Self-perceived food intolerances are common and associated with clinical severity in childhood irritable bowel syndrome

Authors: CHUMPITAZI, BRUNO - Texas Children'S Hospital; WEIDLER, ERICA - Children'S Nutrition Research Center (CNRC); LU, DIANA - Baylor College Of Medicine; TSAI, CYNTHIA - Baylor College Of Medicine; SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC)

Submitted to: Journal of the Academy of Nutrition and Dietetics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/26/2016
Publication Date: 6/15/2016
Citation: Chumpitazi, B.P., Weidler, E.M., Lu, D.Y., Tsai, C.M., Shulman, R.J. 2016. Self-perceived food intolerances are common and associated with clinical severity in childhood irritable bowel syndrome. Journal of the Academy of Nutrition and Dietetics. 116:1458-1464.

Interpretive Summary: Up to 20% of school age children experience belly pain on a regular basis. The cause of the pain is not clear in many cases. However, studies done in adults suggest that foods often incite the pain. Adults are able to identify specific foods that cause belly pain. The goal of our study was to determine if this was true for children. Using questionnaires and diaries we found that up to 60% of healthy children identified at least one food that caused belly pain. In children who had belly pain on a regular basis, up to 93% identified at least one food. The greater the number of foods identified, the worse was the child's quality of life.

Technical Abstract: 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. 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. We conducted a cross-sectional study. Questionnaire and prospective diary data were collected from 2008 to 2014 by trained research coordinators. 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. 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 X2=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]; X2=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]; X2=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. 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.