Nutrient, Fibre, and FODMAP Intakes and Food-related Quality of Life in Patients with Inflammatory Bowel Disease, and Their Relationship with Gastrointestinal Symptoms of Differing Aetiologies

Abstract

Background and Aims Certain foods are reported as gut symptom triggers in IBD, and fructans are shown to worsen non-inflammatory symptoms in inactive IBD, which may result in self-imposed dietary restrictions. The aim of this case-control study was therefore to investigate nutrient and FODMAP intakes, and the relationship between gut symptoms and dietary intake, in IBD. Methods Nutrient, fibre and FODMAP intakes were estimated using 7-day food records in patients with active IBD (Active IBD), inactive IBD with non-inflammatory gut symptoms (Inactive IBD-GI), inactive IBD without gut symptoms (Inactive IBD) and healthy controls. Nutrient, fibre and FODMAP intakes, numbers of participants achieving national nutrient recommendations, and food-related quality of life (FR-QoL) were compared across and between study groups, where appropriate. Results Food diaries were obtained from 232 patients with IBD (65 Active IBD, 86 Inactive IBD-GI, 81 Inactive IBD) and 84 healthy controls. Patients with Active IBD consumed significantly lower intakes of numerous micronutrients, including iron, folate, vitamin C, compared with healthy controls. All IBD groups consumed less total fibre (between 4.5 to 5.8 g/d) than healthy controls (P<0.001), while total FODMAP and fructan intakes were significantly lower in Active IBD compared with healthy controls. Strikingly, FR-QoL was significantly lower in all IBD groups compared with healthy controls (all P<0.001). Conclusions This study revealed significantly lower intakes of fibre, FODMAPs and micronutrients, in addition to poorer FR-QoL, in Active IBD and Inactive IBD-GI with gut symptoms compared with healthy controls. Future research should address dietary restrictions responsible for these differences.

Research progress on the relationship between intestinal microecology and intestinal bowel disease

“…For example, polyglycans have been observed to exacerbate inflammatory symptoms in inactive IBD patients without abdominal pain, diarrhea. 133 , 134 Dietary fiber is metabolized in the gut to SCFAs, resulting in the subsequent activation of GPCR and Treg, and resulting in a reduced inflammatory response and increased mucosal tolerance, thereby protecting CD patients. 135 , 136 In addition, the interaction between gut microbiota and dietary fiber and protein concentration alleviates inflammation and is also a factor that improves intestinal permeability in mice.…”

“…Whether diet intervention can affect the structure and abundance of host intestinal microbiota species is unknown, but studies have shown that symptoms in IBD patients are triggered by some specific dietary conditions. For example, polyglycans have been observed to exacerbate inflammatory symptoms in inactive IBD patients without abdominal pain, diarrhea 133,134 . Dietary fiber is metabolized in the gut to SCFAs, resulting in the subsequent activation of GPCR and Treg, and resulting in a reduced inflammatory response and increased mucosal tolerance, thereby protecting CD patients 135,136 .…”

Food-related quality of life in inflammatory bowel disease: measuring the validity and reliability of the Turkish version of FR-QOL-29

“…The instrument, the FR-QoL-29, is written in English and consists of 29 items that people with IBD rate using a Likert scale. It has been used to show impairments in FR-QoL, and their associated factors, in patients with IBD in a range of English-speaking countries, including the United Kingdom [ 17 , 18 ], United States [ 12 ], Australia [ 19 ] and New Zealand [ 20 ].…”

Low FODMAP diet in irritable bowel syndrome: a review of recent clinical trials and meta-analyses

“…One uncontrolled trial in 25 people and one RCT in 70 people in coeliac disease with persisting symptoms and histologically normal villi-reported gastrointestinal symptom improvement in response to a low FODMAP diet [35,36 ▪ ]. In IBD, intakes of total FODMAPs, fructans and sorbitol are lower in people with active disease, even when adjusted for total energy intake [37 ▪ ]. Evidence from a sham-controlled RCT in 52 people with quiescent IBD who were experiencing ongoing gastrointestinal symptoms reported the low FODMAP diet was superior to sham diet for global symptoms and health-related quality of life, although not for individual symptoms such as pain and bloating [38].…”