited by 10 · see citing works
“4 meals daily and only 13% complied with fat restrictions [21].”
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Self-citationDimino, J., & Kuo, B. (2025) · Diagnostics · doi:10.3390/diagnostics15070935 · Cited by 9 · see citing works
“Despite broad recommendations for dietary management, only around one third of patients received nutrition referrals after their gastroparesis diagnosis [91].”
Comprehensive review: Frailty in pancreas transplant candidates and recipients
Parsons, R. F., Tantisattamo, E., Cheungpasitporn, W., Basu, A., Lu, Y., Lentine, K. L., Woodside, K. J., Singh, N., Scalea, J. R., Alhamad, T., et al. (2023) · Clinical Transplantation · doi:10.1111/ctr.14899 · Cited by 9 · see citing works
Diabetic gastroenteropathy: modern methods of diagnosis and treatment
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European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management
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- Authors
- Parkman, H. P., Yates, K. P., Hasler, W. L., Nguyan, L., Pasricha, P. J., Snape, W. J., Farrugia, G., Calles, J., Koch, K. L., Abell, T. L., McCallum, R. W., Petito, D., Parrish, C. R., Duffy, F., Lee, L., Unalp–Arida, A., Tonascia, J., & Hamilton, F.
- Affiliations
- Temple University (US)
- Johns Hopkins University (US)
- University of Michigan (US)
- Stanford University (US)
- California Pacific Medical Center (US)
- Mayo Clinic (US)
- Wake Forest University Health Sciences (US)
- University of Mississippi (US)
- Texas Tech University (US)
- University of Virginia (US)
- Temple University Hospital (US)
- National Institute of Diabetes and Digestive and Kidney Diseases (US)
- Corresponding author
- Parkman, Henry P.
- ORCID
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2011-08
- Volume
- 141
- Issue
- 2
- Pages
- 486-498.e7
- ISSN
- 0016-5085 (ISSN-L)
- PMC
- PMC3499101
- OpenAlex
- W1981815149
- Cited by
- 198
- References
- 30
- Citations by year
- 2026: 15 · 2025: 21 · 2024: 11 · 2023: 17 · 2022: 12 · 2021: 17 · 2020: 17 · 2019: 12 · 2018: 14 · 2017: 11 · 2016: 14 · 2015: 13 · 2014: 8 · 2013: 5 · 2012: 9
- FWCI
- 7.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (U01DK074008, U01DK073985, U01DK073974, U01DK074007, U01DK073983, U01DK073975, U01DK074035)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Keywords
- diabetic gastroparesis, idiopathic gastroparesis, dietary intake, nutritional deficiency, energy deficiency, malnutrition, vitamin and mineral deficiency, multivitamins, nutrition counseling, food frequency, gastric emptying, bloating, constipation
- MeSH terms
- Iron Deficiencies, Adult, Avitaminosis, Body Weight, Energy Intake, Energy Metabolism, Female, Gastric Emptying, Humans, Male, Middle Aged, Potassium Deficiency, Prospective Studies, Surveys and Questionnaires, Referral and Consultation, Registries, Severity of Illness Index, Zinc, Logistic Models, Gastroparesis, Dietary Supplements, Diabetes Complications
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