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

Published:April 24, 2019DOI:https://doi.org/10.1016/j.jand.2019.01.017

      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

      Linked Article

      • Corrigendum
        Journal of the Academy of Nutrition and DieteticsVol. 120Issue 12
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          In 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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