Implications of Dietary Interventions for GI Disorders

Abstract and Introduction

Abstract

Purpose of review: The aim of this review is to summarize some of the key dietary interventions recommended for common gastrointestinal disorders and to discuss recent evidence regarding their nutritional implications.

Recent findings: The gluten-free diet has been shown to negatively influence overall diet quality. The gluten-free diet is essential in celiac disease, although it is increasingly used for other perceived health benefits for which an analysis of perceived benefit should be weighed against any nutritional risks. Evidence from short-term controlled trials of a diet low in fermentable oligosaccharides, disaccharides, monosaccharide and polyols in irritable bowel syndrome suggests compromised intake of nutrients such as fiber, iron, and calcium, although findings vary across studies. Meanwhile long-term uncontrolled trials suggest dietary adequacy improves with reintroduction and personalization. Although high-fiber diets may be beneficial in diverticular disease and constipation, it may lead to reductions in energy intake and nutrient absorption in at-risk populations.

Summary: The role of therapeutic diets in the management of gastrointestinal disorders is increasingly recognized, but there are limited studies investigating their nutritional implications. The judicious use of dietetic expertise should minimize potential nutritional deficits, however further prospective trials are needed to identify the individuals and nutrients most at risk.

Introduction

Dietary interventions play an integral role in the management of some gastrointestinal disorders. Although diet remains the mainstay of treatment for celiac disease, there has been intensifying interest in the use of diet to manage irritable bowel syndrome (IBS), constipation, diverticular disease, and inflammatory bowel disease (IBD). There has been progressing momentum in the identification and/or evaluation of new dietary interventions for these disorders, but also much needed synthesis of findings in the form of systematic reviews and meta-analyses. Exclusion of one or more foods or dietary constituents for the purposes of managing gastrointestinal disorders may increase the risk of inadequate nutrient intake and may have other nutritional implications. This review will summarize some of the key dietary interventions recommended for common gastrointestinal disorders and discuss recent evidence regarding their nutritional implications.

Table 1. Summary of recent trials reporting the effects of the low FODMAP diet on nutrient intake
Study	Study population	n	Duration	Dietary assessment method	Summary of findings related to nutrient intakes
Energy, macronutrients and fiber	Micronutrients
Randomized placebo-controlled trial [22]	IBS (Rome III)	95 (48 low FODMAP diet, 47 sham diet)	4 weeks	7-day food record	No difference in energy intake between low FODMAP diet and sham diet at follow-up No difference in proportion meeting national recommendation for fiber during low FODMAP diet compared with baseline (53 vs. 53% P =1.00)	Lower proportions meeting national recommendation for calcium during low FODMAP diet compared with baseline (47 vs. 64%, P = 0.039) Lower intakes of iron during low FODMAP diet compared with baseline (10 vs. 11 mg/day, P = 0.008)
Randomized comparative trial [23]	IBS-(Rome III)	78 (48 low FODMAP diet, 37 mNICE diet)	4 weeks	3-day food record	Lower energy intake during low FODMAP diet compared with baseline (1691 vs. 2043 kcal/day, P = 0.01)	Lower intakes of retinol, thiamin, riboflavin and calcium during the low FODMAP diet compared with baseline (P < 0.05)
Delayed intervention randomized controlled trial [24]	IBS (Rome III)	50 (23 low FODMAP diet, 27 delayed low FODMAP diet)	6 months Group 1: 3-month low FODMAP diet, 3-month modified FODMAP diet Group 2: 3-month wait list, 3-month low FODMAP diet	Food frequency questionnaire	Lower fiber intake after 3 months of low FODMAP diet compared with baseline for Group (21 vs. 33 g/day, P < 0.01) and Group 2 (27 vs. 31 g/day; P < 0.05)	No difference in calcium intake during low FODMAP diet compared with baseline for either group
Uncontrolled pre and poststudy [25*]	IBS (NICE guidelines definition)	103 (84 modified low FODMAP diet, 19 habitual diet)	Between 6 and 18 months	Food frequency questionnaire	No difference in proportion meeting dietary recommendation for energy, fat, carbohydrate between modified low FODMAP diet and habitual diet Proportion meeting recommendation for protein higher in modified low FODMAP diet vs. habitual diet (98 vs. 79%, P = 0.01)	No difference in proportion meeting dietary recommendation for fiber and 13 micronutrients between modified low FODMAP diet and habitual diet

Table 1. Summary of recent trials reporting the effects of the low FODMAP diet on nutrient intake

Study

Study population

Duration

Dietary assessment method

Summary of findings related to nutrient intakes

Energy, macronutrients and fiber

Micronutrients

Randomized placebo-controlled trial [22]

IBS (Rome III)

95 (48 low FODMAP diet, 47 sham diet)

4 weeks

7-day food record

No difference in energy intake between low FODMAP diet and sham diet at follow-up No difference in proportion meeting national recommendation for fiber during low FODMAP diet compared with baseline (53 vs. 53% P =1.00)

Lower proportions meeting national recommendation for calcium during low FODMAP diet compared with baseline (47 vs. 64%, P = 0.039) Lower intakes of iron during low FODMAP diet compared with baseline (10 vs. 11 mg/day, P = 0.008)

Randomized comparative trial [23]

IBS-(Rome III)

78 (48 low FODMAP diet, 37 mNICE diet)

4 weeks

3-day food record

Lower energy intake during low FODMAP diet compared with baseline (1691 vs. 2043 kcal/day, P = 0.01)

Lower intakes of retinol, thiamin, riboflavin and calcium during the low FODMAP diet compared with baseline (P < 0.05)

Delayed intervention randomized controlled trial [24]

IBS (Rome III)

50 (23 low FODMAP diet, 27 delayed low FODMAP diet)

6 months Group 1: 3-month low FODMAP diet, 3-month modified FODMAP diet Group 2: 3-month wait list, 3-month low FODMAP diet

Food frequency questionnaire

Lower fiber intake after 3 months of low FODMAP diet compared with baseline for Group (21 vs. 33 g/day, P < 0.01) and Group 2 (27 vs. 31 g/day; P < 0.05)

No difference in calcium intake during low FODMAP diet compared with baseline for either group

Uncontrolled pre and poststudy [25*]

IBS (NICE guidelines definition)

103 (84 modified low FODMAP diet, 19 habitual diet)

Between 6 and 18 months

Food frequency questionnaire

No difference in proportion meeting dietary recommendation for energy, fat, carbohydrate between modified low FODMAP diet and habitual diet Proportion meeting recommendation for protein higher in modified low FODMAP diet vs. habitual diet (98 vs. 79%, P = 0.01)

No difference in proportion meeting dietary recommendation for fiber and 13 micronutrients between modified low FODMAP diet and habitual diet

Nutritional Implications of Dietary Interventions for Managing Gastrointestinal Disorders

Abstract and Introduction

Abstract

Introduction

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Authors and Disclosures

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