There is scarce evidence to support the use of a FODMAP-lowering diet for children with irritable bowel syndrome (IBS), and there is no evidence to recommend its use for other gastrointestinal (GI) diseases and complaints in children, according to a position paper from the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN).
A low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet is increasingly being used to treat children with various GI complaints and disorders.
"Awareness of how and when to use the diet is crucial, as a restrictive diet may impact nutritional adequacy and/or promote distorted eating in vulnerable subjects," the authors note.
Rut Anne Thomassen, Department of Pediatric Medicine, Oslo University Hospital, Norway, and an international team of experts conducted a systematic literature review of the evidence on the safety and efficacy of the low-FODMAP diet in children.
The low-FODMAP diet has not been well studied in children, they report.
From 53 publications and registers that they screened, only seven studies (four randomized clinical trials and three interventions without control group or observational studies) were included in their assessment.
In the seven studies, only 111 children received the low-FODMAP diet, while 85 followed a control diet for comparison (a diet described as healthy, usual, or typical American diet for children).
All of the pediatric studies focused on functional abdominal pain disorders. None addressed nonceliac gluten sensitivity, small-intestinal bacterial overgrowth, or inflammatory bowel disease.
From their review, the authors conclude that, at present, there is "insufficient evidence" to routinely recommend the low-FODMAP diet for the treatment of functional GI disorders, nonceliac gluten sensitivity, inflammatory bowel diseases, or small-intestinal bacterial overgrowth in children.
When the low-FODMAP diet is considered for children, the authors recommend a thorough clinical history and physical examination and assessment of nutritional status and GI symptoms by a multidisciplinary team.
"Ideally, a standardized questionnaire should be used before and following the start of the diet to assess objectively the effect of the low-FODMAP diet," the authors advise.
A dietitian should assess the child's diet to highlight any potential deficiencies, which could be exacerbated by the restrictions of the low-FODMAP diet.
To promote adherence to the diet, potential difficulties, such as how to provide a suitable lunch at school or what to do when the child is staying at a friend's house, should be addressed.
The authors suggest providing parents with written information about sources of FODMAPs and suitable replacement foods. Offering meal plans can reduce the risk of diet mistakes as well as the risk of offering a diet insufficient in essential nutrients, they say.
"This is a useful paper primarily to outline the paucity of data regarding dietary therapies in children and the importance of doing studies in this population," Ashwin Ananthakrishnan, MD, MPH, a gastroenterologist with Massachusetts General Hospital and Harvard Medical School in Boston, who wasn't involved in the research, told Medscape Medical News.
Samuel Nurko, MD, MPH, director of the Center for Motility and Functional Gastrointestinal Disorders at Boston Children's Hospital in Massachusetts, noted that some studies have shown that a low-FODMAP diet can be effective in controlling symptoms for both adults and kids.
"The problem in kids is that the trials are very small, and there's not a lot of them, so the evidence is limited," said Nurko, who wasn't involved in writing the position paper.
That's not to say that it should not be tried in appropriate cases. "There's no question that in some patients, taking away the FODMAPs gives them a big improvement in GI symptoms," Nurko told Medscape Medical News.
"The problem with the low-FODMAP diet is, if you don't do it right, then you get into trouble with nutritional deficiencies," he cautioned.
"If you are going to try the low-FODMAP diet, it has to be short, no more than 4 to 6 weeks, and you need to do a top-down approach. Take FODMAPs out, and then start to reintroduce them. Either kids will respond to the diet, or they won't. If they don't, there is no reason to keep them on the diet. It's a very hard diet to take," Nurko said.
No source of funding for the study was disclosed. The authors, Ananthakrishnan, and Nurko have disclosed no relevant financial relationships.
J Pediatr Gastroenterol Nutr. Published online June 16, 2022. Abstract
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Cite this: Jury Out on Low-FODMAP Diet for Kids - Medscape - Jun 27, 2022.