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Dietary management is considered a potential adjunctive treatment for inflammatory bowel disease (IBD). Short-video sharing platforms have enabled patients to obtain dietary advice more conveniently. However, accessing useful resources while avoiding misinformation is not an easy task for most patients.
This study aimed to evaluate the quality of the information in IBD diet–related videos on Chinese short-video sharing platforms.
We collected and extracted information from a total of 125 video samples related to the IBD diet on the 3 Chinese short-video sharing platforms with the most users: TikTok, Bilibili, and Kwai. Two independent physicians evaluated each video in terms of content comprehensiveness, quality (rated by Global Quality Score), and reliability (rated by a modified DISCERN tool). Finally, comparative analyses of the videos from different sources were conducted.
The videos were classified into 6 groups based on the identity of the uploaders, which included 3 kinds of medical professionals (ie, gastroenterologists, nongastroenterologists, and clinical nutritionists) and 3 types of non–medical professionals (ie, nonprofit organizations, individual science communicators, and IBD patients). The overall quality of the videos was poor. Further group comparisons demonstrated that videos from medical professionals were more instructive in terms of content comprehensiveness, quality, and reliability than those from non–medical professionals. Moreover, IBD diet–related recommendations from clinical nutritionists and gastroenterologists were of better quality than those from nongastroenterologists, while recommendations from nonprofit organizations did not seem to be superior to other groups of uploaders.
The overall quality of the information in IBD diet-related videos is unsatisfactory and varies significantly depending on the source. Videos from medical professionals, especially clinical nutritionists and gastroenterologists, may provide dietary guidance with higher quality for IBD patients.
Inflammatory bowel disease (IBD) includes two clinical phenotypes, ulcerative colitis (UC) and Crohn disease (CD), both of which are characterized by chronic and relapsing intestinal inflammation [
Previous studies have shown that IBD patients exposed to social media are more likely to engage with IBD-related information [
A recent study of internet use by patients with IBD revealed that over half of patients considered the internet to be the most common source of information, and the majority of patients rated internet information as “trustworthy” or “very trustworthy” [
All collected videos were sourced from TikTok, Bilibili, or Kwai, 3 of the most popular Chinese short-video sharing platforms. The search keywords were 炎症性肠病 (“inflammatory bowel disease”), 溃疡性结肠炎 (“ulcerative colitis”), or 克罗恩病 (“Crohn disease”) combined with “饮食”(“diet”), or “营养”(“nutrition”). The entire search process was conducted and completed between May 3 and May 5, 2022. We included only Chinese-language videos that primarily focused on an IBD (CD or UC) diet. Videos were excluded if they were duplicates, had no sound or poor sound quality, were for commercial purposes, were irrelevant to the topic, if the author identity could not be obtained, or if they were not in Chinese. Videos with multiple parts were counted as a single video. In addition, videos related to enteral or parenteral nutrition for IBD were also excluded (
Search strategy and video screening procedure.
The content, reliability, and quality of the videos were evaluated by scoring. Based on the recommendations from the International Organization for the Study of Inflammatory Bowel Disease (IOIBD) and the best available evidence to date [
Detailed content evaluation of diet recommendations for patients with inflammatory bowel disease.
Aspects of diet | Recommendations |
Fruits and vegetables | Adequate daily intake of fruits and vegetables. |
Carbohydrates | Adequate daily intake of all carbohydrates, including gluten-containing foods. |
Meats | Moderate intake of red meat, chicken, and fish, with less intake of processed meats. |
Fats | Consumption of less saturated fat/myristic acid, avoidance of trans fats, and consumption of more wild fish rich in omega-3 fatty acid. |
Alcohol | Low intake of alcoholic beverages. |
Food additives | Limited intake of foods containing food additives, including maltodextrin, artificial sweeteners, emulsifiers, and thickeners. |
To minimize bias introduced by personal recommendation algorithms, new accounts were registered and logged for each video platform. The evaluation tasks were accomplished by 2 qualified physicians (ZH and ZW) working in the division of digestive disease in a tertiary teaching hospital. All videos were browsed without downloading, reposting, liking, or commenting. Before starting to score the videos, the 2 raters first reviewed dietary guidance from the IOIBD [
After the inclusion and exclusion criteria were applied, a total of 125 videos were included for further data extraction and analysis (
Characteristics of the videos across sources.
Source (Description) | Video duration in seconds (mean total 69, IQR 43-116), median (IQR) | Number of likes (median total 47, IQR 8/118), median (IQR) | Videos, n (%) | ||||
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Gastroenterologists (doctors who specialize in gastroenterology) | 71 (47-93) | 88 (9-289) | 26 (21) | |||
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Nongastroenterologists (doctors who specialize in medical fields other than gastroenterology) | 53 (34-88) | 71 (30-287) | 42 (34) | |||
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Clinical nutritionists (professionals who provide nutrition or diet advice for patients) | 118 (52-220) | 78 (25-107) | 4 (3) | |||
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Overall | 60 (27-93) | 71 (13-287) | 72 (58) | |||
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Nonprofit organizations (public accounts operated by organizations) | 97 (45-109) | 10 (7-87) | 18 (14) | |||
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Individual science communicators (general users who participate in general scientific communications) | 67 (38-121) | 6 (2-50) | 22 (18) | |||
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Patients (patients with inflammatory bowel disease) | 125 (98-278) | 92 (5-216) | 13 (10) | |||
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Overall | 96 (59-141) | 10 (4-87) | 53 (42) |
We evaluated the content comprehensiveness of each video; the results showed that very few videos could provide comprehensive guidance on diet for patients with IBD. Almost half of the 125 videos (n=60, 48%) offered recommendations on fat consumption for patients with IBD based on guidance from the IOIBD, followed by recommendations on meat (n=43, 34%), fruits and vegetables (n=40, 32%), alcohol (n=38, 30%), and carbohydrates (n=29, 23%), while for food additives, only 14% (n=18) of the videos addressed the topic and gave the appropriate recommendations. Next, we compared content comprehensiveness across the sources of videos. As is shown in
Comparison of content comprehensiveness between sources. (A-C) Radar charts showing the percentage of each inflammatory bowel disease diet–related recommendation among videos from different sources. (D-E) Violin plots showing the total content scores among videos from different sources. *
We first assessed the general quality of each video using the GQS scale; as shown in
Comparisons of Global Quality Score and DISCERN score among different sources. (A) Ridge plot showing the overall distribution of Global Quality Score among different sources. (B-D) Violin plots showing the Global Quality Score among videos from different sources. (E) Ridge plot showing the overall distribution of DISCERN scores among different sources. (F-H) Violin plots showing the DISCERN scores among videos from different sources. GQS: Global Quality Score. *
Global Quality Score and DISCERN scores for inflammatory bowel disease diet–related videos by source.
Source | GQSa scores (total 3, IQR 2-3), median (IQR) | GQS scores (total 2.61, SD 0.90), mean (SD) | DISCERN scores (total 2, IQR 2-3), median (IQR) | DISCERN scores (total 2.40, SD 0.75), mean (SD) | |
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Gastroenterologists | 3 (2-4) | 3.08 (0.98) | 3 (2-3) | 2.77 (0.65) |
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Nongastroenterologists | 3 (2-3) | 2.48 (0.77) | 2 (2-3) | 2.38 (0.73) |
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Clinical nutritionists | 4 (3-5) | 4.00 (0.82) | 4 (3-4) | 3.50 (0.58) |
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Overall | 3 (2-3) | 2.78 (0.94) | 3 (2-3) | 2.58 (0.74) |
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Nonprofit organizations | 3 (2-3) | 2.67 (0.84) | 2 (2-3) | 2.33 (0.59) |
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Individual science communicators | 2 (2-3) | 2.41 (0.80) | 2 (2-3) | 2.05 (0.72) |
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Patients | 2 (2-2) | 1.92 (0.49) | 2 (2-3) | 2.08 (0.76) |
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Overall | 2 (2-3) | 2.40 (0.79) | 2 (2-3) | 2.15 (0.69) |
aGQS: Global Quality Score.
In this study, we reviewed the 3 most popular Chinese short-video sharing platforms: TikTok, Bilibili, and Kwai. We evaluated the content, quality, and reliability of all videos on the topic of IBD diet. In general, the overall quality of these videos was not satisfactory, which is probably due to the fact that health-related information on these platforms is not regulated or monitored before being posted. In addition, the quality of the videos varied significantly depending on the source. Our results showed that very few videos were comprehensive enough to cover all components of daily diet for patients with IBD and provide appropriate and trustworthy recommendations. This was especially the case for food additives and carbohydrate intake, as less than 30% of the videos addressed these topics and provided correct dietary advice. Meanwhile, during our review of the video content, we found that some videos provided inaccurate dietary recommendations; for example, 5 videos mentioned that patients with IBD at any stage should completely avoid fiber-rich vegetables and whole-grain carbohydrates, while 7 videos stated that patients with IBD should avoid dairy intake. These recommendations are contrary to guidance from the IOIBD and are not backed by evidence. Nutritional supplementation, including with vitamins and micronutrients such as calcium, iron, and zinc, for patients with IBD is also an important issue, but it is noteworthy that according to our search results, there were few videos addressing and providing recommendations on this issue, so we did not analyze or discuss this content further. Given the increasing availability and promotion of nutritional supplements on the market today, the discussion and interpretation of this issue deserves more attention.
Previous studies have indicated that the overall quality of health education videos varied according to the identity of the author [
Improved knowledge of IBD, its management, and the principles of its treatment may lead to better disease outcomes and a decrease in the impact of this disease on daily life [
Dietary therapy has long been accepted as a classic treatment modality by a majority of patients, especially those with digestive diseases [
In 2020, the nutrition cluster of the IOIBD developed an expert consensus on IBD diet based on the best current evidence, which included specific dietary components and food groups in the daily diet and provided detailed recommendations for the diet of IBD patients. Nevertheless, despite the availability of these expert authority opinions and guidelines, it is difficult for most patients and family members without a medical background to learn about these recommendations through appropriate and convenient sources. The advent of the internet has removed obstacles to health information communication; this is especially the case for certain websites and mobile apps, including TikTok, that use a video format. There is strong evidence that COVID-19–related videos on TikTok were viewed at least 93.1 billion times during the pandemic by July 2020 [
It is quite common for patients to use the internet as a source of information for disease self-management, especially patients with chronic illnesses such as IBD and diabetes mellitus. Videos are generally considered to present complex health information in a more comprehensible and impressive way when compared with text. Thus, social media with visual content is gradually becoming an important information source for patients. On the other hand, these platforms are also powerful ways for health care practitioners to reach and educate their patients. In fact, the positive role of video education is supported by a growing body of evidence. Compared with a written pamphlet, online video-based education was shown to markedly improve disease knowledge and clinical outcomes among patients with atopic dermatitis in a randomized controlled trial [
Internet-based health promotion has become a topic of increasing attention, and a guideline on publishing and disseminating health-science knowledge through various media was recently issued by the Chinese government. However, there is no formal guideline focused on health-promoting videos anywhere in the world, as far as we know. Considering the increased popularity of video-sharing platforms, the essential criteria for content on these platforms should be discussed. In any case, health practitioners and video-sharing platform operators should be the first to act to change this situation. The platforms should be encouraged to set up health sections that are separate from other videos. Only videos audited by professionals or made by verified medical professionals should be allowed to be uploaded in this section. Alternatively, although videos have overcome educational barriers to a certain extent by presenting complex information in an easier-to-access way, it is still difficult for many audiences to understand professional vocabulary due to the complexity of medicine. Thus, medical professionals should be taught to make their videos more comprehensible, while non–medical professionals should be requested to present evidence-based information as much as possible. Excellent health-promoting videos must balance scientific soundness, popularity, and ease of understanding. Finally, given that good and bad videos are currently intermingled, it is necessary for health practitioners to screen videos containing health information for content and quality to provide patients with guidance.
There are still limitations to be considered in this study. First, we only included videos uploaded on Chinese video-sharing platforms, so the findings may not be generalizable to platforms in other languages (eg, YouTube). Second, there were uncertainties in this study due to a small sample size of videos by clinical nutritionists. In general, more cross-language comparative studies with larger sample sizes will be necessary in the future to confirm our findings.
In this study, 125 IBD diet-related videos from 3 short-video sharing platforms (TikTok, Bilibili, and Kwai) were evaluated for their information quality. The results demonstrated that the quality of these videos was unsatisfactory and varied widely depending on the type of source. Overall, videos from medical professionals were more instructive in terms of comprehensiveness of content, quality, and reliability than those from non–medical professionals. Moreover, IBD diet recommendations from clinical nutritionists and gastroenterologists were of better quality than those from nongastroenterologists, while recommendations from nonprofit organizations did not seem to be superior to other groups of uploaders. Overall, given the growing popularity of video sharing platforms, discussion of essential criteria should be put on the agenda.
Modified DISCERN quality criteria for assessing the reliability of videos; 1 point for answering yes, 0 points for answering no.
Global Quality Score (GQS) scoring; ranges from 1 to 5.
Crohn disease
Global Quality Score
inflammatory bowel disease
International Organization for the Study of Inflammatory Bowel Disease
ulcerative colitis
YB, SW, and ZL are joint senior authors. ZH conceived and designed the study. ZH and ZW reviewed and scored the videos. ZH, YS, and YL collected and analyzed the data. LK and TW interpreted the data. ZH wrote the original draft. XF, SW, and XF revised the manuscript. YB and ZL reviewed and edited the manuscript. All authors contributed to the article and approved the submitted version. This work was supported by the National Natural Science Foundation of China (grants 81873546 and 82170567), the Shu Guang project of the Shanghai Municipal Education Commission and Shanghai Education Development Foundation (grant 19SG30), the National Key R&D Program of China (grant 2018YFC1313103) and the 234 Discipline Climbing Plan of Changhai Hospital, Second Military Medical University/Naval Medical University (grant 2019YXK004).
None declared.