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P278 Defining low FODMAP thresholds in irritable bowel syndrome
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  1. Christian C Shaw,
  2. Rachel L Buckle,
  3. Anupam Rej,
  4. Nick Trott,
  5. Imran Aziz,
  6. David S Sanders
  1. Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK

Abstract

Introduction Studies support the use of the low FODMAP diet (LFD) in irritable bowel syndrome (IBS). Whether an optimal threshold of restriction exists is yet to be determined, but <12 g total FODMAPs has been suggested.1 There are no current recommendations for individual FODMAPs such as fructans. Pre and post dietary intervention levels were explored.

Methods A systematic review was performed of publications reporting total FODMAP and fructan intakes pre and post dietary intervention. LFD dietary trials (n=15) were identified on PubMed using MESH terms ‘low FODMAP’, ‘irritable bowel syndrome’ and ‘fructans’. From the articles identified, studies having no data on total FODMAP intake or fructan intake were excluded (n=6). Percentage change in total FODMAP intake pre- and post dietary intervention were assessed in eligible articles (n=9). All eligible articles (n=9) had data on total FODMAPs (n=7 after restriction stage and n=2 in long term) and 7 articles had data on fructan intakes (n=5 after the restriction stage and n=2 at long term). Studies assessing fructan intake in healthy participants were included for comparison (n=2).

Results Total FODMAPs at baseline or in the control group was 13.0–29.6 g/d (n=7 studies) and following the LFD restriction phase 3.1–22.0 g/d (n= 7 studies), with a 24.1–85.8% reduction across studies (see graph 1). Of the 7 studies, 6 achieved the suggested threshold <12 g/d. Total FODMAPs at long-term was 9.0–20.6 g/d (n=2 studies). Baseline fructan intake was 2.3–4.0 g/d (n=5 studies) and following the LFD restriction phase 1.0–2.1 g/d (n=5 studies), with a 33.3–69.2% reduction across studies. Fructan intake at long-term was 2 g/d (n=2 studies). Fructan intakes in healthy individuals was 3.9–4 g/d (n=2 studies).

Conclusions The total FODMAP threshold of <12 g/d was achieved in the majority of studies, but intakes in the long term varied, between 9–22 g/d. Fructan intakes <2.2 g/d were commonly reached following the LFD restriction phase with a 33.3–69.2% reduction seen, which was maintained in the long term. Whether a fructan reduction in isolation would provide symptom benefit should be explored, as less restrictive dietary approaches are needed.

Reference

  1. Tuck CJ, Reed DE, Muir JG, Vanner SJ. Implementation of the low FODMAP diet in functional gastrointestinal symptoms: A real—World experience. Neurogastroenterol. Motil. 2019, 1–13

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