Application of The FODMAP Diet in a Paediatric Setting
Abstract
:1. Introduction
2. Overview of the Fodmap Dietary Strategy
3. Efficacy of the Fodmap Diet in Paediatric IBS
4. Safety of the Fodmap Diet in Paediatrics
4.1. Nutrition and Growth
4.2. Disordered Eating
4.3. Psychosocial Impacts on Family and Adherence to the Diet
4.4. Effect on Gut Microbiota
5. Practical Delivery of the Fodmap Diet
5.1. Role of the Dietitian—What They Do
5.2. Future Directions in FODMAP Treatments
5.3. Sucrase-Isomaltase Deficiency
5.4. Supplementary Digestive Enzymes
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Study | Design | Patients | Intervention(s) | Endpoints | Comments | |
---|---|---|---|---|---|---|
Abdominal Symptoms | Other | |||||
Chumpitazi 2015 USA [27] | Double blind randomised cross-over control trial | n = 33 7–17 years IBS (Rome III) | Low FODMAP diet: 0.15 g/kg/d FODMAPs or max 9 g/day vs. Typical American childhood diet (TACD): 0.7 g/kg/d FODMAPs or max 50 g/day)
| Abdominal pain:
|
| Short intervention of only 48 h Study designed to examine predictive microbiota |
Baranguán 2019 Spain [32] | Prospective observational | n = 20 5–15 years Functional abdominal pain | List of foods categorised as ‘allowed’ or ‘not allowed’ based on FODMAP content
| Reduction in:
|
| Small sample size, no control group |
Brown 2020 New Zealand [33] | Retrospective observational | n = 29 4–17 years Chronic persistent and relapsing symptoms consistent with functional bowel disorder | Dietitian led education across all 3 phases of the diet | Complete resolution in:
|
| No control, retrospective symptom response survey taken 2–28 months after intervention |
Dogan 2020 Turkey [34] | Randomised controlled trial | n = 60 (30 low FODMAP, 30 control) 6–18 years IBS (Rome IV) | Low FODMAP: <0.5 g FODMAP per meal vs. Control: ‘healthy’ diet avoiding certain foods specifically, e.g., caffeine, acidic, spicy, high fat
| Decrease in abdominal pain on 100 mm visual analogue scale after 2 months:
| Subjective ratings from doctors on symptom improvement using Clinical Global Impression Improvement—43% ‘much improved’ on low FODMAP vs. 3% control | No reporting of:
|
Boradyn 2021 Poland [35] | Double-blinded randomised control trial | n = 27 5–12 years Functional abdominal pain (Rome III) | Modified NICE a guidelines (n = 14) vs. low FODMAP diet (n = 13)
| Abdominal pain intensity and frequency:
| Higher non-compliance in 2nd week of low FODMAP diet (median: 6.0, IQR: 4.0–9.0 times per week) vs. NICE (median: 1.5, IQR: 1.0–2.0) (p < 0.05) | Both diets considered to be therapeutic—no placebo control |
Strategy | Examples |
---|---|
Ask |
|
Educate |
|
Tailor |
|
Age Group | Behavioural and Lifestyle Considerations |
---|---|
5–12 years |
|
12–17 years |
|
Red Flag Symptom | What Are We Missing? |
---|---|
Nocturnal waking symptoms | Gastroesophageal reflux disease (GORD) |
Rectal bleeding | Inflammatory bowel disease (IBD), malignancy |
Anaemia | Coeliac disease, IBD, malignancy |
Suboptimal growth/unexplained weight loss | Coeliac disease, IBD, malignancy, non-IgE-mediated allergy |
Recurrent vomiting | Infection, non-IgE mediated allergy |
Family history of IBD/coeliac disease | Coeliac disease, IBD |
Fever | Infection, malignancy, IBD |
Coeliac disease not yet excluded | Coeliac disease |
Pain in an unusual place (i.e., joint pain, difficulty swallowing, chest pain, etc.) | GORD, IBD, malignancy, eosinophilic esophagitis |
Delayed puberty | Coeliac disease, IBD, malignancy |
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Rhys-Jones, D.; Varney, J.E.; Muir, J.G.; Gibson, P.R.; Halmos, E.P. Application of The FODMAP Diet in a Paediatric Setting. Nutrients 2022, 14, 4369. https://doi.org/10.3390/nu14204369
Rhys-Jones D, Varney JE, Muir JG, Gibson PR, Halmos EP. Application of The FODMAP Diet in a Paediatric Setting. Nutrients. 2022; 14(20):4369. https://doi.org/10.3390/nu14204369
Chicago/Turabian StyleRhys-Jones, Dakota, Jane E. Varney, Jane G. Muir, Peter R. Gibson, and Emma P. Halmos. 2022. "Application of The FODMAP Diet in a Paediatric Setting" Nutrients 14, no. 20: 4369. https://doi.org/10.3390/nu14204369