The relationship between FODMAP intake and acute gastrointestinal symptoms in adults with IBS A novel analysis using the FAST Diary
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1 The relationship between FODMAP intake and acute gastrointestinal symptoms in adults with IBS A novel analysis using the FAST Diary Macintosh A 1, Wright-McNaughton M 1, Frampton C 2, Skidmore P 1, Gearry RB 2, Muir J 3, Dwyer E 3 Departments of 1 Human Nutrition and 2 Medicine (Christchurch), University of Otago, New Zealand. Department of Gastroenterology 3, Monash University, Melbourne, Australia.
2 Introduction IBS is a functional GI disorder Characterised by abdominal pain and change in bowel habit Affects 10-20% of the population More prevalent in women than men Multifactorial aetiology Visceral hypersensitivity, diet, stress, microbiome.
3 Patient beliefs of effective treatment for IBS Diet Prescription drugs OTC drugs Alternative medications Counselling Lacy et al. APT 2007
4 FODMAPS Fermentable Oligosaccharides Fructans and Galactans (GOS) Disaccharides Lactose Monosaccharides- Fructose (in excess of glucose) And Polyols - Sorbitol and Mannitol The low FODMAP diet has shown to alleviate symptoms in ~75% of people with IBS Shepherd et al, 2006., Barrett et al, 2010., De Roest et al, 2012., Shepherd et al 2010.
5 FODMAPS and IBS symptom generation Kortlever et al, 2016
6 Development of the FAST diary Food and Symptom Times (FAST) diary Validated and pilot tested by Morag Wright-McNaughton Three day food diary 24-hour symptom scales Bowel motion information
7 FAST Diary - food diaries
8 FAST diary - symptom scales Symptoms assessed: - Abdominal - Pain - Bloating - Swelling - Fullness - Bowel motions - 24 hour scale - Bristol stool type Severity scale - 1 not bad at all - 2 A little bad - 3 Somewhat bad - 4 Quite bad - 5 Very bad
9 Aims To investigate the relationship between total FODMAP intake and acute gastrointestinal symptoms in adults with IBS To investigate the relationship between individual FODMAPs and acute gastrointestinal symptoms
10 Methods - data collection FAST validation study 51 IBS participants Aged Dunedin and Christchurch COMFORT Study 52 IBS participants Aged Christchurch
11 Methods ROME IV questionnaire IBS subtype IBS-C, IBS-D, IBS-M and IBS-U Demographic questionnaire Age and gender Three day food and symptom diary (FAST)
12 Methods - food diary analysis The FODMAP Calculator 309 days of food diaries entered FODMAP content of each meal Individual and total
13 Methods - alignment of symptoms and foods Meal time FODMAP content of each meal (individual and total) Acute symptoms (within 3 hours post meal) Timing, severity and duration
14 Results Demographics N (%) 103 participants Sex Female 91 (88.3) Male 12 (11.7) Age Mean (SD) 40.8 years (16.5) IBS- Subtype IBS-D 48 (46.6) IBS-M 32 (31.1) IBS-C 22 (21.4) IBS-U 1 (1.0) All data expressed as n (%) unless stated otherwise
15 Mean FODMAP intake per day (grams) Mean FODMAP intake by subtype Mean FODMAP intake was 18.6 grams per day IBS-D IBS-C IBS-M IBS Subtype
16 Average FODMAP intake by subtype FODMAP (g) Sorbitol Mannitol GOS Lactose Fructose Fructan 0 IBS-C IBS-D IBS-M IBS subtype
17 FODMAP intake vs acute symptom onset 15 Present * * Absent FODMAP (g) Bloating Fullness Pain Distension Bowel motion * p<0.05 Symptom
18 Fructan intake vs acute symptom onset 6 * * Present Absent Fructan (g) Bloating Fullness Symptom Pain Distension Bowel motion * p<0.05
19 Lactose intake vs acute symptom onset 10 8 * * Present Absent Lactose (g) Bloating Fullness Pain Distension Bowel motion ** P<0.001 Symptom
20 Proportion expericing symptom Bowel motion likelihood after FODMAP intake 1 P< >4 FODMAP intake per meal (grams)
21 Proportion experiencing symptom Proportion experiencing symptoms Fructan & GOS intake - likelihood of symptoms 1.0 Fructan intake and bowel motions P< GOS intake and acute abdominal fullness P< Fructan intake per meal (grams) GOS intake per meal (grams)
22 FODMAP intake vs symptom severity No consistent relationship observed between FODMAP intake and level of severity
23 Conclusions High intake of FODMAPs is associated with acute GI symptoms in people with IBS Amounts of FODMAPs causing symptoms likely to be individualised Fructans and GOS may be a major driver of some abdominal symptoms Severity of symptoms is not associated with FODMAP intake
24 Implications More evidence for the FODMAP-IBS hypothesis First study to show acute effect of FODMAPs on GI symptoms in free-living people with IBS Dietary advice should be individualised when determining thresholds IBS symptom severity will be determined by more than just FODMAPs Consistent with the multifactorial pathogenesis of IBS
25 Future Research Relationship between intake of individual FODMAPs and acute symptoms by IBS subtype Further explore relationship between FODMAP intake and acute bowel motions by Bristol stool type
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