Abstract
Background
A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols
(FODMAP) has gained increasing acceptance for the treatment of irritable bowel syndrome
but safety concerns have been raised regarding nutritional adequacy. Changes in nutrient
intake during the elimination phase of the low-FODMAP diet remain predominantly unknown.
Objective
To determine changes in the mean reported daily nutrient content before and after
4 weeks of a low-FODMAP diet vs modified National Institute for Health and Clinical
Excellence (mNICE) dietary intervention and to identify nutritional inadequacies based
on comparison to the Dietary Reference Intakes in patients with irritable bowel syndrome-diarrhea
subtype.
Design
Post hoc analysis of a randomized controlled trial entailing a 4-week trial period
comparing the low-FODMAP and mNICE diets.
Participants and setting
A total of 78 patients (41 low FODMAP and 37 mNICE) meeting the Rome III criteria
for irritable bowel syndrome-diarrhea subtype were consecutively recruited from gastroenterology
and primary care clinics at the University of Michigan Medical Center between October
2012 and November 2015.
Methods
Participants randomized to the low-FODMAP arm were instructed to decrease their dietary
intake of FODMAPs, whereas participants randomized to the mNICE intervention arm were
instructed to eat small frequent meals, avoid trigger foods, and avoid excess alcohol
and caffeine.
Main outcome measures
Post hoc evaluation for presence of micronutrient deficiencies per Dietary Reference
Intakes when implementing low-FODMAP vs mNICE dietary interventions. Dietary intake
was analyzed via 3-day food diaries at baseline and during the final week of the assigned
diet.
Statistical analyses performed
A post hoc analysis utilizing either a t test or χ2 analysis was conducted between before and after data.
Results
Both diets resulted in fewer daily kilocalories consumed, fewer number of daily meals
consumed, and less daily carbohydrate intake. Among the patients following the low-FODMAP
diet, there was a statistically significant decrease from baseline in several micronutrients,
which was not observed in the mNICE cohort. However, these differences in the low-FODMAP
group remained significant only for riboflavin after correcting for calorie-adjusted
nutrient intake. Comparing Dietary Reference Intakes of participants pre- and postintervention,
fewer patients met the Dietary Reference Intakes for thiamin and iron in the low FODMAP
group, and for calcium and copper in the mNICE group.
Conclusions
During a 4-week dietary intervention, the mean daily intake of most micronutrients
remained stable and within the Recommended Dietary Allowances for both diets. Although
decrease in several micronutrients was observed with implementation of the low-FODMAP
diet relative to the mNICE diet, most of these disappeared after adjusting for energy
intake.
Keywords
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Biography
S. Eswaran is an associate professor in gastroenterology, Division of Gastroenterology, University of Michigan Medicine, Ann Arbor.
Biography
R. D. Dolan is a resident in internal medicine, Division of Gastroenterology, University of Michigan Medicine, Ann Arbor.
Biography
K. Jackson is a statistician and study coordinator, Division of Gastroenterology, University of Michigan Medicine, Ann Arbor.
Biography
W. Chey is a professor in gastroenterology, Division of Gastroenterology, University of Michigan Medicine, Ann Arbor.
Biography
S. C. Ball is a trained dietitian nutritionist, Nutrition Obesity Research Center, University of Michigan Medicine, Ann Arbor.
Article info
Publication history
Published online: May 15, 2019
Accepted:
March 6,
2019
Received:
August 3,
2018
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST W. Chey is a consultant and has received grant funding from Nestlé S.A., Sweden. No potential conflict of interest was reported by the other authors.
FUNDING/SUPPORT Research reported in this article was supported by a Michigan Nutrition Obesity Research Center Grant (P30 DK089503), a Clinical and Translational Science Award Grant (2UL1TR000433-06), as well as Prometheus Therapeutics and Diagnostics (San Diego, CA).
Identification
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