Fructose Malabsorption in Children with Recurrent Abdominal Pain: Positive Effects of Dietary Treatment

Abstract

Objective: The objective of this study was to analyze the effect of a fructose-restricted diet in otherwise healthy children with abdominal pain and pathologic fructose hydrogen breath test.

Subjects and methods: 75 children (aging 3–14 years) with recurrent abdominal pain without gastrointestinal disease and fructose malabsorption followed a fructose restricted diet for 4 weeks.

Results: A median decline of weekly pain frequency from 4 (mean 3.64+1.6) before diet to 1 (mean 1.46+1.4; p<0.001) under fructose restriction was documented. The intensity of pain decreased from median 6 (mean 5.83+2.0) before intervention to median 3 (mean 3.4+2.5; p<0.001) with diet. Several additional life quality-influencing parameters such as daily stool frequency, nausea, problems to fall asleep, missed school days also improved significantly.

Conclusions: Our study provides evidence that dietary fructose restriction represents a useful approach to address recurrent abdominal symptoms in children with fructose malabsorption.

Zusammenfassung

Ziel: Das Ziel der Untersuchung war die Analyse des Effekts einer fruktosereduzierten Ernährung bei anderweitig gesunden Kindern mit rezidivierenden Bauchschmerzen und einem pathologischen Fruktose-H₂-Atemtest.

Patienten und Methode: 75 Kinder im Alter von 3–14 Jahren mit rezidivierenden Bauchschmerzen ohne gastrointestinale Erkrankung und Fruktosemalabsorption unterzogen sich einer fruktosereduzierten Diät über 4 Wochen.

Ergebnisse: Die wöchentliche Bauchschmerzfrequenz reduzierte sich im Median von 4 (Mittelwert 3,64+1,6) vor Diät auf 1 (Mittelwert 1,46+1,4; p<0,001) unter fruktosereduzierter Kost. Die Schmerzintensität nahm im Median von 6 (Mittelwert 5,83+2,0) vor der Intervention auf 3 (Mittelwert 3,4+2,5; p<0,001) unter Diät ab. Weitere die Lebensqualität beeinflussende Parameter wie die tägliche Stuhlfrequenz, Übelkeit, Einschlafstörungen und Schulfehltage erfuhren eine signifikante Verbesserung.

Schlussfolgerung: Unsere Ergebnisse zeigen, dass eine fruktosereduzierte Ernährung eine effektive Intervention bei Kindern und Jugendlichen mit Fruktosemalabsorption und rezidivierenden Bauchschmerzen sein kann.

fructose malabsorption - fructose restricted diet - children - abdominal pain

Fruktosemalabsorption - fruktosereduzierte Diät - Kinder - rezidivierende Bauchschmerzen

References

• 1 Benninga MA, Mayer EA. The power of placebo in pediatric functional gastrointestinal disease.  Gastroenterology. 2009;  137 1207-1210
• 2 Bray GA, Nielsen SJ, Popkin BM. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity.  Am J Clin Nutr. 2004;  79 537-543
• 3 Castello A, Guma A, Sevilla L. et al . Regulation of GLUT5 gene expression in rat intestinal mucosa: regional distribution, circadian rhythm, perinatal development and effect of diabetes.  Biochem J. 1995;  309 (Pt 1) 271-277
• 4 Choi YK, Johlin Jr FC, Summers RW. et al . Fructose intolerance: an under-recognized problem.  Am J Gastroenterol. 2003;  98 1348-1353
• 5 Fernandez-Banares F, Rosinach M, Esteve M. et al . Sugar malabsorption in functional abdominal bloating: a pilot study on the long-term effect of dietary treatment.  Clin Nutr. 2006;  25 824-831
• 6 Flegal KM, Carroll MD, Ogden CL. et al . Prevalence and trends in obesity among US adults, 1999–2000.  JAMA. 2002;  288 1723-1727
• 7 Gibney M, Sigman-Grant M, Stanton Jr JL. et al . Consumption of sugars.  Am J Clin Nutr. 1995;  62 178S-193S discussion 194S
• 8 Gibson PR, Newnham, Barrett JS. et al . Review article: fructose malabsorption and the bigger picture.  Aliment Pharmacol Ther. 2007;  25 349-363
• 9 Gomara RE, Halata MS, Newman LJ. et al . Fructose intolerance in children presenting with abdominal pain.  J Pediatr Gastroenterol Nutr. 2008;  47 303-308
• 10 Hoekstra JH, van den Aker JH, Kneepkens CM. et al . Evaluation of 13CO2 breath tests for the detection of fructose malabsorption.  J Lab Clin Med. 1996;  127 303-309
• 11 Hoekstra JH, van Kempen AA, Bijl SB. et al . Fructose breath hydrogen tests.  Arch Dis Child. 1993;  68 136-138
• 12 Johlin Jr FC, Panther M, Kraft N. Dietary fructose intolerance: diet modification can impact self-rated health and symptom control.  Nutr Clin Care. 2004;  7 92-97
• 13 Ledochowski M, Widner B, Bair H. et al . Fructose- and sorbitol-reduced diet improves mood and gastrointestinal disturbances in fructose malabsorbers.  Scand J Gastroenterol. 2000;  35 1048-1052
• 14 Nicklas TA, Webber LS, Srinivasan SR. et al . Secular trends in dietary intakes and cardiovascular risk factors of 10-year-old children: the Bogalusa Heart Study (1973–1988).  Am J Clin Nutr. 1993;  57 930-937
• 15 Olesen M, Gudmand-Hoyer E. Efficacy, safety, and tolerability of fructooligosaccharides in the treatment of irritable bowel syndrome.  Am J Clin Nutr. 2000;  72 1570-1575
• 16 Pedersen A, Sandstrom B, van Amelsvoort JM. The effect of ingestion of inulin on blood lipids and gastrointestinal symptoms in healthy females.  Br J Nutr. 1997;  78 215-222
• 17 Rumessen JJ, Gudmand-Hoyer E. Fructans of chicory: intestinal transport and fermentation of different chain lengths and relation to fructose and sorbitol malabsorption.  Am J Clin Nutr. 1998;  68 357-364
• 18 Saps M, Seshadri R, Sztainberg M. et al . A prospective school-based study of abdominal pain and other common somatic complaints in children.  J Pediatr. 2009;  154 322-326
• 19 Saps M, Youssef N, Miranda A. et al . Multicenter, randomized, placebo-controlled trial of amitriptyline in children with functional gastrointestinal disorders.  Gastroenterology. 2009;  137 1261-1269
• 20 Shepherd SJ, Gibson PR. Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management.  J Am Diet Assoc. 2006;  106 1631-1639
• 21 Shepherd SJ, Parker FC, Muir JG. et al . Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence.  Clin Gastroenterol Hepatol. 2008;  6 765-771
• 22 Skoog SM, Bharucha AE. Dietary fructose and gastrointestinal symptoms: a review.  Am J Gastroenterol. 2004;  99 2046-2050
• 23 Varea V, de Carpi JM, Puig C. et al . Malabsorption of carbohydrates and depression in children and adolescents.  J Pediatr Gastroenterol Nutr. 2005;  40 561-565
• 24 Vuilleumier S. Worldwide production of high-fructose syrup and crystalline fructose.  Am J Clin Nutr. 1993;  58 733S-736S
• 25 Wasserman D, Hoekstra JH, Tolia V. et al . Molecular analysis of the fructose transporter gene (GLUT5) in isolated fructose malabsorption.  J Clin Invest. 1996;  98 2398-2402

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