Disordered Eating Behaviors Many Years After Education in a Low FODMAP Diet in Patients With Irritable Bowel Syndrome

The impact of teaching patients with irritable bowel syndrome (IBS) a FODMAP diet on eating behaviors is unknown. We aimed to ascertain disordered eating behaviors and their relationships to current dietary intake and clinical status many years after FODMAP education.

Patients with IBS educated on a FODMAP diet by a gastrointestinal dietitian mean 7.1 (range 2.5-13.4) years prior were cross-sectionally evaluated for current eating behaviors utilizing multiple risk tools, mental health (Depression Anxiety Stress Scales), gastrointestinal symptoms (IBS-SSS), overall, food-related quality of life and dietary intake (Complete Nutritional Assessment Questionnaire), and retrospective analysis of documented mental health conditions. Of 74 participants (84% women, median age 59 (IQR 47-67) years), disordered eating behaviors were identified in 38% by the risk tools comprising Eating Attitudes Test (EAT)-26 in 7%, Nine Item ARFID screen (NIAS) in 24%, ORTO-7 for orthorexia in 21%. While these behaviors were associated with reduced overall and food-related quality of life, multivariable regression analyses identified only psychological distress and symptom severity as independent predictors of ARFID and orthorexia risk. Self-perceived eating pattern (strict low-FODMAP, personalized-FODMAP or habitual diets), level of measured FODMAP intake, or time since dietary education were not related to disordered eating behaviors. No new diagnoses or exacerbation of eating disorders were observed since dietary education.

Disordered eating behaviors are commonly present in long-term follow-up of patients with IBS after FODMAP dietary education, but these are related to psychological distress and symptom burden, not to specific dietary effects associated with such education.