Habitual FODMAP Intake in Relation to Symptom Severity and Pattern in Patients with Irritable Bowel Syndrome
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Questionnaires
2.2.1. IBS Severity Scoring System (IBS-SSS)
2.2.2. The Patient Health Questionnaire (PHQ-15)
2.2.3. Hospital Anxiety and Depression (HAD) scale
2.2.4. Visceral Sensitivity Index (VSI)
2.2.5. Multidimensional Fatigue Inventory-20 (MFI-20)
2.3. Dietary Assessment
2.4. Statistical Analysis
3. Results
3.1. Reported Diet Intake
3.2. Correlations between FODMAP Intake and Symptom Severity in Women
3.3. Univariable Regression Analyses
3.4. Multivariable Regression Analyses
4. Discussion
5. Conclusions
Author Contributions
Funding
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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IBS-C | IBS-D | IBS-M | IBS-U | Difference between Groups | |
---|---|---|---|---|---|
Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | p-Value | |
Women (n = 145) | (n = 36) | (n = 40) | (n = 33) | (n = 36) | |
Age, y | 40.2 ± 15.6 | 35.6 ± 13.3 | 35.0 ± 13.2 | 39.7 ± 16.1 | 0.30 |
Weight, kg | 65 ± 11.6 | 65 ± 12.7 | 65.7 ± 16.1 | 63.0 ± 9.1 | 0.84 |
BMI (kg/m2) | 23.0 ± 3.3 | 23.6 ± 4.3 | 23.4 ± 4.7 | 22.5 ± 2.8 | 0.68 |
Men (n = 44) | (n = 8) | (n = 14) | (n = 12) | (n = 10) | |
Age, y | 40.5 ± 11.8 | 39.7 ± 16.0 | 34.1 ± 13.5 | 35.5 ± 12.3 | 0.65 |
Weight, kg | 78.6 ± 11.3 | 80.5 ± 10.4 | 81.8 ± 9.6 | 85.4 ± 15.8 | 0.68 |
BMI (kg/m2) | 23.3 ± 3.6 | 24.5 ± 3.5 | 25.2 ± 2.1 | 25.5 ± 4.3 | 0.52 |
All (n = 189) | (n = 44) | (n = 54) | (n = 45) | (n = 46) | |
IBS-SSS | 306 ± 81 | 302 ± 92 | 304 ± 84 | 291 ± 83 | 0.83 |
Pain intensity | 52 ± 26 | 48 ± 27 | 54 ± 25 | 46 ± 24 | 0.48 |
Pain frequency | 58 ± 34 | 52 ± 35 | 53 ± 33 | 54 ± 32 | 0.81 |
Bloating severity | 61 ± 29 | 58 ± 27 | 58 ± 31 | 60 ± 28 | 0.92 |
Bowel habit dissatisfaction | 65 ± 28 | 72 ± 23 | 73 ± 21 | 61 ± 29 | 0.065 |
Daily life interference | 70 ± 23 | 72 ± 18 | 66 ± 26 | 69 ± 24 | 0.61 |
VSI | 48.5 ± 17.5 | 43.7 ± 16.1 | 41.9 ± 15.9 | 48.1 ± 14.4 | 0.14 |
PHQ | 12.2 ± 4.0 | 13.8 ± 5.6 | 14.3 ± 4.7 | 11.6 ± 4.3 | 0.025 * |
HAD | 12.9 ± 8.1 | 14.2 ± 6.2 | 13.6 ± 7.0 | 12.1 ± 7.4 | 0.53 |
MFI-20 | 59.1 ± 15.4 | 62.0 ± 16.2 | 60.7 ± 17.3 | 55.9 ± 16.2 | 0.32 |
IBS-C | IBS-D | IBS-M | IBS-U | Difference between Groups | |
---|---|---|---|---|---|
Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | p-Value | |
Women (n = 145) | (n = 36) | (n = 40) | (n = 33) | (n = 36) | |
Energy, kcal | 1943 ± 487 | 1982 ± 497 | 2076 ± 546 | 2132 ± 462 | 0.36 |
Protein, E% | 17.4 ± 3.2 | 16.4 ± 3.4 | 16.1 ± 3.6 | 15.4 ± 2.7 | 0.087 |
Carbohydrates, E% | 38.0 ± 8.5 | 40.8 ± 6.6 | 41.3 ± 9.8 | 40.8 ± 6.9 | 0.31 |
Fat, E% | 38.7 ± 8.5 | 38.2 ± 6.1 | 38.2 ± 8.5 | 38.5 ± 6.1 | 0.99 |
Alcohol, E% | 4.0 ± 4.6 | 2.3 ± 2.9 | 2.4 ± 3.2 | 3.5 ± 2.7 | 0.10 |
Dietary fiber, E% | 1.8 ± 0.6 | 2.1 ± 0.8 | 1.9 ± 0.5 | 1.9 ± 0.7 | 0.39 |
Dietary fiber, g | 17.8 ± 7.4 | 20.6 ± 8.8 | 19.6 ± 7.0 | 20.0 ± 7.0 | 0.43 |
Total FODMAPs, g | 19.0 ± 8.2 | 17.0 ± 8.3 | 23.9 ± 13.2 | 20.1 ± 12.1 | 0.054 |
Galacto-oligosaccharides, g | 0.5 ± 0.4 | 0.5 ± 0.4 | 0.6 ± 0.6 | 0.4 ± 0.2 | 0.25 |
Fructans, g | 2.0 ± 0.9 | 2.3 ± 1.2 | 2.8 ± 1.6 | 2.5 ± 1.1 | 0.08 |
Polyols, g | 1.4 ± 1.6 | 0.9 ± 1.3 | 1.5 ± 1.7 | 0.9 ± 1.0 | 0.14 |
Lactose, g | 10.0 ± 6.2 | 7.6 ± 6.6 | 13.6 ± 8.1 | 10.0 ± 8.3 | 0.009 * |
Excess fructose, g | 5.1 ± 3.7 | 5.6 ± 5.7 | 5.4 ± 7.8 | 6.3 ± 7.2 | 0.87 |
Men (n = 44) | (n = 8) | (n = 14) | (n = 12) | (n = 10) | |
Energy, kcal | 2292 ± 354 | 2309 ± 515 | 2432 ± 710 | 2369 ± 516 | 0.93 |
Protein, E% | 16.9 ± 1.4 | 15.1 ± 2.4 | 18.4 ± 5.1 | 19.0 ± 8.2 | 0.21 |
Carbohydrates, E% | 38.6 ± 8.8 | 44.5 ± 6.4 | 37.6 ± 8.4 | 43.0 ± 5.0 | 0.065 |
Fat, E% | 42.1 ± 6.9 | 32.0 ± 6.8 | 36.7 ± 8.8 | 34.5 ± 7.9 | 0.037 * |
Alcohol, E% | 0.9 ± 1.7 | 6.1 ± 6.0 | 5.7 ± 5.4 | 1.5 ± 2.0 | 0.017 * |
Dietary fiber, E% | 1.5 ± 0.4 | 2.0 ± 0.7 | 1.6 ± 0.3 | 1.9 ± 0.8 | 0.182 |
Dietary fiber, g | 18.1 ± 6.7 | 23.2 ± 9.3 | 18.5 ± 5.5 | 21.4 ± 8.3 | 0.343 |
Total FODMAPs, g | 19.9 ± 9.1 | 19.6 ± 12.2 | 21.7 ± 18.4 | 28.9 ± 12.0 | 0.38 |
Galacto-oligosaccharides, g | 0.5 ± 0.2 | 0.8 ± 0.6 | 0.5 ± 0.6 | 0.6 ± 0.5 | 0.52 |
Fructans, g | 2.3 ± 1.2 | 3.2 ± 2.1 | 2.4 ± 1.0 | 3.3 ± 1.9 | 0.40 |
Polyols, g | 1.0 ± 1.5 | 0.5 ± 0.7 | 0.8 ± 1.4 | 1.7 ± 2.5 | 0.36 |
Lactose, g | 11.1 ± 7.8 | 9.5 ± 8.6 | 11.1 ± 10.5 | 14.5 ± 12.6 | 0.69 |
Excess fructose, g | 5.1 ± 5.0 | 5.6 ± 4.4 | 6.9 ± 11.8 | 8.8 ± 5.1 | 0.69 |
All (n = 189) | (n = 44) | (n = 54) | (n = 45) | (n = 46) | |
Total FODMAPs, g/1000 kcal | 9.73 ± 3.96 | 8.83 ± 4.91 | 10.90 ± 5.99 | 10.13 ± 5.57 | 0.25 |
Galacto-oligosaccharides, g/1000 kcal | 0.24 ± 0.21 | 0.30 ± 0.30 | 0.27 ± 0.31 | 0.21 ± 0.15 | 0.27 |
Fructans, g/1000 kcal | 1.03 ± 0.41 | 1.24 ± 0.67 | 1.24 ± 0.60 | 1.24 ± 0.62 | 0.28 |
Polyols, g/1000 kcal | 0.70 ± 0.83 | 0.41 ± 0.60 | 0.60 ± 0.69 | 0.50 ± 0.72 | 0.23 |
Lactose, g/1000 kcal | 5.15 ± 3.02 | 4.18 ± 4.26 | 6.14 ± 3.94 | 5.00 ± 4.20 | 0.11 |
Excess fructose, g/1000 kcal | 2.59 ± 1.98 | 2.69 ± 2.33 | 2.64 ± 3.72 | 3.18 ± 3.11 | 0.75 |
All | IBS-C | IBS-D | IBS-M | IBS-U | |
---|---|---|---|---|---|
IBS-SSS total | 0.217 ** | 0.246 | 0.257 | −0.159 | 0.518 ** |
Pain intensity | 0.153 | 0.276 | −0.069 | 0.088 | 0.258 |
Pain frequency | 0.168 * | 0.081 | 0.220 | −0.061 | 0.386 * |
Bloating severity | 0.104 | 0.232 | 0.214 | −0.229 | 0.188 |
Bowel habit dissatisfaction | 0.124 | 0.090 | 0.088 | −0.160 | 0.323 |
Daily life interference | 0.159 | 0.229 | 0.086 | 0.090 | 0.347 * |
VSI | −0.058 | −0.075 | 0.100 | −0.120 | −0.015 |
PHQ | 0.091 | 0.175 | 0.148 | 0.059 | 0.090 |
HAD | 0.095 | 0.278 | −0.036 | 0.148 | 0.047 |
MFI-20 | 0.046 | 0.132 | 0.010 | 0.037 | −0.014 |
Independent Variable | All | IBS-C | IBS-D | IBS-M | IBS-U | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
R2 | B | p-Value | R2 | B | p-Value | R2 | B | p-Value | R2 | B | p-Value | R2 | B | p-Value | |
Age | 0.009 | 0.545 | 0.208 | 0.051 | −1.226 | 0.141 | 0.003 | 0.363 | 0.692 | 0.000 | −0.022 | 0.982 | 0.049 | −1.199 | 0.141 |
BMI | 0.001 | −0.633 | 0.709 | 0.021 | −3.664 | 0.368 | 0.000 | −0.396 | 0.902 | 0.023 | −2.949 | 0.340 | 0.046 | 5.128 | 0.174 |
Energy, kcal | 0.029 | −0.030 | 0.042 * | 0.009 | −0.033 | 0.261 | −0.022 | −0.012 | 0.698 | 0.012 | −0.035 | 0.249 | −0.001 | −0.031 | 0.330 |
CVw kcal | 0.001 | 0.242 | 0.683 | 0.036 | 1.178 | 0.266 | 0.030 | −1.246 | 0.283 | 0.023 | −1.114 | 0.404 | 0.104 | 2.374 | 0.055 |
CVw FODMAP | 0.003 | −0.199 | 0.532 | 0.017 | −0.654 | 0.447 | 0.023 | −0.569 | 0.355 | 0.066 | −0.992 | 0.156 | 0.072 | 0.846 | 0.115 |
EA FODMAP | 0.043 | 16.32 | 0.012 * | 0.039 | 15.09 | 0.250 | 0.046 | 18.89 | 0.186 | 0.009 | −7.735 | 0.607 | 0.233 | 33.77 | 0.003 * |
EA GOS | 0.000 | −1,154 | 0.859 | 0.052 | −16.19 | 0.182 | 0.007 | −6.438 | 0.605 | 0.000 | −1.246 | 0.933 | 0.047 | 18.38 | 0.204 |
EA FOS | 0.000 | 0.068 | 0.992 | 0.013 | −8.814 | 0.514 | 0.005 | −5.303 | 0.679 | 0.009 | 7.296 | 0.602 | 0.019 | 10.71 | 0.420 |
EA polyols | 0.001 | 2.238 | 0.731 | 0.000 | 1.034 | 0.938 | 0.003 | −4.255 | 0.745 | 0.022 | 10.09 | 0.415 | 0.000 | 0.101 | 0.995 |
EA lactose | 0.000 | −0.606 | 0.927 | 0.009 | −8.583 | 0.589 | 0.006 | −6.460 | 0.629 | 0.028 | −14.06 | 0.370 | 0.070 | 18.44 | 0.124 |
EA excess fructose | 0.045 | 16.09 | 0.011 * | 0.029 | 12.49 | 0.318 | 0.042 | 15.33 | 0.213 | 0.000 | −0.071 | 0.996 | 0.199 | 34.52 | 0.007 * |
All | IBS-C | IBS-D | IBS-M | IBS-U | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Adjusted R2 | B | p-Value | Adjusted R2 | B | p-Value | Adjusted R2 | B | p-Value | Adjusted R2 | B | p-Value | Adjusted R2 | B | p-Value | |
Full model 1 EA FODMAP | 0.246 | 5.092 | 0.362 | 0.338 | 7.752 | 0.523 | 0.174 | 14.82 | 0.251 | 0.273 | −28.42 | 0.023 | 0.313 | 21.89 | 0.047 |
Energy intake | −0.013 | 0.362 | −0.010 | 0.696 | 0.004 | 0.882 | −0.016 | 0.526 | −0.026 | 0.286 | |||||
Age | 0.116 | 0.791 | −0.104 | 0.910 | 1.434 | 0.161 | −0.333 | 0.712 | −0.853 | 0.259 | |||||
BMI | −2.668 | 0.106 | −4.163 | 0.320 | −1.945 | 0.528 | −3.692 | 0.192 | −0.151 | 0.976 | |||||
PHQ | 8.217 | 0.000 | 13.16 | 0.001 | 7.784 | 0.007 | 8.457 | 0.008 | 5.938 | 0.040 | |||||
Full model 2 EA FODMAP minus lactose | 0.241 | 1.860 | 0.744 | 0.327 | −1.676 | 0.886 | 0.137 | −1.873 | 0.876 | 0.123 | −12.15 | 0.386 | 0.336 | 26.10 | 0.029 |
Energy intake | −0.014 | 0.243 | −0.014 | 0.607 | 0.000 | 0.988 | −0.005 | 0.860 | −0.023 | 0.349 | |||||
Age | 0.142 | 0.746 | −0.008 | 0.993 | 1.545 | 0.139 | −0.240 | 0.810 | −0.993 | 0.191 | |||||
BMI | −2.685 | 0.111 | −4.246 | 0.330 | −1.851 | 0.567 | −3.350 | 0.277 | −1.055 | 0.823 | |||||
PHQ | 8.243 | 0.001 | 13.49 | 0.001 | 8.343 | 0.005 | 9.118 | 0.014 | 7.212 | 0.010 |
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Nybacka, S.; Störsrud, S.; Lindqvist, H.M.; Törnblom, H.; Simrén, M.; Winkvist, A. Habitual FODMAP Intake in Relation to Symptom Severity and Pattern in Patients with Irritable Bowel Syndrome. Nutrients 2021, 13, 27. https://doi.org/10.3390/nu13010027
Nybacka S, Störsrud S, Lindqvist HM, Törnblom H, Simrén M, Winkvist A. Habitual FODMAP Intake in Relation to Symptom Severity and Pattern in Patients with Irritable Bowel Syndrome. Nutrients. 2021; 13(1):27. https://doi.org/10.3390/nu13010027
Chicago/Turabian StyleNybacka, Sanna, Stine Störsrud, Helen M. Lindqvist, Hans Törnblom, Magnus Simrén, and Anna Winkvist. 2021. "Habitual FODMAP Intake in Relation to Symptom Severity and Pattern in Patients with Irritable Bowel Syndrome" Nutrients 13, no. 1: 27. https://doi.org/10.3390/nu13010027
APA StyleNybacka, S., Störsrud, S., Lindqvist, H. M., Törnblom, H., Simrén, M., & Winkvist, A. (2021). Habitual FODMAP Intake in Relation to Symptom Severity and Pattern in Patients with Irritable Bowel Syndrome. Nutrients, 13(1), 27. https://doi.org/10.3390/nu13010027