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.
Keywords
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Biography
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
Biography
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
Biography
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
Biography
K. Whelan is a professor of dietetics, Department of Nutritional Sciences, King's College London, London, UK.
Biography
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
Article info
Publication history
Published online: April 24, 2019
Accepted:
January 23,
2019
Received:
August 21,
2018
Footnotes
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.
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© 2020 by the Academy of Nutrition and Dietetics.
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- CorrigendumJournal of the Academy of Nutrition and DieteticsVol. 120Issue 12
- PreviewIn the April 2020 issue of the Journal (pp. 535-547) there is a mistake in the “Excess fructose” row of table six. The estimated marginal means (95% CI) for “After completing dietary intervention trial” for “Low FODMAP diet” should be “1.1 (0.6-1.6)”; for “Sham diet” “1.9 (1.4-2.4)”; for “Habitual diet” “1.4 (0.6-2.3)”. The value for “ANCOVA P” should be “0.071”; the value for “Planned contrasts low FODMAP diet vs sham diet” should be “0.022”; and the value for “Planned contrasts low FODMAP diet vs habitual diet” should be “0.463.” The authors regret this error.
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