A Low FODMAP Diet Is Nutritionally Adequate and Therapeutically Efficacious in Community Dwelling Older Adults with Chronic Diarrhoea

Abstract

The low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP)diet has been extensively researched, but not in the management of older adults with functional gastrointestinal symptoms. This study determines the positive and negative impacts of this dietary treatment in older adults with chronic diarrhea. A non-blinded intervention study was conducted with adults over 65 years with chronic diarrhea referred for colonoscopy where no cause was found. Participants followed a dietitian-led low FODMAP diet for six weeks and completed a structured assessment of gastrointestinal symptoms, the Hospital Anxiety and Depression scale, and a four-day food diary before and after the intervention. Twenty participants, mean age 76 years, were recruited. Adherence to the low FODMAP diet was acceptable; mean daily FODMAP intake reduced from 20.82 g to 3.75 g (p < 0.001) during the intervention and no clinically significant changes in macro- or micronutrient intakes were observed. There were clinically significant improvements in total gastrointestinal symptoms (pre diet 21.15/88 (standard deviation SD = 10.99), post diet 9.8/88 (SD = 9.58), p < 0.001) including diarrhea (pre diet 9.85 (SD = 3.84), post diet 4.05 (SD = 3.86), p < 0.001) and significant reductions in anxiety (pre diet 6.11/21 (SD = 4.31), post diet 4.26/21 (SD = 3.38), p < 0.05). In older adults the low FODMAP diet is clinically effective and does not jeopardise nutritional intake when supervised by an experienced dietitian.

Keywords: diet; fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet; food; gastrointestinal diseases; nutrition; older adults; quality of life; therapy.

Figure 1

Flow diagram of participant recruitment. FODMAP: fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.

Figure 2

Individual gastrointestinal symptom improvement (Total Structured Assessment of Gastrointestinal Symptoms (SAGIS) scores) from baseline to follow-up. Mean difference from the pre intervention to follow-up scores was 11.35 with a standard deviation of 10.75 p < 0.001.

Figure 3

Individual diarrhea improvement scores from baseline to follow-up. Mean difference from the pre intervention to follow-up scores of 5.8 with a standard deviation of 4.48 p < 0.001.