title: Low-FODMAP formula improves diarrhea and nutritional status in hospitalized patients receiving enteral nutrition: a randomized, multicenter, double-blind clinical trial.
abstract: BACKGROUND
  Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) are poorly absorbed, short-chain carbohydrates that play an important role in inducing functional gut symptoms. A low-FODMAP diet improves abdominal symptoms in patients with inflammatory bowel disease and irritable bowel syndrome. However, there were no study for the effect of FODMAP content on gastrointestinal intolerance and nutritional status in patients receiving enteral nutrition (EN).
  
  
  METHODS
  In this randomized, multicenter, double-blind, 14-day clinical trial, eligible hospitalized patients receiving EN (n = 100) were randomly assigned to three groups; 84 patients completed the trial (low-FODMAP EN, n = 30; moderate-FODMAP EN, n = 28; high-FODMAP EN, n = 26). Anthropometric and biochemical parameters were measured; stool assessment was performed using the King's Stool Chart and clinical definition.
  
  
  RESULTS
  Baseline values were not significantly different among the three groups. After the 14-day intervention, diarrhea significantly improved in the low-FODMAP group than in the moderate- and high-FODMAP groups (P < 0.05). King's Stool scores in diarrhea subjects were significantly and steadily reduced in the low-FODMAP group compared with the other two groups (P for time and EN type interaction <0.05). BMI increased significantly in the low- and high-FODMAP groups during the intervention (P < 0.05 for both), and showed a trend toward increasing in the moderate-FODMAP group (P < 0.10). Serum prealbumin increased significantly in all groups by 14-day; by 3-day, it had increased to the levels at 14-day in the low-FODMAP group. At 14-day, serum transferrin had increased significantly in the moderate-FODMAP group. In addition, subjects were classified by final condition (unimproved, normal maintenance, diarrhea only improved, constipation only improved, and recurrent diarrhea/constipation improved). Seventy-five percent of the diarrhea improved group consumed the low-FODMAP EN formula. 38.5 and 46.2% of recurrent diarrhea/constipation improved group consumed the low- and moderate-FODMAP EN respectively. BMI significantly increased in all groups except the unimproved. Prealbumin levels significantly increased in the diarrhea-improved and recurrent diarrhea/constipation groups at 3-day and continued by 14-day, and in the constipation-improved group at 14-day. Transferrin levels significantly increased in the diarrhea-improved and recurrent diarrhea/constipation groups at 14-day.
  
  
  CONCLUSIONS
  Low-FODMAP EN may improve diarrhea, leading to improved nutritional status and facilitating prompt recovery from illness.
authors.affiliation: Department of Food Science Nutrition, Dong-A University, Brain Busan 21 Project, Busan, 604-714, Republic of Korea. yunsora0917@naver.com.
authors.forename: So Ra
authors.initials: SR
authors.lastname: Yoon
authors.affiliation: Department of Rehabilitation Medicine, Dong-A University Hospital, Busan, South Korea. jhlee08@dau.ac.kr.
authors.forename: Jong Hwa
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Food Science Nutrition, Dong-A University, Brain Busan 21 Project, Busan, 604-714, Republic of Korea. wogid5626@naver.com.
authors.forename: Jae Hyang
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Rehabilitation Medicine, Dong-A University Hospital, Busan, South Korea. ssdkg125@hanmail.net.
authors.forename: Ga Yoon
authors.initials: GY
authors.lastname: Na
authors.affiliation: Central Research Institute, Dr. Chung's Foods Co., Ltd., Cheongju, Chungbuk, Republic of Korea. ohkite@hanmail.net.
authors.forename: Kyun-Hee
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Central Research Institute, Dr. Chung's Foods Co., Ltd., Cheongju, Chungbuk, Republic of Korea. lyb007@vegemil.co.kr.
authors.forename: Yoon-Bok
authors.initials: YB
authors.lastname: Lee
authors.affiliation: Central Research Institute, Dr. Chung's Foods Co., Ltd., Cheongju, Chungbuk, Republic of Korea. 82jgh@vegemil.co.kr.
authors.forename: Gu-Hun
authors.initials: GH
authors.lastname: Jung
authors.affiliation: Department of Food Science Nutrition, Dong-A University, Brain Busan 21 Project, Busan, 604-714, Republic of Korea. oykim@dau.ac.kr.
authors.forename: Oh Yoen
authors.initials: OY
authors.lastname: Kim
mesh_terms: D003967:Diarrhea / Q000178:diet therapy*; D004187:Disaccharides / Q000627:therapeutic use; D004311:Double-Blind Method; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005285:Fermentation; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009005:Monosaccharides / Q000627:therapeutic use*; D009752:Nutritional Status; D009844:Oligosaccharides / Q000627:therapeutic use; D011134:Polysaccharides / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D004187:Disaccharides; D009005:Monosaccharides; D009844:Oligosaccharides; D011134:Polysaccharides