Severidade dos sintomas da síndrome do intestino irritável e consumo de FODMAPs em estudantes universitários / Severity of irritable bowel syndrome symptoms and fodmaps intake in university students

ABSTRACT BACKGROUND: Irritable bowel syndrome (IBS) symptoms such as diarrhea, bloating and abdominal pain can reduce University student's productivity and learning ability. One of the possible treatments for IBS is the temporarily exclusion of foods that have a high content of short-chain fermentable carbohydrates, the fermentable, oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). OBJECTIVE: This study aimed to assess University student's intake of foods that are rich in FODMAPs, looking for possible associations with the severity of IBS symptoms. METHODS: A cross-sectional study was carried out, with undergraduate students from a private University in the city of São Paulo, Brazil, aged between 19 and 46 years old and that were enrolled in different courses and stages. Students were invited to participate and those who gave their formal consent were included in this research. A sociodemographic and lifestyle questionnaire was applied, in addition to the Gastrointestinal Symptom Rating Scale - GSRS. Students also responded a short Food Frequency Questionnaire, developed to investigate habitual FODMAPs intake of Brazilian adult population. Spearman's correlation analysis between the student's GSRS scores and the frequency of foods rich in FODMAPs intake were performed in SPSS v.21. RESULTS: Fifty-six students were interviewed, with mean age of 21.4 years old (SD=4.41), with a predominance of women (76.8%). The GSRS results showed that 58.9% of students felt minimal to moderate abdominal discomfort and 14.3% had moderately severe to very severe abdominal pain during the prior week to the interview. Besides abdominal pain, the gastrointestinal symptoms that were most reported by students were flatulence (98.2%), stomach rumbling (89.3%) and eructations (85.7%). Greater symptom severity was observed in women (P=0.004) and sedentary students (P=0.003). Regarding FODMAPs consumption, honey (P=0.04), chocolate (P=0.03) and milk table cream (P=0.001) intakes were positively correlated with the greater severity of symptoms. CONCLUSION: Although clinical diagnosis is necessary to establish IBS, 73.2% of the students presented minimal to very severe abdominal pain during the prior week. Female had sedentary students had greater severity of gastrointestinal symptoms. A low FODMAP diet, well oriented, could bring some symptoms relief to these University students.

RESUMO CONTEXTO: Os sintomas da síndrome do intestino irritável (SII), como diarreia, "inchaço" e dor abdominal, podem reduzir a produtividade e a capacidade de aprendizagem do estudante universitário. Um dos possíveis tratamentos para a SII é a exclusão temporária de alimentos que possuem alto teor de carboidratos fermentáveis de cadeia curta, os fermentáveis, oligossacarídeos, dissacarídeos, monossacarídeos e polióis (FODMAPs). OBJETIVO: Este estudo teve como objetivo avaliar a ingestão de alimentos ricos em FODMAPs por estudantes universitários, buscando possíveis associações com a gravidade dos sintomas da SII. MÉTODOS: Foi realizado um estudo transversal, com alunos de graduação de uma Universidade privada da cidade de São Paulo, Brasil, com idades entre 19 e 46 anos, matriculados em diferentes cursos e estágios. Os alunos foram convidados a participar e aqueles que deram seu consentimento formal foram incluídos nesta pesquisa. Foi aplicado um questionário sociodemográfico e de estilo de vida, além da Gastrointestinal Symptom Rating Scale - GSRS. Os alunos também responderam a um pequeno Questionário de Frequência Alimentar, desenvolvido para investigar o consumo habitual de FODMAPs na população adulta brasileira. A análise de correlação de Spearman entre os escores GSRS do aluno e a frequência do consumo de alimentos ricos em FODMAPS foi realizada no SPSS v.21. RESULTADOS: Foram entrevistados 56 alunos, com média de idade de 21,4 anos (DP=4,41) e predomínio do sexo feminino (76,8%). Os resultados do GSRS mostraram que 58,9% dos alunos sentiram desconforto abdominal mínimo a moderado e 14,3% tiveram dor abdominal moderadamente intensa a muito intensa durante a semana anterior à entrevista. Além das dores abdominais, os sintomas gastrointestinais mais referidos pelos estudantes foram flatulência (98,2%), roncos estomacais (89,3%) e eructações (85,7%). Maior gravidade dos sintomas foi observada em mulheres (P=0,004) e estudantes sedentários (P=0,003). Em relação ao consumo de FODMAPs, a ingestão de mel (P=0,04), chocolate (P=0,03) e creme de leite (P=0,001) se correlacionou positivamente com a maior gravidade dos sintomas. CONCLUSÃO: Embora o diagnóstico clínico seja necessário para o estabelecimento da presença da SII, 73,2% dos alunos apresentaram dor abdominal mínima a muito intensa na semana anterior ao estudo. Estudantes do sexo feminino e sedentários apresentaram maior gravidade dos sintomas gastrointestinais. Uma dieta pobre em FODMAP, bem orientada, poderia trazer algum alívio destes sintomas a estes universitários.

Low FODMAP Diet and Inflammatory Bowel Disease: Benefits and Risks / 胃肠病学

Patients with inflammatory bowel disease (IBD) often suffer from functional gastrointestinal symptoms, such as abdominal pain, bloating, constipation and/or diarrhea. Diets low in fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) can effectively reduce these symptoms and have been used in treatment of IBD. However, some studies suggested that low FODMAP diet might increase the risk of malnutrition and alter gut microbiota. In this article, the effect and mechanism of low FODMAP diet on functional gastrointestinal symptoms of patients with IBD and the potential adverse effects and solutions were reviewed.

Advances in Study on Effect of Low FODMAPs Diet on Gastrointestinal Dysfunction in Patients with IBD / 胃肠病学

Studies showed that low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) diet can improve the symptoms of gastrointestinal dysfunction of inflammatory bowel disease (IBD) patients, the mechanism may be related to decrease of secretion of intestinal liquid and production of gas.Specific carbohydrate diet and paleolithic diet may be suitable for IBD patients.This article reviewed the advances in study on effects of different diets on gastrointestinal dysfunction in patients with IBD.

Brazilian Society for Food and Nutrition position statement: gluten-free diet

Position statement: The Brazilian Society for Food and Nutrition (SBAN) bases the following position statement on a critical analysis of the literature on the indications of a gluten-free (GF) diet. (1) There is insufficient evidence to assume that healthy individuals would experience any benefits from the consumption of a GF diet. (2) Recent studies suggest that gluten sensitivity may be confounded by sensitivity to low-fermentable, poorly absorbed, short-chain carbohydrates known as fermentable oligo-, di-, and mono-saccharides and polyols (FODMAPs). (3) Epidemiological data supports that evenover weight celiac disease (CD) individuals fail to achieve weight loss under a GF diet. (4) Recent experimental data showed possible deleterious effects of GF feeding on the intestinal microbiota of healthy individuals. (5) GF diets can be healthy for the general population, as long as GF-processed foods are avoided, and the ingestion of other whole grains, and low-energy-density vegetables is assured. This position statement has been externally reviewed and approved by the board of the Brazilian Society for Food and Nutrition, and has not gone through the journal' s standard peer review process.

Restriction of FODMAP in the management of bloating in irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common functional bowel disorder. Up to 96% of IBS patients experience bloating, resulting in poor response to conventional therapies and high consultation rates. Many IBS patients report that food triggers symptoms, particularly diets with poorly absorbed, short-chain carbohydrates, and restrict intake of certain foods to control their symptoms. IBS patients are especially susceptible to an attack due to visceral hypersensitivity. An emerging therapeutic strategy excludes fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) from the diet. There is evidence supporting the efficacy of a low FODMAP diet in improving symptoms of bloating in IBS patients. Individualised, structured dietary guidance may benefit those with persistent troublesome symptoms despite traditional therapies. In view of the multifactorial aetiology of the condition, it is probably best to use a multipronged approach, involving combination therapies, to address bloating in IBS patients.

Sensibilidad no celíaca al gluten: Una patología más que responde al gluten / Non-celiac gluten sensitivity: Another condition that responds to gluten

Remission of gastrointestinal and general symptoms after gluten withdrawal has been described in some non-celiac individuals for nearly 30 years. Only recently, efforts have been made to define this entity, now referred to as "non- celiac gluten sensitivity". It includes patients that clinically respond to gluten free diet without exhibiting allergic or autoimmune features to explain such response. Wheat allergy, celiac disease, irritable bowel syndrome and symptoms induced by high FODMAPs (Fermentable, Oligo-, Di-, Mono-saccharides And Polyols) consumption are the main differential diagnoses. The relationship with neuropsychiatric disorders such as schizophrenia and autism has not been demonstrated, but currently it gives ground to great hope in families with affected children. Epidemiology of non-celiac gluten sensitivity is not clear. It is described as more common among women and less common in children. Genetic and immune factors, changes in intestinal microbiota and non-gluten components present in wheat grains are main factors postulated in the pathogenesis of this condition. To date, there are no specific biomarkers for non-celiac gluten sensitivity and diagnosis is reached by excluding other causes of disease. A trial with gluten-free diet and subsequent gluten challenge is the methodology most frequently used to confirm diagnosis.

Efecto de la dieta reducida enfodmaps en el manejo desíntomas gastrointestinales / Effect of a low-fodmaps diet in gastrointestinal symptoms

El enfoque de la dieta reducida en Oligosacáridos, Disacáridos, Monosacáridos y Polialcoholes Fermentables (FODMAPs) con el fin de controlar los Síntomas Gastrointestinales (GI), ha sido estudiado principalmente en pacientes con Síndrome de Intestino Irritable (SII). La absorción deficiente, el efecto osmótico y la fermentación bacteriana de los FODMAPs en el intestino son fenómenos normales, donde la aparición de síntomas (distensión, dolor abdominal y alteración de la motilidad intestinal) ocurrirá si la respuesta subyacente es exagerada o anormal. Discusión: La implementación de la Dieta Reducida en FODMAPs (DRF) requiere de una etapa de restricción de los mismos, seguida por una de reintroducción. La evidencia que se dispone a la fecha resulta prometedora en el control de síntomas GI, tanto del SII, Sensibilidad al Gluten No Celíaca (SGNC) y Enfermedad Inflamatoria Intestinal (EII). Asimismo, se ha vinculado el contenido de FODMAPs de las fórmulas enterales con la diarrea asociada a la nutrición enteral. El impacto a largo plazo de la restricción de FODMAPs sobre la microbiota intestinal es aún desconocido.Conclusión: Se requiere de mayor evidencia para poder recomendar la DRF como tratamiento de primera línea. El asesoramiento dietético por parte de un licenciado en nutrición sobre la misma es indispensable para su eficacia...

Dieta restrita de FODMEPs como opção terapêutica na síndrome do intestino irritável: revisão sistemática / FODAPs restricted diet as a treatment option in irritable bowel syndrome: systematic review

A Síndrome do Intestino Irritável (SII) é considerada, a partir do Consenso de ROMA III, um distúrbio gastrointestinal funcional, caracterizado por dor, mudança no hábito intestinal, distensão abdominal e constipação e/ou diarreia. Este distúrbio é classificado de acordo com o padrão de perturbações do trânsito intestinal e seu tratamento depende da apresentação clínica. A terapia farmacológica é bastante diversificada; contudo, a primeira opção para o manejo da SII são as medidas não farmacológicas. Uma modificação dietética que está se mostrando eficaz na terapêutica da SII é a redução da ingesta de FODMEPs, que é acrônimo de fermentável, oligossacarídeos, dissacarídeos, monossacarídeos e polióis. Este trabalho objetiva analisar se esta dieta propicia benefícios no tratamento da SII. Para tanto, realizou-se uma revisão sistemática da literatura científica nas bases de dados eletrônicas Pubmed, Medline, Trip, Science Direct, Scielo. Não foram encontrados artigos em língua portuguesa. A avaliação metodológica foi CASP. Um total de onze artigos primários foi incluído na revisão. A maioria dos estudos não apenas correlaciona os FODMEPs aos sintomas da SII, mas também considera a dieta com restrição FODMEPs como um tratamento não farmacológico imprescindível. Sabe-se que a sintomatologia da SII é influenciada pela ação do sistema nervoso entérico por fatores psicológicos e alimentares. Estudos observacionais expõem a restrição de FODMEPs como uma abordagem inovadora para o alívio dos sintomas. Um obstáculo na redução de FODMEPs é a dificuldade de o paciente aderir à dieta, pois esta é muito restritiva. No cenário brasileiro, essa abordagem para a SII ainda não foi explorada, o que é notabilizado pela inexistência de estudos acerca do tema. Conclui-se que a redução da ingesta de FODMEPs é uma alternativa na abordagem terapêutica da SII refratária. Os gastroenterologistas não podem mais ignorar os efeitos benéficos desse tipo de dieta. Estudos que adaptam a dieta FODMEPs aos hábitos alimentares dos brasileiros precisam ser realizados com urgência.

Irritable Bowel Syndrome (IBS) is considered by ROME III Criteria a functional gastrointestinal disorder characterized by pain, change in bowel habits, abdominal distension and constipation and/or diarrhea. This disorder is classified according to the standard of intestinal symptoms and its treatment relies on clinical presentation. The pharmacologic therapy is diverse, however, the first option for the management of IBS are non-pharmacological measures. A dietary modification that has been effective in the treatment of IBS is reducing the intake of FODMAPs, which is an acronym of fermentable, oligosaccharides, disaccharides, monosaccharides and polyols. This work is a systematic review of scientific literature published on electronic databases such as Pubmed, Medline, Trip, Science Direct, Scielo and analyses whether this diet provides benefits to the treatment of IBS. There are not any articles in Portuguese on the subject and the methodological evaluation was conducted through CASP. Only ten primary studies were found and they were all included in this work. Most of these studies not only correlate FODMAPs with the symptoms of IBS, but also consider this restricted diet as an important non-pharmacological treatment. It is known that the symptoms of IBS are influenced by the action of the enteric nervous system, psychological and dietary factors. Observational studies show that restricting FODMAPs is an innovative approach for the relief of symptoms. One obstacle in reducing FODMAPs is its restrictive nature that discourages patients to adhere to it. In the Brazilian context, this approach to IBS has not been explored yet, which might be explained by the lack of studies on the subject. It was concluded that reducing the intake of FODMEPs is an alternative therapeutic approach to refractory IBS and gastroenterologists can no longer ignore the beneficial effects of this type of diet. Studies considering FODMAPs eating habits in Brazil still need to be undertaken.

The Low FODMAP Diet and Its Application in East and Southeast Asia

There is growing interest in using food choice/dietary change to influence clinical outcomes in patients with irritable bowel syndrome (IBS). The low fermentable oligo-, di-, mono-saccharides, and polyols (FODMAPs) diet is an evidence-based approach that is gaining popularity in many Western countries. The low FODMAP diet is based on restricting dietary intake of short chain carbohydrates that are slowly absorbed or indigestible and not absorbed during passage through the small intestine. These are collectively described as "FODMAPs" and comprise oligosaccharides (mostly fructans, galacto-oligosaccharides), sugar polyols, fructose in excess of glucose, and lactose in lactose malabsorbers. The general strategy of the diet is to avoid foods high in FODMAPs and replace them with foods low in FODMAPs, with long-term restriction limited to what is required to control symptoms. The likely mechanism of action is minimisation of the stimulation of mechanoreceptors exerted by distension of the intestinal lumen with water from osmotic effects and gases from bacterial fermentation in those with visceral hypersensitivity. The success of this dietary approach greatly depends on detailed knowledge about the FODMAP composition of food commonly consumed in that country. While the content of foods associated with East and Southeast Asian cuisines has not been fully explored, major high FODMAP sources are frequently used and include onion, garlic, shallots, legumes/pulses, and wheat-based products. Thus, this dietary approach holds great promise in treating IBS patients in East and Southeast Asia. The aim of this review is to highlight how the diet is implemented, its efficacy, and troublesome ingredients frequently used in Asian dishes.

Current Issues on Irritable Bowel Syndrome: Diet and Irritable Bowel Syndrome / 대한소화기학회지

Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders. It is a multifactorial disorder with its pathogenesis attributed to abnormal gastrointestinal motility, low-grade inflammation, visceral hypersensitivity, communication in the gut-brain axis, and so on. Traditionally, IBS has been treated with diet and lifestyle modification, fiber supplementation, psychological therapy, and pharmacological treatment. Carbohydrates are intermingled with a wide range of regularly consumed food including grains such as rye and wheat, vegetables, fruits, and legumes. Short-chain carbohydrates that are poorly absorbed exert osmotic effects in the intestinal lumen increasing its water volume, and are rapidly fermented by bacteria with consequent gas production. These effects may be the basis for the induction of most of the gastrointestinal symptoms. This has led to the use of lactose-free diets in those with lactose intolerance and of fructose-reduced diets for fructose malabsorption. As all poorly absorbed short-chain carbohydrates have similar and additive effects in the intestine, a concept has been developed to regard them collectively as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) and to evaluate a dietary approach that restricts them all. Based on the observational and comparative studies, and randomized-controlled trials, FODMAPs have been shown to trigger gastrointestinal symptoms in patients with IBS. Food choice via the low FODMAPs and potentially other dietary strategies is now a realistic and efficacious therapeutic approach for managing symptoms of IBS.