Microbiome composition associated with efficacy of low FODMAP diet in pediatric IBS
Low FODMAP diet reduced abdominal pain frequency in children with irritable bowel syndrome, and those who responded had different baseline gut microbial composition, according to study results.
Researchers performed a randomized, double-blind crossover trial of children aged 7 to 17 years with Rome III-defined IBS recruited from September 2011 to December 2013 to evaluate the efficacy of low fermentable oligosaccharides, disaccharides, monosaccharides and polylols (FODMAP) diet in pediatric IBS, and to determine if gut microbial composition or metabolic capacity are associated with response to the diet.
Thirty-three patients (67% female; mean age, 11.5 ± 3 years) completed a 1-week baseline period during which they adhered to their habitual diet. Then they were randomly assigned to receive a low FODMAP diet or typical American diet for 2 days, returned to their habitual diet for a 5-day washout period, and then crossed over to the other intervention diet for 2 days. Stool samples were collected at baseline to determine gut microbial composition and metabolic capacity, breath samples were collected on the second day of each dietary intervention for gas production analyses, and number of abdominal pain episodes were reported through a Pain and Stool Diary.
Fewer abdominal pain episodes per day occurred during low FODMAP (mean, 1.1 ± 0.2) compared with typical American diet (mean, 1.7 ± 0.4; P < .05), and compared with baseline (mean, 1.4 ± 0.2), fewer abdominal pain episodes per day occurred during low FODMAP diet while more episodes occurred during the typical American diet (both P < .01).
The baseline gut microbial compositions of the eight patients who had significant improvement with low FODMAP diet only were enriched with taxa known to have greater saccharolytic metabolic capacity, including Bacteroides, Ruminococcaceae and Faecalibacterium prausnitzii, as well as three Kyoto Encyclopedia of Genes and Genomes orthologues, two of which are related to FODMAP carbohydrate metabolism.
“In conclusion, a low FODMAP diet appears to ameliorate GI symptoms in children with IBS,” the researchers wrote. “Those who responded robustly to the diet appear to have a different baseline microbiome composition, with greater saccharolytic capacity, than those who do not respond to a low FODMAP diet. Future research may determine whether evaluation of the gut microbiome may lead to personalized low FODMAP or other dietary intervention therapy in those with IBS.” – by Adam Leitenberger
Disclosure: Chumpitazi reports he received funding from the NIH, QOL Medical, and is a consultant for Mead Johnson Nutrition. Please see the study for a full list of all other researchers’ relevant financial disclosures.