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July 14, 2021
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Severe food avoidance, restriction reduces quality of life in IBS

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Patients with irritable bowel syndrome who engaged in severe food avoidance and restriction experienced more severe IBS symptoms and a reduced quality of life, according to study results.

“Food intake is an important trigger of GI symptoms in IBS and the presence of food-related GI symptoms are associated with more severe IBS symptoms and a reduced quality of life. However, the factors explaining these meal-related symptoms are still not clear,” Chloe Melchior, MD, PhD, Institute for Research and Innovation in Biomedicine at Normandy University, and colleagues wrote in Clinical Gastroenterology and Hepatology. “IBS patients are more likely to avoid or restrict some food items themselves to improve their symptoms, but the factors involved in food avoidance and restriction in IBS or the link to nutrient intake are not known.”

FODMAP diet
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To characterize IBS symptoms, quality of life and nutrient intake among patients participating in severe food avoidance and restriction, researchers analyzed 955 patients with IBS (mean age, 38.3 years; 75% women) from four prospective studies who completed the IBS quality of life questionnaire. Patients also completed self-reported questionnaires that assessed stool form, GI symptom severity, psychological distress, GI-specific anxiety and somatic symptom severity; within a subset of 246 patients, a 4-day food diary assessed food intake.

According to study results, 26% of patients reported they frequently did not eat when they were hungry due to IBS, 54% of patients reported they frequently avoided foods and 31% of patients reported they frequently found food unappealing because of IBS; overall, 13.2% of patients with IBS reported severe food avoidance and restriction. Researchers noted severe restriction correlated with a decreased quality of life as well as more severe psychological, GI and somatic symptoms. Further, among patients with IBS keeping a food diary, restriction correlated with lower total energy intake as well as a lower intake of proteins and carbohydrates.

“Identifying these patients is important and will allow clinicians to propose a multidisciplinary management. ... Indeed, this specific subgroup seems to need extra attention from clinicians and dietitians," Melchior and colleagues concluded. "Further investigations are needed to understand the underlying pathophysiological mechanisms, including the role of the gut factors, and to assess the effects of dietary and behavioral management in this specific population.”