Diet and Pediatric Functional Gastrointestinal Disorders in Mediterranean Countries
Caterina Strisciuglio,
Sabrina Cenni,
Maria Rosaria Serra,
Pasquale Dolce,
Sanja Kolacek,
Sara Sila,
Ivana Trivic,
Michal Rozenfeld Bar Lev,
Raanan Shamir,
Aco Kostovski,
Alexandra Papadopoulou,
Eleftheria Roma,
Christina Katsagoni,
Danijela Jojkic-Pavkov,
Angelo Campanozzi,
Elena Scarpato,
Erasmo Miele,
Annamaria Staiano
Affiliations
Caterina Strisciuglio
Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
Sabrina Cenni
Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
Maria Rosaria Serra
Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy
Pasquale Dolce
Department of Public Health, University of Naples “Federico II”, 80138 Naples, Italy
Sanja Kolacek
Referral Center for Pediatric Gastroenterology and Nutrition, Children’s Hospital University of Zagreb Medical School, 10000 Zagreb, Croatia
Sara Sila
Referral Center for Pediatric Gastroenterology and Nutrition, Children’s Hospital University of Zagreb Medical School, 10000 Zagreb, Croatia
Ivana Trivic
Referral Center for Pediatric Gastroenterology and Nutrition, Children’s Hospital University of Zagreb Medical School, 10000 Zagreb, Croatia
Michal Rozenfeld Bar Lev
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
Raanan Shamir
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
Aco Kostovski
Faculty of Medicine, University Children Hospital, 1000 Skopje, North Macedonia
Alexandra Papadopoulou
Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, “Agia Sofia” Children’s Hospital, 11527 Athens, Greece
Eleftheria Roma
First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece
Christina Katsagoni
Department of Clinical Nutrition, “Agia Sofia” Children’s Hospital, 11527 Athens, Greece
Danijela Jojkic-Pavkov
Department of Paediatrics, Institute for Child and Youth Health Care of Vojvodina, Medical Faculty Novi Sad, 21000 Novi Sad, Serbia
Angelo Campanozzi
Pediatrics, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
Elena Scarpato
Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy
Erasmo Miele
Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy
Annamaria Staiano
Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy
Background: The increased intake of FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyol) rich foods has been suggested as a possible trigger of functional gastrointestinal disorders (FGIDs). Despite the high FODMAP content, the Mediterranean diet (MD) appears to have beneficial effects on health. Our aim was to evaluate whether the prevalence of FGIDs in different Mediterranean countries may be influenced by FODMAP consumption and adherence to the MD. Methods: A school-based, cross-sectional, multicenter study was performed in six countries in the Mediterranean area: Croatia, Greece, Israel, Italy, Macedonia, and Serbia. Subjects 4-18 years were examined in relation to their eating habits and the presence of FGIDs, using Rome IV criteria, 3-day food diaries and Mediterranean Diet Quality Index in Children and Adolescents (KIDMED) questionnaires. Results: We enrolled 1972 subjects between 4 and 9 years old (Group A), and 2450 subjects between 10 and 18 years old (Group B). The overall prevalence of FGIDs was 16% in Group A and 26% in Group B. FODMAP intake was significantly different among countries for both age groups. In both groups, no significant association was found between FGIDs and FODMAPs. Adherence to the MD in all countries was intermediate, except for Serbia, where it was low. In both groups, we found a statistically significant association between FGIDs and the KIDMED score (Group A: OR = 0.83, p p = 0.005). Moreover, a significant association was found between the KIDMED score and functional constipation (Group A: OR = 0.89, p = 0.008; Group B: OR = 0.93, p = 0.010) and postprandial distress syndrome (Group A: OR = 0.86, p = 0.027; Group B: OR = 0.88, p = 0.004). Conclusions: Our data suggest that the prevalence of FGIDs in the Mediterranean area is not related to FODMAP consumption, whereas adherence to the MD seems to have a protective effect.