Habitual FODMAP Intake in Relation to Symptom Severity and Pattern in Patients with Irritable Bowel Syndrome.

Sanna Nybacka,Anna Winkvist,Stine Störsrud,Magnus Simrén,Helen M. Lindqvist,Hans Törnblom

doi:10.3390/nu13010027

Abstract

Restricting intake of FODMAPs (Fermentable Oligo-, Di-, Monosaccharides and Polyols) is used as treatment for irritable bowel syndrome (IBS). However, whether habitual FODMAP consumption correlates to symptom severity, and if this relationship differs among IBS subtypes, is unclear. The aim was to study the relationship between habitual FODMAP intake and symptom severity. A total of 189 patients with IBS—IBS with constipation (IBS-C) n = 44 (22.3%), IBS with diarrhea (IBS-D) n = 54 (27.4%), mixed IBS (IBS-M) n = 46 (23.4%) and unsubtyped IBS (IBS-U) n = 46 (23.4%)—recorded food intake during four days. Symptom severity was measured with the IBS severity scoring system (IBS-SSS). For FODMAP intake, a lower lactose intake was noted among women with IBS-D, p = 0.009. In women, there was a statistically significant relationship between energy-adjusted FODMAP intake and IBS-SSS (r = 0.21, p = 0.003). This was mainly driven by the subtype IBS-U, where excess fructose intake accounted for 19.9% of explained variance in IBS-SSS (p = 0.007). This study demonstrates small differences in FODMAP intake among IBS patients with different subtypes. Association between IBS symptoms and FODMAP intake was most prominent in unsubtyped IBS. However, patients who are intolerant to certain FODMAPs may already have reduced their FODMAP intake, and this warrants future cohort or experimental studies to uncover.

Highlights

Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) disorder that is characterized by recurrent abdominal pain together with an abnormal frequency and/or consistency of stools [1]
fermentable oligo- (FODMAPs) intake and IBS symptom severity were demonstrated with differences among subtypes, where excess fructose intake accounted for a large share of explained variance in symptom severity among women with unsubtyped IBS (IBS-U)
We demonstrated that reported energy intake was weakly, but statistically significantly, related to lower IBS symptom severity, meaning that individuals who reported a low intake of energy experienced having more GI symptoms than individuals who reported a higher energy intake

Summary

Introduction

Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) disorder that is characterized by recurrent abdominal pain together with an abnormal frequency and/or consistency of stools [1]. IBS is associated with a large health care utilization [2,3], efficient treatment options are still limited. As many patients with IBS report diet as a major factor in triggering or worsening. GI symptoms [4,5,6,7], dietary treatment is often considered as a first-line option. There is some evidence that intake of alcohol [8,9], caffeine [5,8], and spicy foods [4,8], as well as foods rich in fat and carbohydrates [4,5] might trigger symptoms and should be limited in intake, but not all patients respond to these dietary modifications.

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