Long‐term impact of the low‐FODMAP diet on gastrointestinal symptoms, dietary intake, patient acceptability, and healthcare utilization in irritable bowel syndrome

• Published in: Neurogastroenterology and motility Vol. 30; no. 1
• Main Authors: O'Keeffe, M., Jansen, C., Martin, L., Williams, M., Seamark, L., Staudacher, H. M., Irving, P. M., Whelan, K., Lomer, M. C.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.01.2018
• Subjects: Adult; Delivery of Health Care - statistics & numerical data; Diet; Dietary intake; Eating; Female; Fermented Foods; FODMAP; Food intake; Food quality; Health services utilization; Humans; Intestine; Irritable bowel syndrome; Irritable Bowel Syndrome - diet therapy; Male; Middle Aged; nutrient intake; Patient Satisfaction; Prospective Studies; Quality of Life; Reintroduction; Treatment Outcome; diet; nutrient intake; irritable bowel syndrome; FODMAP
• ISSN: 1350-1925; 1365-2982
• DOI: 10.1111/nmo.13154

Background The low‐FODMAP diet is a frequently used treatment for irritable bowel syndrome (IBS). Most research has focused on short‐term FODMAP restriction; however, guidelines recommend that high‐FODMAP foods are reintroduced to individual tolerance. This study aimed to assess the long‐term effectiveness of the low‐FODMAP diet following FODMAP reintroduction in IBS patients. Methods Patients with IBS were prospectively recruited to a questionnaire study following completion of dietitian‐led low‐FODMAP education. At baseline and following FODMAP restriction (short term) only, gastrointestinal symptoms were measured as part of routine clinical care. Following FODMAP reintroduction, (long term), symptoms, dietary intake, acceptability, food‐related quality of life (QOL), and healthcare utilization were assessed. Data were reported for patients who continued long‐term FODMAP restriction (adapted FODMAP) and/or returned to a habitual diet (habitual). Key Results Of 103 patients, satisfactory relief of symptoms was reported in 12% at baseline, 61% at short‐term follow‐up, and 57% at long‐term follow‐up. At long‐term follow‐up, 84 (82%) patients continued an ‘adapted FODMAP’ diet (total FODMAP intake mean 20.6, SD 14.9 g/d) compared with 19 (18%) of patients following a ‘habitual’ diet (29.4, SD 22.9 g/d, P=.039). Nutritional adequacy was not compromised for either group. The ‘adapted FODMAP’ group reported the diet cost significantly more than the ‘habitual’ group (P<.001) and affected social eating (P<.01) but there was no effect on food‐related QOL. Healthcare utilization was similar between both groups. Conclusion and Inferences Low‐FODMAP education is effective for long‐term IBS management, enables a nutritionally adequate diet, and is broadly acceptable to patients. This study assessed the long‐term impact of the low‐FODMAP diet on clinical response, dietary intake, patient acceptability, food‐related QOL, and healthcare use. Over half of patients report long‐term symptom relief, the diet is nutritionally adequate, and acceptable to patients. The findings support using the low‐FODMAP diet for long‐term IBS management. Baseline; Short‐term follow‐up; Long‐term follow‐up.