Food intolerance and the few-foods(or oligoantigenic)diet in children with attention-deficit hyperactivity disorder

The hypothesis that some children with attention-deficit hyperactivity disorder(ADHD)may show sensitivity or allergic reactions to various food items has led to the development of the the few-foods(or oligoantigenic)diet.The rationale of the diet is to eliminate certain foods from the diet in order to exclude potential allergens contained either naturally in food or in artificial ingredients with allergenic properties.The oligoantigenic diet attempts to identify individual foods to which a person might be sensitive.First,ADHD symptoms are monitored while multiple foods are excluded from the diet.Subsequently,if symptoms remit,foods are re-introduced,while observing the individual for the return of symptoms.An advantage of the oligoantigenic diet is that it can be tailored to the individual.A growing body of evidence suggests that behavioral symptoms of subgroups of children with ADHD may benefit from the elimination of certain foods.The effect sizes of an oligoantigenic diet regarding improvement of ADHD symptoms have been found to be medium to large.Available evidence suggests that the investigation of the role of food hypersensitivities in ADHD is a promising avenue worthy of further exploration.Further large-scale,randomized controlled studies including assessment of long-term outcome are therefore warranted.

Immunoglobulin G-mediated food intolerance and metabolic syndrome influence the occurrence of reflux esophagitis in Helicobacter pylori-infected patients

BACKGROUND Reflux esophagitis has an increasing prevalence and complex and diverse symptoms.Identifying its risk factors is crucial to understanding the etiology,prevention,and management of the disease.The occurrence of reflux esophagitis may be associated with food reactions,Helicobacter pylori(H.pylori)infection,and metabolic syndromes.AIM To investigate the risk factors for reflux esophagitis and analyze the effects of immunoglobulin(Ig)G-mediated food intolerance,H.pylori infection,and metabolic syndrome on reflux esophagitis.METHODS Outpatients attending the Second Medical Center of the PLA General Hospital between 2017 and 2021 were retrospectively enrolled.The patients’basic information,test results,gastroscopy results,H.pylori test results,and IgG-mediated food intolerance results were collected.Multivariate logistic regression analysis was used to analyze risk factors for reflux esophagitis.Statistical mediation analysis was used to evaluate the effects of IgG-mediated food intolerance and metabolic syndrome on H.pylori infection affecting reflux esophagitis.RESULTS A total of 7954 outpatients were included;the prevalence of reflux esophagitis,IgG-mediated food intolerance,H.pylori infection,and metabolic syndrome were 20.84%,61.77%,35.91%,and 60.15%,respectively.Multivariate analysis showed that the independent risk factors for reflux esophagitis included IgG-mediated food intolerance(OR=1.688,95%CI:1.497-1.903,P<0.00001)and metabolic syndrome(OR=1.165,95%CI:1.030-1.317,P=0.01484),and the independent protective factor for reflux esophagitis was H.pylori infection(OR=0.400,95%CI:0.351-0.456,P<0.00001).IgG-mediated food intolerance had a partially positive mediating effect on H.pylori infection as it was associated with reduced occurrence of reflux esophagitis(P=0.0200).Metabolic syndrome had a partially negative mediating effect on H.pylori infection and reduced the occurrence of reflux esophagitis(P=0.0220).CONCLUSION Patients with IgG-mediated food intolerance and metabolic syndrome were at higher risk of developing reflux esophagitis,while patients with H.pylori infection were at lower risk.IgG-mediated food intolerance reduced the risk of reflux esophagitis pathogenesis in patients with H.pylori infection;however,metabolic syndrome increased the risk of patients with H.pylori infection developing reflux esophagitis.

Food intolerance and sensitivity are associated with features of fibromyalgia in a self-selected community population

Introduction:People are now presenting with chronic musculoskeletal pain at a younger age,and many of them fulfil criteria for fibromyalgia.We have recently shown a strong association between fibromyalgia symptoms and autistic traits in a self-selected community population,with the relationship mediated in part by the presence of hypermobility.Many respondents also described food sensitivities and intolerances.This study explores the relationships between food issues and fibromyalgia symptoms in this population.Methods:We adopted a nonexperimental,correlational design and collected data from a volunteer sample of 442 adults(aged 18–60)who completed online self-report questionnaires assessing each of fibromyalgia symptoms(ACR criteria),autistic traits(RAADS score)and hypermobility(Beighton’s test).Subjects were also asked to record any food sensitivities,allergies,or intolerances,along with their consequences.Correlation analyses and linear regressions were used to test the relationships between these features and each of fibromyalgia,autistic traits and hypermobility.We analysed the data with parametric and non-parametric techniques to assess the significance and power of relationships,and the potential mediating effect of food-related symptoms in the correlation between fibromyalgia features and autistic traits.Results:Our self-selected community population had a mean age of 24 years and was 77%female.The self-reported prevalence of fibromyalgia,autistic traits and hypermobility was 40%,65%and 44%respectively.Hypermobile individuals showed a high prevalence of autistic traits,reaching 79%among females and 88%among males.Half of all subjects reported food sensitivity and 31%reported food intolerance.The incidence of food-related symptoms was higher among subjects who met criteria for fibromyalgia than those who reported autistic traits or hypermobility.Food sensitivity and food intolerance were both more significantly associated with fibromyalgia(r=0.24,P>0.001 and r=0.38,P>0.001)than with autistic traits(r=0.172,P>0.01 and r=0.148,P>0.01).Discussion:This community study provides evidence for an association between features of fibromyalgia and reported food intolerance and sensitivity.Although self-selected,the findings in our predominantly young population suggest that gluten and lactose consumption may be associated with higher levels of musculoskeletal pain.The study population commonly reported that avoidance of gluten and/or lactose containing foods reduced symptoms.Dietary adjustment may merit further investigation as a therapeutic modality for some patients with fibromyalgia.

Association between Helicobacter pylori infection and food-specific immunoglobulin G in Southwest China

BACKGROUND Helicobacter pylori(H.pylori)has been found to be associated with extragastrointestinal diseases,possibly including adverse food reactions(such as food allergy or intolerance).However,there are few studies on H.pylori and food allergy or intolerance,and the results are inconsistent.Food-specific immunoglobulin(Ig)G has been revealed to be associated with food allergy or intolerance and can be used as a marker to explore the correlation between H.pylori infection and food allergy or intolerance.AIM To explore the relationship between H.pylori infection and food-specific IgG METHODS We retrospectively analyzed the physical examination data of 21822 subjects from February 2014 to December 2018 in this study.H.pylori infection was detected using the 13C urea breath test.Food-specific IgG of eggs,milk and wheat in serum was assessed.Subjects were grouped according to H.pylori positivity,and the positive rates of three kinds of food-specific IgG were compared between the two groups.Multivariable logistic regression analysis was performed to elucidate the association between H.pylori infection and food-specific IgG.RESULTS The total infection rate of H.pylori was 39.3%,and the total food-specific IgGpositive rates of eggs,milk and wheat were 25.2%,9.0%and 4.9%,respectively.The infection rate of H.pylori was higher in males than in females,while the positive rates of food-specific IgG were lower in males than in females.The positive rates of food-specific IgG decreased with age in both males and females.In the H.pylori-positive groups,the positive rates of food-specific IgG of eggs,milk and wheat were all lower than those in the H.pylori-negative groups.Multivariate logistic regression analysis revealed that H.pylori infection was negatively correlated with the food-specific IgG-positive rates of eggs,milk and wheat(odds ratio value of eggs 0.844-0.873,milk 0.741-0.751 and wheat 0.755-0.788,in different models).CONCLUSION H.pylori infection was found to be negatively associated with the food-specific IgG of eggs,milk and wheat in Southwest China.

Diet and functional dyspepsia: Clinical correlates and therapeutic perspectives

Hypervigilance and symptoms anticipation,visceral hypersensitivity and gastroduodenal sensorimotor abnormalities account for the varied clinical presentation of functional dyspepsia(FD)patients.Many patients recognize meals as the main triggering factor;thus,dietary manipulations often represent the first-line management strategy in this cohort of patients.Nonetheless,scarce quality evidence has been produced regarding the relationship between specific foods and/or macronutrients and the onset of FD symptoms,resulting in nonstandardized nutritional approaches.Most dietary advises are indeed empirical and often lead to exclusion diets,reinforcing in patients the perception of“being intolerant”to food and self-perpetuating some of the very mechanisms underlying dyspepsia physiopathology(i.e.,hypervigilance and symptom anticipation).Clinicians are often uncertain regarding the contribution of specific foods to dyspepsia physiopathology and dedicated professionals(i.e.,dietitians)are only available in tertiary referral settings.This in turn,can result in nutritionally unbalanced diets and could even encourage restrictive eating behaviors in severe dyspepsia.In this review,we aim at evaluating the relationship between dietary habits,macronutrients and specific foods in determining FD symptoms.We will provide an overview of the evidence-based nutritional approach that should be pursued in these patients,providing clinicians with a valuable tool in standardizing nutritional advises and discouraging patients from engaging into indiscriminate food exclusions.