PWE-131 Fodmap Intake and the Risk of Irritable Bowel Syndrome in the Community: a Prospective Study

Introduction The cause of IBS is uncertain; however, food intolerance shares many features with this condition. Consumption of Fermentable Oligo–, Di– and Mono–saccharides And Polyols (FODMAPs) has been shown to induce IBS-type symptoms (Shephard 2008) and clinical trials have shown that a low FODMAP diet can improve symptoms in this patient group (Halmos 2014). However, FODMAP intake is not higher in IBS than in health (Bohn 2013) and the outcome of low FODMAP diet may not be better than standard dietary advice in this condition (Bohn 2015). Previous research has shown that psychological factors are associated with increased symptoms in IBS patients (Zhu 2013, Van Oudenhove 2016). This population based study tests the hypothesis that high FODMAP intake increases the risk of IBS symptoms more in individuals with psychiatric disease and/or life event stress than in members of the community without risk factors for functional gastrointestinal disease. Methods Subjects aged 16–74 were randomly selected from five South-Chinese communities. All subjects completed questionnaires by face-to-face inquiry with investigators including demographic information, gastrointestinal symptoms (Rome III), dietary intake (food frequency chart validated in Chinese community), psychiatric disease (HADS), life event stress (LES) and quality of life (SF-8). Results are presented as odds ratio with 95% confidence intervals. Results From 1999/2115 (94.7%) members of the community that completed study questionnaires, 117 (5.9%) had IBS by Rome III criteria. The IBS group ingested less lactose than the ‘No-IBS’ group (p≥0.024). Intake of other FODMAPs was similar in both groups (p≥0.346). Compared to the ‘No-IBS’ group, subjects with IBS had a greater likelihood of depression (OR 1.5 (0.97–2.32); p≥0.05), anxiety (2.84 (1.84–4.39), p<0.001), recent life event stress (1.5 (1.03–2.20); p≥0.03) and medical or surgical co-morbidity (OR 2.90 (1.30–5.45), p<0.001). The IBS group also had lower quality of life (P<0.001). Joint risk analysis identified high intake of total FODMAP intake as a risk factors for IBS only in subjects with psychiatric disease and/or life event stress (OR 2.3 (1.1–4.8), p<0.029). Similar effects were seen for individual symptoms, in particular bloating (OR 2.4 (1.3–4.6), p<0.008). Increased risk of IBS was identified with ingestion of high intake of individual FODMAPs (e.g. fructose, fructans, lactose) in combination with psychosocial factors, but not with sucrose (control) in any group. Conclusions Overall FODMAP intake was similar in IBS and No-IBS groups in the community and FODMAP intake alone was not associated with abdominal symptoms. However, consistent with the study hypothesis, joint risk analysis demonstrates that high FODMAP intake does increase the risk of IBS symptoms in subjects with psychiatric disease and/or high levels of psychosocial stress, factors known to increase visceral sensitivity to digestive events.(ClinicalTrials: NCT01286597)