SUMMARY Background A low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet can ameliorate symptoms in adult irritable bowel syndrome (IBS) within 48 hours. Aim To determine the efficacy of a low FODMAP diet in childhood IBS and whether gut microbial composition and/or metabolic capacity are associated with its efficacy. Methods In a double-blind, crossover trial, children with Rome III IBS completed a one-week baseline period. They then were randomized to a low FODMAP diet or typical American childhood diet (TACD), followed by a 5-day washout period before crossing over to the other diet. GI symptoms were assessed with abdominal pain frequency being the primary outcome. Baseline gut microbial composition (16S rRNA sequencing) and metabolic capacity (PICRUSt) were determined. Metagenomic biomarker discovery (LEfSe) compared Responders (≥50% decrease in abdominal pain frequency on low FODMAP diet only) versus Non-Responders (no improvement during either intervention). Results Thirty-three children completed the study. Less abdominal pain occurred during the low FODMAP diet versus TACD (1.1 ± 0.2 (SEM) episodes/day versus 1.7 ± 0.4, P<0.05). Compared to baseline (1.4 ± 0.2), children had fewer daily abdominal pain episodes during the low FODMAP diet (P<0.01) but more episodes during the TACD (P<0.01). Responders were enriched at baseline in taxa with known greater saccharolytic metabolic capacity (e.g., Bacteroides, Ruminococcaceae, Faecalibacterium prausnitzii) and 3 KEGG orthologs, of which two relate to carbohydrate metabolism. Conclusions In childhood IBS, a low FODMAP diet decreases abdominal pain frequency. Gut microbiome biomarkers may be associated with low FODMAP diet efficacy.

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In a randomized controlled trial of children with IBS, we found fructans to exacerbate several symptoms. However, fructan sensitivity cannot be identified based on baseline gastrointestinal symptoms, dietary intake, psychosocial factors, or gas production. Clinicaltrials.gov no: NCT02842281.

Features associated with lipodystrophy syndrome arise in some HIV-infected children. Subjects receiving pediatric dosing regimens were less likely than those receiving adult regimens to develop lipodystrophy.