Nutrient Intake, Diet Quality, and Diet Diversity in Irritable Bowel Syndrome and the Impact of the Low FODMAP Diet

doi:10.1016/j.jand.2019.01.017

Journal of the Academy of Nutrition and Dietetics

Volume 120, Issue 4, April 2020, Pages 535-547

https://doi.org/10.1016/j.jand.2019.01.017 Get rights and content

Abstract

Background

Individuals with irritable bowel syndrome (IBS) may modify their diet, which may pose nutritional risk. Further, some dietary approaches, such as a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), are restrictive and may contribute to nutritional inadequacy.

Objective

Our aim was to evaluate habitual nutrient intake, diet quality, and diversity in IBS and the effect of a 4-week low FODMAP diet on these parameters compared with controls.

Design

Data from two randomized controlled trials were included for this secondary analysis. Participants were randomized to low FODMAP diet (n=63) or control diet (sham diet n=48, habitual diet n=19).

Participants/setting

Participants included 130 individuals with IBS referred to a tertiary center in London, UK between January 2010 to June 2011 and January 2013 to November 2014.

Intervention

Participants in one trial were randomized to receive either low FODMAP dietary counseling or sham control dietary counseling. In the other, they were randomized to receive low FODMAP dietary counseling or to continue habitual diet. All advice was provided by a specialist dietitian.

Main outcome measures

Habitual (usual) dietary intake at baseline (n=130) and after a 4-week intervention period was measured using 7-day food records.

Statistical analyses performed

Analysis of covariance and χ² tests evaluated differences across groups at 4 weeks.

Results

When examining habitual intake of individuals with IBS, fiber intake was low, with only 6 (5%) achieving the target (30 g/day). In those receiving low FODMAP advice, there was no difference in intake of most nutrients compared with controls. However, there was lower intake of starch (109 g/day) vs habitual control diet (128 g/day; P=0.030), and higher intake of vitamin B-12 (6.1 μg/day) vs habitual (3.9 μg/day) and sham control diets (4.7 μg/day; P<0.01). Overall scores for diet quality were lower after low FODMAP advice vs habitual control diet (P<0.01).

Conclusion

This study demonstrates many individuals with IBS fail to meet dietary reference values for multiple nutrients. A 4-week low FODMAP diet, when delivered by a specialist dietitian, does not impact on intake of most nutrients or diet diversity but decreases diet quality compared with control diets.

Section snippets

Experimental Design, Treatments, and Participants

Data from individuals with IBS referred to a tertiary center in London, UK, that were recruited to two previously published randomized controlled trials were included in this secondary analysis.26, 27 Participants were recruited between January 2010 to June 2011 and January 2013 to November 2014. Participants were diagnosed with IBS using Rome III criteria,²⁸ were aged 18 to 65 years, and had no other major gastrointestinal conditions or organ dysfunction, recent weight loss, or other specific

Results

Diet records for 130 participants were included in the analysis of habitual diet in individuals with IBS. Most participants were female with a diarrhea-predominant IBS subtype and most did not take IBS medications (Table 3).

Discussion

This is the most comprehensive evaluation of the habitual energy and nutrient intake of individuals with IBS, including an assessment of diet quality and diet diversity. Many individuals reported dietary intakes that did not meet recommendation for various nutrients; however, overall nutrient intake was comparable to the general population. For example, mean fiber intake was 18 g/day, which is the same as that found in a national survey of the UK general population,⁴⁴ which contrasts with

Conclusions

This study demonstrates that many individuals with IBS fail to meet the DRV for a number of nutrients and overall diet quality is low. Furthermore, a 4-week low FODMAP diet, when delivered by a specialist dietitian, does not significantly impact overall nutrient intake or measures of diet diversity, but leads to a lower diet quality compared with control diets. Overall diet quality should be assessed and considered throughout the dietetic consultation process, with specific emphasis on

H. M. Staudacher is an Alfred Deakin Postdoctoral Research Fellow, Food and Mood Centre, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Melbourne, Australia; at the time of the study, she was a clinical doctoral research fellow, Department of Nutritional Sciences, King's College London, London, UK

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F. S. E. Ralph is a dietitian, Department of Nutrition and Dietetics, Berkshire Healthcare NHS Foundation Trust, Reading, London, UK; at the time of the study, she was a dietetics student, Department of Nutritional Sciences, King's College London, London, UK

P. M. Irving is a lecturer, Department of Nutritional Sciences, King’s College London, and a consultant gastroenterologist, Department of Gastroenterology, Guys and St Thomas’ NHS Foundation Trust, London, UK

K. Whelan is a professor of dietetics, Department of Nutritional Sciences, King's College London, London, UK.

M. C. E. Lomer is a reader in dietetics, Department of Nutritional Sciences, King’s College London, and a senior consultant dietitian, Departments of Gastroenterology and Nutrition and Dietetics, Guys and St Thomas’ NHS Foundation Trust, London, UK

: STATEMENT OF POTENTIAL CONFLICT OF INTEREST M. C. E. Lomer and K. Whelan are co-inventors of a mobile application relating to the low FODMAP diet. No potential conflict of interest was reported by the remaining authors.

: FUNDING/SUPPORT This study/project is funded by the National Institute for Health Research (NIHR) [CDRF-2012-03-060]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

: ACKNOWLEDGEMENTS The authors thank professor Peter Gibson, MD, FRACP, and Jane Muir, PhD (Monash University, Melbourne, Australia) for providing analysis of total and individual FODMAP intake data.

: AUTHOR CONTRIBUTIONS All authors conceived the study and developed the research plan; H. M. Staudacher and F. S. E. Ralph conducted the data collection; H. M. Staudacher, F. S. E. Ralph, M. C. E. Lomer, and K. Whelan developed the analysis plan; F. S. E. Ralph and H. M. Staudacher analyzed the data; H. M. Staudacher and F. S. E. Ralph wrote the paper; M. C. E. Lomer, K. Whelan, and P. M. Irving had primary responsibility for final content. All authors provided critical comment on the intellectual content of the manuscript and approved the final version for submission.

^∗: Certified in the United Kingdom.

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ResearchOriginal ResearchNutrient Intake, Diet Quality, and Diet Diversity in Irritable Bowel Syndrome and the Impact of the Low FODMAP Diet

Abstract

Background

Objective

Design

Participants/setting

Intervention

Main outcome measures

Statistical analyses performed

Results

Conclusion

Section snippets

Experimental Design, Treatments, and Participants

Results

Discussion

Conclusions

Clin Gastroenterol Hepatol

Gastroenterology

Nutr Res

Gastroenterology

Am J Clin Nutr

Gastroenterology

J Nutr

Functional bowel disorders Gastroenterology

J Am Diet Assoc

Am J Clin Nutr

Gastroenterology

Perceived food intolerance in subjects with irritable bowel syndrome—etiology, prevalence and consequences

Eur J Clin Nutr

A dietary survey of patients with irritable bowel syndrome

J Hum Nutr Diet

Are food constituents relevant to the irritable bowel syndrome in young adults? A Rome III based prevalence study of the Korean medical students

J Neurogastroenterol Motil

Diet and functional gastrointestinal disorders: A population-based case-control study

Am J Gastroenterol

Dietary intakes in people with irritable bowel syndrome

BMC Gastroenterol

Habitual diet and diet quality in irritable bowel syndrome: A case-control study

Neurogastroenterol Motil

Diet in subjects with irritable bowel syndrome: A cross-sectional study in the general population

BMC Gastroenterol

Nutrient intake in patients with irritable bowel syndrome compared with the general population

Neurogastroenterol Motil

Comparison of dietary assessment methods in nutritional epidemiology: Weighed records v. 24 h recalls, food-frequency questionnaires and estimated-diet records

Br J Nutr

IBS patients have a poorer quality diet and exercise less than organic GI disease patients or normal controls

Gastroenterology

The low FODMAP diet: Recent advances in understanding its mechanisms and efficacy in IBS

Gut

The low FODMAP diet in the management of irritable bowel syndrome: An evidence-based review of FODMAP restriction, reintroduction and personalisation in clinical practice

J Hum Nutr Diet

Research
Original Research
Nutrient Intake, Diet Quality, and Diet Diversity in Irritable Bowel Syndrome and the Impact of the Low FODMAP Diet