title: Randomised clinical trial: gut microbiome biomarkers are associated with clinical response to a low FODMAP diet in children with the irritable bowel syndrome.
abstract: BACKGROUND
  A low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet can ameliorate symptoms in adult irritable bowel syndrome (IBS) within 48 h.
  
  
  OBJECTIVE
  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 1-week baseline period. They then were randomised 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) vs. Nonresponders (no improvement during either intervention).
  
  
  RESULTS
  Thirty-three children completed the study. Less abdominal pain occurred during the low FODMAP diet vs. TACD [1.1 ± 0.2 (SEM) episodes/day vs. 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 three Kyoto Encyclopedia of Genes and Genomes orthologues, 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. ClinicalTrials.gov identifier: NCT01339117.
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
authors.forename: B P
authors.initials: BP
authors.lastname: Chumpitazi
authors.affiliation: Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA.|Texas Children's Microbiome Center, Department of Pathology, Texas Children's Hospital, Houston, TX, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Cope
authors.affiliation: Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA.|Texas Children's Microbiome Center, Department of Pathology, Texas Children's Hospital, Houston, TX, USA.
authors.forename: E B
authors.initials: EB
authors.lastname: Hollister
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Tsai
authors.affiliation: Children's Nutrition Research Center, Houston, TX, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: McMeans
authors.affiliation: Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA.|Texas Children's Microbiome Center, Department of Pathology, Texas Children's Hospital, Houston, TX, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Luna
authors.affiliation: Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA.|Texas Children's Microbiome Center, Department of Pathology, Texas Children's Hospital, Houston, TX, USA.
authors.forename: J
authors.initials: J
authors.lastname: Versalovic
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.|Children's Nutrition Research Center, Houston, TX, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Shulman
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000293:Adolescent; D015415:Biomarkers / Q000378:metabolism; D002648:Child; D018592:Cross-Over Studies; D004187:Disaccharides / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D005285:Fermentation; D000069196:Gastrointestinal Microbiome; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000178:diet therapy* / Q000382:microbiology; D008297:Male; D009005:Monosaccharides / Q000008:administration & dosage; D009844:Oligosaccharides / Q000008:administration & dosage; D011108:Polymers / Q000008:administration & dosage; D012336:RNA, Ribosomal, 16S
chemical_list: D015415:Biomarkers; D004187:Disaccharides; D009005:Monosaccharides; D009844:Oligosaccharides; D011108:Polymers; D012336:RNA, Ribosomal, 16S; C024617:polyol