SUN-P140
Nutrient intakes and the validity and reliability of dietary data
in irritable bowel syndrome patients
C Stevenson,* R Blaauw,* E Fredericks,** J Visser,* S Roux**
*Division of Human Nutrition, Stellenbosch University, South Africa
**Department of Biochemistry, Nelson Mandela Metropolitan University, South Africa
Introduction and Aim
Methods
 Participants completed three day estimated food records (EFR).
Diet is central to the management of irritable bowel syndrome (IBS).
Up to two thirds of patients exclude certain foods from their diet to
improve symptoms. This can lead to low intakes of certain essential
nutrients. Furthermore the validity and reliability of IBS dietary data is
unknown.
 Risk of key nutrient inadequacies was determined using the
estimated average requirement (EAR) cut-point method. This
method examines the prevalence of nutrient inadequacy in groups
by estimating the proportion of individuals in the group with usual
intakes below the EAR (median requirement) for a specific
nutrient.
The aim of this study was to prospectively assess nutrient intakes of
South African IBS patients and determine the validity and reliability of
the dietary intake data in a smaller subset of these patients.
 Reliability was assessed with a test-retest (eight week interval) of
the three day EFR.
This study was an extension of a randomized clinical trial (Clinical
Trials Registry number NCT01886781).
 Validity was assessed using dietary fatty acid (FA) intake from the
EFR and correlating to plasma FA profiles.
Results
 In total n= 103 [n=69 C (constipation predominant)-IBS and n=34 D
(diarrhea predominant)-IBS patients were recruited]. N=5 (4.8%)
were used for validity testing and n= 6 (5.8%) for reliability
testing.
 The mean (SD) age was 46.70 ± 13.01 years and males/females
participation was n = 11/92 (10.7% male and 87.3% female).
 The prevalence of risk of inadequate nutrient intakes in IBS
patients using the EAR cut point method indicated to a large
number of nutrients with inadequate intakes. Of special
importance are those nutrients with inadequate intakes in > 80%
of cases e.g. protein, dietary fibre, calcium and folate (Table 1).
 There was no significant difference in nutrient intakes between DIBS and C-IBS groups. So both groups data is combined.
 Table 1. Prevalence of risk of inadequate nutrient intakes in IBS
using the EAR cut point method (n = 103)
Nutrients
 IBS patients consumed significantly less energy than the
recommended value (7.45 MJ versus 9.28 MJ, p<0.000).
Percentage(%)
 The macronutrient distribution showed 35% of patients consuming
above Acceptable Macronutrient Distribution Range (AMDR)
values for fat and 60% consuming below AMDR values for
carbohydrates (Figure 1).
100
90
80
70
60
50
40
30
20
10
0
EARs or EER or IBS (n = 103) mean Prevalence below
AI
intake
EAR (%)
Carbohydrates (g)
100*
189.11
4.5
Protein (g)
76.29*
58.60
85.44
Total dietary fiber (g) 25.04*
10.72
96.12
Calcium (mg)
873*
529
95.15
Iron (mg)
Vitamin C (mg)
Folate (µg)
Vitamin A (µg)
6.83*
62.2*
320*
518.4*
6.33
64.5
157.67
512.49
61.17
67.96
99.03
66.02
EAR – Estimated Average Requirement, EER – Estimated Energy Requirement, AI – Adequate Intake,
IBS – Irritable Bowel Syndrome and * weighted for the study population.
 The EFR proofed to be very reliable, with no significant difference
in mean nutrient intakes found between the test and retest values,
with the exception of protein (expressed as a percentage of total
energy).
Below AMDR
Protein (AMDR: 10-25%)
Within AMDR
Fat (AMDR: 20-35%)
Above AMDR
Carbohydrate (AMDR: 45-65%)
 None of the dietary FAs and plasma FAs correlated significantly
(C14:0, C16:0, C18:0, C18:2, C20:4).
Figure 1. Comparisons of percentage macronutrient intakes with AMDRs
(adults > 18 years; using usual intake distributions) in IBS group (n = 103)
Conclusion
 The data suggests that patients with IBS are at high risk of inadequate nutrient intakes, especially calcium and folate.
 Excessive intake of dietary fat and insufficient intake of carbohydrates were found.
 Three day EFR demonstrated good reliability.
ESPEN2016
 However, using plasma FAs to validate dietary intake data showed poor results suggesting that further research and testing are needed in a larger
grouping of patients.
Thanks to the NNIA and NRF (RSA)
140--SUN-P
Nutritional assessment
Cheryl Stevenson
DOI: 10.3252/pso.eu.ESPEN2016.2016
Poster
presented at: