Jury on low-FODMAP diet for children

There is scant 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) illnesses and symptoms. children, according to a position paper from the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN).

A low-FODMAP diet (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) is increasingly being used to treat children with various GI complaints and disorders.

“Awareness of how and when the diet should be used is critical, as a restrictive diet can affect nutritional adequacy and/or promote disrupted eating in vulnerable individuals,” the authors note.

Rut Anne Thomassen, Department of Pediatrics, University Hospital of Oslo, 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.

Of 53 publications and registries they screened, only seven studies (four randomized clinical trials and three interventions with no control or observational studies) were included in their review.

In the seven studies, only 111 children were fed the low-FODMAP diet, while 85 were on a control diet (a diet described as healthy, common or typical American diet for children) for comparison.

All pediatric studies focused on functional abdominal pain disorders. None treated non-celiac gluten sensitivity, small intestinal bacterial overgrowth, or inflammatory bowel disease.

From their review, the authors conclude that there is currently “insufficient evidence” to routinely recommend the low-FODMAP diet for the treatment of functional GI disorders, non-celiac gluten sensitivity, inflammatory bowel disease, or small intestinal bacterial overgrowth. in children.

When considering the low-FODMAP diet 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 after the start of the diet to objectively assess the effect of the low-FODMAP diet,” the authors advise.

A dietitian should assess the child’s diet to reveal any deficiencies, which could be exacerbated by the limitations of the low-FODMAP diet.

To promote adherence to the diet, potential issues need to be addressed, such as how to provide an appropriate lunch at school or what to do if the child is staying with a friend.

The authors suggest providing parents with written information about sources of FODMAPs and appropriate replacement foods. Offering meal plans can reduce the risk of nutritional errors, as well as the risk of offering a diet lacking in essential nutrients, they say.

“useful paper”

Ashwin Ananthakrishnan, MD, MPH, a gastroenterologist at Massachusetts General Hospital and Harvard Medical School in Boston, said, “This is a particularly helpful article to outline the paucity of data on dietary therapies in children and the importance of doing studies in this population. was not involved in the study, said 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 managing symptoms for both adults and adults. as children.

“The problem in children is that the trials are very small, and there aren’t many, so the evidence is limited,” said Nurko, who was not involved in writing the position paper.

That’s not to say it shouldn’t be tried in appropriate cases. “There is no doubt that in some patients, taking the FODMAPs off gives them a great improvement in GI symptoms,” Nurko said. Medscape Medical News

“The problem with the low-FODMAP diet is that if you don’t do it right, you’re going to have problems with nutritional deficiencies,” he warned.

“If you’re going to try the low-FODMAP diet, it should be short, no more than 4 to 6 weeks, and you should take a top-down approach. Take out FODMAPs and then start reintroducing them. Either kids will respond to the diet or not. If they don’t, there’s no reason to keep them on the diet. It’s a very difficult diet to take,” Nurko said.

No funding source for the study has been disclosed. The authors, Ananthakrishnan and Nurko have not disclosed any relevant financial relationships.

J Pediatr Gastroenterol Nutr. Published online June 16, 2022. Summary

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