Self-Perceived Food Intolerances Are Common and Associated with Clinical Severity in Childhood Irritable Bowel Syndrome

Abstract

Background: Adults with irritable bowel syndrome (IBS) frequently identify foods as exacerbating their gastrointestinal symptoms. In children with IBS, the prevalence of perceived food intolerances and their impact are unknown.

Objective: Our aim was to determine the prevalence of self-perceived food intolerances and the relationship of these intolerances to abdominal pain, psychosocial distress, and quality of life in children with IBS.

Design: We conducted a cross-sectional study. Questionnaire and prospective diary data were collected from 2008 to 2014 by trained research coordinators.

Participants/setting: Participants were children 7 to 18 years old (pediatric Rome III IBS, n=154; age-sex matched healthy children, n=32) in Houston, TX.

Measures: Perceived food intolerances and avoided foods were captured using the Childhood Food and Symptom Association Questionnaire. IBS severity was assessed by a ≥7-day pain diary and validated psychosocial questionnaires assessing quality of life, somatization, functional disability, depression, and anxiety.

Statistical analyses performed: We used descriptive Spearman bivariate correlation, χ(2), and Poisson log-linear generalized model with Wald χ(2) statistics.

Results: A greater proportion of children with IBS (143 of 154 [92.9%]) vs healthy children (20 of 32 [62.5%]) identified at least one self-perceived food intolerance (χ(2)=22.5; P<0.001). Children with IBS identified a greater number (median=4 [25% to 75% quartile=2 to 6]) of perceived symptom-inducing foods than healthy children (median=2 [25% to 75% quartile=0 to 4]; χ(2)=28.6; P<0.001). Children with IBS avoided more foods (median=2 [25% to 75% quartile=1 to 4]) than healthy children (median=0 [25% to 75% quartile=0 to 2.75]; χ(2)=20.8; P<0.001). The number of self-perceived food intolerances was weakly associated (r value range= -0.17 to 0.21) with pain frequency, pain severity, somatization, anxiety, functional disability, and decreased quality of life.

Conclusions: Children with IBS have a high prevalence of self-perceived food intolerances. The number of these intolerances is weakly associated with measures of IBS severity.

Keywords: Children; Diet; FODMAP; Irritable bowel syndrome (IBS); Pediatric.

Conflict of interest statement

DISCLOSURE Bruno Chumpitazi receives funding from the National Institutes of Health (NIH), QOL Medical Inc. and is a consultant for Mead Johnson Nutrition. Robert Shulman receives funding from the NIH, and Mead-Johnson Inc. and is a consultant for Nutrinia Inc. and Gerson Lehrman Group. The remaining authors do not conflicts of interest to disclose.

Copyright © 2016 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Number of self-perceived food intolerances in children with irritable bowel syndrome (n=154) versus healthy children (n=32). IBS = children with irritable bowel syndrome; HC = healthy children

Figure 2

Number of avoided foods in children with irritable bowel syndrome (n=154) versus healthy health controls (n=32). IBS = children with irritable bowel syndrome; HC = healthy children