Digestive Diseases and Sciences

, Volume 63, Issue 5, pp 1261–1269 | Cite as

Adherence to a Low FODMAP Diet in Relation to Symptoms of Irritable Bowel Syndrome in Iranian Adults

  • Helia Pourmand
  • Ammar Hassanzadeh Keshteli
  • Parvane Saneei
  • Hamed Daghaghzadeh
  • Ahmad Esmaillzadeh
  • Peyman Adibi
Original Article



Most studies assessing the influence of a low fermentable oligo-, di-, monosaccharides and polyols (FODMAP) diet on irritable bowel syndrome (IBS) symptoms were clinical trials with a small sample size.


This study was done to examine the association between adherence to a low FODMAP diet and symptoms of irritable bowel syndrome in Iranian adults.


In this cross-sectional study, data on 3362 Iranian adults were collected. Dietary intakes of study participants were assessed using a validated 106-item self-administered dish-based, semi-quantitative food frequency questionnaire. Based on earlier studies, we identified all foods with a high FODMAP content in our dataset. Participants were categorized into quartiles in terms of dietary intakes of these foods. Total FODMAP score for each individual was computed by summing up the scores of all foods. Individuals in the highest quintile of FODMAP score were defined as those with the greatest adherence to the low FODMAP diet. A modified Persian version of the ROME III questionnaire was used for assessment of IBS, which was defined according to ROME III criteria.


Adherence to the low FODMAP diet was significantly associated with low intakes of macro- and micro-nutrients as well as all food groups (P < 0.001 for all). Participants with the greatest adherence to the low FODMAP diet, compared to those with the lowest adherence, had not significantly lower odds for having IBS, either before (95% CI 0.93, 1.58, P < 0.05) or after adjustment for potential confounders (95% CI 0.80, 1.60, P < 0.05). This was also the case for IBS subtypes; such that those with the greatest adherence to the low FODMAP diet, compared to those with the lowest adherence, were not less likely to have these types of IBS.


In conclusion, we did not find any significant association between adherence to the low FODMAP diet and IBS. Further studies are required to reach a definite conclusion in this regard.


Diet FODMAP Irritable bowel syndrome Abdominal pain 



Fermentable oligo-, di-, monosaccharides and polyols




Low FODMAP diet


High FODMAP diet


Typical American childhood diet


Irritable bowel syndrome


IBS with diarrhea predominant


IBS with constipation predominant



We wish to thank all staff of Isfahan University of Medical Sciences, who kindly participated in our study and staffs of Public Relations Unit, and other authorities of IUMS for their excellent cooperation. The present study was supported by a grant from National Institute for Medical Research Development (NIMAD), Islamic Republic of Iran. The Grant Number is 963261. The authors would like to thank all participants and their parents.

Author’s contribution

HP and AE conducted the study, carried out the statistical analyses, wrote the manuscript and contributed in the interpretation of the findings. AHK, PS, HD and PA contributed to the conception, design and data collection. AE supervised the study. All authors approved the final version of the manuscript.

Compliance with ethical standards

Conflict of interest

None of the authors had any personal or financial conflicts of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Helia Pourmand
    • 1
    • 2
  • Ammar Hassanzadeh Keshteli
    • 3
  • Parvane Saneei
    • 4
  • Hamed Daghaghzadeh
    • 5
  • Ahmad Esmaillzadeh
    • 2
    • 6
    • 7
  • Peyman Adibi
    • 5
  1. 1.Students’ Research CommitteeTehran University of Medical SciencesTehranIran
  2. 2.Department of Community Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
  3. 3.Department of MedicineUniversity of AlbertaEdmontonCanada
  4. 4.Food Security Research CenterIsfahan University of Medical SciencesIsfahanIran
  5. 5.Integrative Functional Gastroenterology Research CenterIsfahan University of Medical SciencesIsfahanIran
  6. 6.Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular Cellular Sciences InstituteTehran University of Medical SciencesTehranIran
  7. 7.Department of Community Nutrition, School of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran

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