Case Control Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Jul 9, 2022; 11(4): 330-340
Published online Jul 9, 2022. doi: 10.5409/wjcp.v11.i4.330
Effects of adherence to the Mediterranean diet in children and adolescents with irritable bowel syndrome
Mohammed Al-Biltagi, Doaa El Amrousy, Heba El Ashry, Sara Maher, Mahmoud A Mohammed, Samir Hasan
Mohammed Al-Biltagi, Department of Pediatrics, University Medical center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
Mohammed Al-Biltagi, Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31527, Al Gharbia, Egypt
Mohammed Al-Biltagi, Department of Pediatrics, University Medical Center, Dr. Sulaiman Al-Habib Medical Group, Manama 26671, Bahrain
Doaa El Amrousy, Samir Hasan, Department of Pediatrics, Tanta University, Faculty of Medicine, Tanta 31527, Alghrabia, Egypt
Heba El Ashry, Department of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta 31527, Alghrabia, Egypt
Sara Maher, Department of Immunology, Theodor Bilharz Research Institute, Cairo 12411, Egypt
Mahmoud A Mohammed, Department of Industrial Pharmacy, Faculty of Pharmacy, Assiut University, Assiut 71515, Egypt
Author contributions: Hasan S, El-Amrousy D, and El-Ashry H performed the clinical part and collected the data; Maher S performed the laboratory part; Mohammed MA did the statistical analysis; Al-Biltagi M analyzed the data and wrote the manuscript; and All the authors revised and agreed on the final version of the manuscript.
Institutional review board statement: We performed to study according to the latest version of Helsinki's Declaration. The Research and Ethics Committee at the Ministry of Health, Kingdom of Bahrain, approved the study.
Informed consent statement: An informed written consent was signed by all subjects (and their caregivers).
Conflict-of-interest statement: None of the authors had potential undisclosed conflicts of interest.
Data sharing statement: Data are available upon reasonable request.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammed Al-Biltagi, MBChB, MD, MSc, PhD, Chairman, Professor, Department of Pediatrics, University Medical center, King Abdulla Medical City, Arabian Gulf University, King Abdulaziz Avenue, Manama 26671, Bahrain. mbelrem@hotmail.com
Received: December 13, 2021
Peer-review started: December 13, 2021
First decision: March 24, 2022
Revised: March 24, 2022
Accepted: April 28, 2022
Article in press: April 28, 2022
Published online: July 9, 2022
Processing time: 205 Days and 6.4 Hours
Abstract
BACKGROUND

Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder in children and adults, which increased over the past twenty years. The Mediterranean diet is a well-known diet full of antioxidants and anti-inflammatory ingredients.

AIM

To evaluate the safety, tolerability, and effects of adherence to the Mediterranean diet on disease patterns in children and adolescents with IBS.

METHODS

This prospective, cross-sectional case-controlled study included 100 consecutive IBS patients diagnosed according to Rome IV criteria, aged 12-18 years. Patients were subdivided into two groups (50 patients each); Group I received a Mediterranean diet, and Group II on their regular diet for six months. Besides IBS scores (IBS-SSS, IBS-QoL, and total score), different clinical and laboratory parameters were evaluated at the start and end of the study.

RESULTS

The Mediterranean diet was safe and well-tolerated in IBS patients. IBS children and adolescents with good adherence to the Mediterranean diet (KIDMED Score ≥ 8 points); group I showed significant improvement in IBS scores. IBS-SSS in the Mediterranean diet group was 237.2 ± 65 at the beginning of the study and decreased to 163.2 ± 33.8 at the end of the study (P < 0.001). It did not show a significant improvement in the group with a regular diet (248.3 ± 71.1 at the beginning of the study compared to 228.5 ± 54.3 at the study end with P < 0.05). The mean IBS-SSS in the Mediterranean diet group significantly improved compared with the group with a regular diet. Mean IBS-QoL in group I improved from 57.3 ± 12.9 at the start of the study to 72.4 ± 11.2 at the study end (P < 0.001) and significantly improved when compared to its level in group II at the study end (59.2 ± 12.7 with P < 0.001), while group II showed no significant improvement in IBS-QoL at the study end when compared to the beginning of the study (59.2 ± 11.7 with P >0.05). The mean total IBS score in group I became 28.8 ± 11.2 at the end of our study compared to 24.1 ± 10.4 at the start (P < 0.05) and significantly improved when compared to its level in group II at the end of the study (22.1 ± 12.5 with P < 0.05), while in group II, non-significant improvement in the total score at the end of our study compared to its mean level at the start of the study (22.8 ± 13.5 with P > 0.05).

CONCLUSION

The Mediterranean diet was safe and associated with significant improvement in IBS scores in children and adolescent patients with IBS.

Keywords: Mediterranean diet, Irritable bowel syndrome, Children and adolescents, Safety, Tolerability

Core Tip: Diet is an essential factor in the pathogenesis and management of irritable bowel syndrome (IBS) patients. Studies involving different modalities of diets in IBS are lacking with contradictory results. The Mediterranean diet is a well-known balanced diet with anti-inflammatory properties. We prospectively studied 100 pediatric and adolescent patients with IBS, divided into two equal groups: group I received a Mediterranean diet, and group II had a regular diet for six months. Different clinical and laboratory parameters besides IBS scores were evaluated at the start and end of the study. The current study showed that the Mediterranean diet is a safe and effective low-cost new strategy in pediatric and adolescent patients with IBS.