Food contributing to fermentable oligosaccharide, disaccharide, monosaccharide, and polyols intake in Korean adults (2025)

BACKGROUND/OBJECTIVES

The dietary intake of foods with fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) is known to adversely affect patients with irritable bowel syndrome (IBS). However, the effects of FODMAP have been studied predominantly among Western populations. This study aimed to identify foods high in FODMAP content which form a part of the Korean adult diet and obtain basic data for the preparation of IBS guidelines.

SUBJECTS/METHODS

An online survey of 1,000 adults from the general population in the age group of 20 to 40 years was performed. Data from 787 participants (men, 386; women, 401) were analyzed. The general characteristics of the participants, health status, IBS diagnosis using the Rome III diagnostic criteria, semi-quantitative food frequency questionnaire findings, and food items causing symptoms were analyzed.

RESULTS

Overall, 169 participants (21.5%) had IBS. The contribution of the FODMAP nutrients in both IBS and healthy groups was as follows: fructan > lactose > excess fructose > sorbitol > mannitol > galacto-oligosaccharides (GOS). The fructan intake was 4.6 ± 2.2 g/day and 4.3 ± 2.5 g/day in the IBS and healthy groups (P = 0.014), respectively. In the IBS group, the ratio of the intake of fructan to the total FODMAP intake was 39.5%, 29.8%, and 5.8% through onions, garlic, and bananas, respectively.

CONCLUSIONS

Fructan was the FODMAP nutrient most consumed by Korean adults. Therefore, given the difference in the dietary habits of each country’s population, the dietary guidelines for IBS should be country specific.

Keywords: Nutrition assessment, FODMAP, irritable bowel syndrome, Korea

Study subjects

Data was collected through an online cross-sectional survey of adults aged between 20 and 40 years who responded that they agreed about the relationship between their intestinal health and dietary habits. The survey was conducted from April to August 2020. Subjects excluded from this survey were those with inflammatory bowel disease and those taking drugs that could seriously affect gastrointestinal motility (antibiotics, anticonvulsants, antipsychotics, and medications for Parkinson’s). Data were collected from approximately 1,000 participants (men: 497, women: 503). Finally, we analyzed the data of 787 participants after excluding those who responded insincerely and those providing incomplete data, such as that related to their IBS diagnosis (n = 10), food frequency, or symptoms associated with specific foods (n = 68), stress status (n = 25), and those with an intake of less than 500 kcal or more than 6,000 kcal (n = 110). The questionnaire comprised questions on stools type (one question), food intake/symptom frequency according to food intake (118 questions), stress (five questions), and general information (11 questions). This study was approved by the Institutional Review Board of Wonkwang University (WKIRB-202004-SB-012) and all procedures were performed in accordance with the Helsinki Declaration.

Dietary intake survey and FODMAP nutrient analysis

A survey on the dietary intake was conducted using a modified version of the semi-quantitative food frequency questionnaire (FFQ) from the Korea National Health and Nutrition Examination Survey. In the online semi-FFQ survey, information on each food item was provided based on dedicated containers for single-serving portions or publicly recognized reference portions to help individuals respond objectively about their intake. To analyze the intake of FODMAP according to participants’ responses to the semi-FFQ, a FODMAP database of the total sugar, fructose, and lactose content was created using version 9.2 of the National Standard Food Ingredients Table of the Rural Development Administration. As the Korean FODMAP database had insufficient data, data on food and nutrients were obtained from the United States Department of Agriculture food database and previous reports [13,22,23,24]. Through previous studies, we collected information on the presence of certain FODMAP components in various foods. These components include excess fructose (7 types) found in mangoes, pears, and apples, sorbitol (43 types) found in strawberries, turnips, cabbage, mushrooms, corn, plums, and grapes, mannitol (29 types) found in tofu, soybeans, turnips, peaches, potatoes, and carrots, as well as raffinose (10 types) and stachyose (10 types) found in soybeans, tofu, onions, and other foods, and fructans (39 types) found in soybeans, tofu, garlic, onions, chives, cereals, and other foods (Supplementary Table 1).

Diagnosis of IBS

The IBS Module (Korean version) of the Rome III Adult Questionnaire was used to diagnose IBS. The participants who satisfied 2 of the following three items related to bowel movement were diagnosed with IBS: Display of IBS symptoms in the past 6 months, experience of abdominal pain at least once a week in the past three months, and experience of pain unrelated to menstruation (in women) [25].

Other health status questionnaire

The International Physical Activity Questionnaire was used to evaluate physical activity levels [26]. Also, the Brief Encounter Psychosocial Instrument (Korean version) was used to evaluate stress levels. The items were rated as “not at all,” “rarely,” “neutral,” “often,” or “very often.” The low, moderate, and high-stress groups comprised participants with scores of 1.8, 1.8–2.8, and ≥ 2.8, respectively [27].

Statistical analysis

The Statistical Package for Social Science version 26 (IBM Corp., Armonk, NY, USA) was used to analyze the total rate of FODMAP intake and food products high in FODMAP. To identify the food products contributing to FODMAP intake, the FODMAP nutrients of each food were analyzed. In addition, statistical analyses were performed using cross-analysis and the Mann-Whitney U test. All data was considered statistically significant at a level of less than 0.05.

General characteristics

The participant characteristics are presented in Table 1. A total of 169 (21.5%) participants (mean age, 30.5 ± 7.4 yrs) were diagnosed with IBS. In contrast, 618 (78.5%) participants (healthy group; mean age, 31.0 ± 7.9 yrs) were not diagnosed with IBS. Of the 169 participants diagnosed with IBS, 70 (41.4%) were male and 99 (58.6%) were female. The IBS group had significantly higher scores for stress status than those in the healthy group for both men and women (P < 0.001).

Intake of nutrients and FODMAP in the IBS and healthy groups

The results of the analysis of nutrient and FODMAP intake according to the IBS status are shown in Table 2. The energy intake in the IBS group was 2,813.3 ± 1,057.2 kcal/day while that in the healthy group was 2,739.0 ± 1,070.6 kcal/day. No significant difference was observed in the energy intake of the two groups. These results were common to both men and women. The fat intake in the IBS group was 73.8 ± 36.7 g/day, which was significantly higher than that in the healthy group (67.6 ± 35.5 g/day; P = 0.015). These results showed significant differences only among men (IBS group vs. healthy group: 78.0 vs. 69.6 g/day, P = 0.033). The total FODMAP intake was 11.2 ± 7.3 g/day and 10.8 ± 7.9 g/day in the IBS and healthy groups, respectively, with no significant difference between the groups (P = 0.157). However, the FODMAP nutrients with significant differences in intake between the groups were mannitol and fructan. The mannitol intake was significantly different between the 2 groups (P = 0.013), with no significant difference between men and women. The fructan intake in the IBS group was 4.6 ± 2.2 g/day while that in the healthy group was 4.3 ± 2.5 g/day (P = 0.014), with significant differences only among men (IBS group vs. healthy group: 4.6 vs. 5.0 g/day, P = 0.026).

Proportion of specific FODMAP content in the total FODMAP intake

The intake ratio of the FODMAP components to total FODMAP is shown in Fig. 1. The contribution of FODMAP nutrients in the diagnosis of IBS was analyzed to be in the following order: fructan > lactose > excess fructose > sorbitol > mannitol > galacto-oligosaccharides (GOS) in men, and lactose > fructan > excess fructose > sorbitol > mannitol > GOS in women. Fructan accounted for the highest proportion of the FODMAP intake in the IBS group at 47.6% for men and 37.9% for women. Lactose accounted for 34.3% of the FODMAP intake in males and 40.5% in females, thus showing gender-based differences in FODMAP nutrients with a high intake rate.

Proportion of specific FODMAP content intake from specific foods

The results of the analysis of the contribution of FODMAP intake to food intake are presented in Supplementary Table 2. The results by gender are presented in Supplementary Table 3. In the IBS group, for fructan, which had the highest intake to total FODMAP intake ratio, the intake contribution was 39.5% due to onions, 29.8% by garlic, 5.8% by bananas, 5.8% by rice cake (mostly rice), 5.7% by carrots, 3.2% by chives, 2.8% by white bread, and 1.8% by watermelons. In the healthy group, the contribution of onions was 39.5%, garlic 30.0%, carrot 6.0%, banana 5.9%, rice cake (mostly rice) 4.5%, chives 3.6%, white bread 2.4%, and watermelons 1.9%. In the case of lactose, there was a slight difference in the order of food contribution between the IBS and healthy groups. In the IBS group, the lactose contributions of various foods were as follows: milk (74.7%) > ice cream (8.9%) > yogurt (3.4%) > liquid yogurt (3.4%) > chocolate (3.0%) > butter (1.3%) > canned pineapple (1.2%) > ice milk (1.2%). The following order of contribution was observed in the healthy group: milk (75.1%) > ice cream (9.9%) > yogurt (3.7%) > liquid yogurt (3.2%) > chocolate (2.2%) > ice milk (1.3%) > canned pineapple (1.2%) > butter (1.0%).

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Supplementary Materials