Factors associated with adherence to a low fermentable carbohydrate diet in children with functional gastrointestinal disorders

Authors: TENENBAUM, RACHEL - Texas Children'S Hospital; CZYZEWSKI, DANITA - Texas Children'S Hospital; MCMEANS, ANN - Children'S Nutrition Research Center (CNRC); NARAYANA, VISHNU - Baylor College Of Medicine; CHUMPITAZI, BRUNO - Children'S Nutrition Research Center (CNRC); LEVY, RONA - University Of Washington; SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC); MUSAAD, SALMA - Children'S Nutrition Research Center (CNRC); MIRABILE, YIMING - Children'S Nutrition Research Center (CNRC); SELF, MARIELLA - Texas Children'S Hospital

Submitted to: Journal of the Academy of Nutrition and Dietetics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/5/2023
Publication Date: 9/7/2023
Citation: Tenenbaum, R.B., Czyzewski, D., McMeans, A., Narayana, V., Chumpitazi, B.P., Levy, R.L., Shulman, R.J., Musaad, S., Mirabile, Y.Z., Self, M. 2023. Factors associated with adherence to a low fermentable carbohydrate diet in children with functional gastrointestinal disorders. Journal of the Academy of Nutrition and Dietetics. https://doi.org/10.1016/j.jand.2023.09.001.
DOI: https://doi.org/10.1016/j.jand.2023.09.001

Interpretive Summary: Some children and adults develop stomach pain after they eat certain foods. This is particularly true for children and adults with irritable bowel syndrome. A diet that removes foods that are poorly digested and absorbed can be of benefit to some of these individuals. However, this restrictive diet can be difficult for some people to follow. We carried out a study to find out what factors may be associated with children being able to follow the diet. We found that having a better quality of life was associated with a better ability to follow the diet. Emotional/behavioral problems or abdominal pain were not associated with being able to follow the diet. We are now investigating what facets of quality of life may be responsible.

Technical Abstract: The low FODMAP diet (LFD) has been associated with reduced symptomology in pediatric functional gastrointestinal disorders (FGIDs). The LFD is a complex dietary intervention that may be difficult to follow; thus, there is great interest in determining factors that contribute to adherence. The objective of this study was to examine whether baseline abdominal pain, emotional/behavioral problems, and/or quality of life predict adherence to the LFD in children with FGIDs. This was a single group pre-post intervention design within a larger randomized controlled trial. Thirty 7-12-year-old children with FGIDs were recruited from pediatric GI and primary care settings throughout Texas from 2019-2021. Evaluated participants were randomized to an LFD intervention as part of a larger randomized controlled trial. Participants received dietary counseling and followed the LFD for 3 weeks. Emotional/behavioral problems and quality of life were obtained via parent-report, and abdominal pain was measured via child-report. Adherence was assessed utilizing diet records and computed via a decrease in consumption of overall FODMAP intake. A hierarchical generalized linear mixed regression model examined factors associated with adherence. Greater baseline quality of life was associated with better adherence to the LFD (beta coefficient Beta=-.02, p=.03), while baseline emotional/behavioral problems and abdominal pain complaints were not significantly associated with adherence (all ps>.28). Higher child quality of life as reported by parents was related to increased adherence to this complex dietary intervention.