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Randomized Controlled Trial
. 2024 Jun;124(6):757-762.
doi: 10.1016/j.jand.2023.09.001. Epub 2023 Sep 7.

Factors Associated With Adherence to a Low Fermentable Carbohydrate Diet in Children With Functional Gastrointestinal Disorders

Rachel B Tenenbaum, Danita Czyzewski, Ann McMeans, Vishnu Narayana, Bruno P Chumpitazi, Rona L Levy, Robert J Shulman, Salma Musaad, Yiming Zhang Mirabile, Mariella Self
Randomized Controlled Trial

Factors Associated With Adherence to a Low Fermentable Carbohydrate Diet in Children With Functional Gastrointestinal Disorders

Rachel B Tenenbaum et al. J Acad Nutr Diet. 2024 Jun.

Abstract

Background: The low-fermentable oligosaccharides, disaccharides, monosaccharides and polyols (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.

Objective: To examine whether baseline abdominal pain, emotional/behavioral problems, or quality of life predict adherence to the LFD in children with FGIDs.

Design: This was a single-group pre-post intervention design within a larger randomized controlled trial.

Participants/setting: Thirty 7- to 12-year-old children with FGIDs were recruited from pediatric gastrointestinal and primary care settings throughout Texas from 2019 to 2021. Evaluated participants were randomized to an LFD intervention as part of a larger randomized controlled trial.

Intervention: Participants received dietary counseling and followed the LFD for 3 weeks.

Measures: Emotional or behavioral problems and quality of life were obtained via parent report, and abdominal pain was measured via child report. Adherence was assessed by using diet records and computed by a decrease in consumption of overall FODMAP intake.

Statistical analyses performed: A hierarchical generalized linear mixed regression model examined factors associated with adherence.

Results: Greater baseline quality of life was associated with better adherence to the LFD (beta coefficient β = -.02, P = 0.03), and baseline emotional/behavioral problems and abdominal pain complaints were not significantly associated with adherence (all Ps > 0.28).

Conclusions: Higher child quality of life as reported by parents was related to increased adherence to this complex dietary intervention.

Keywords: Adherence; Functional gastrointestinal disorders; Low FODMAP diet; Pediatrics.

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Conflict of interest statement

Conflicts of Interest: Bruno P. Chumpitazi receives royalties from the Rome Foundation for the use of the modified Bristol Stool Scale for children. All other authors have no conflict of interest. This study was supported R01 016786 (RJS and RL) from the National Institutes of Health, the USDA/ARS under Cooperative Agreement No. 58-3092-0-001, and P30 DK56338 which funds the Texas Medical Center Digestive Disease Center.

Figures

Figure 1.
Figure 1.
Flow diagram of study procedures and measures at each time point for the evaluation of adherence to a Low Fermentable Carbohydrate diet (LFD) in 30 children with functional gastrointestinal disorders
Figure 2.
Figure 2.
Percent change of participants’ high fermentable carbohydrate food consumption (FODMAP) from baseline to the end of treatment period during a low FODMAP diet intervention for children with functional gastrointestinal disorders (n=30)
See this image and copyright information in PMC

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