Diet and gut health in residents of a retirement village
Nanayakkara, Thanthirige Wathsala Sripali
Background: New Zealand has an aging population with increasing demand for long-term aged care residential facilities. Irritable bowel syndrome (IBS) is a common functional gastrointestinal (GI) symptoms affecting 10 – 15% of the Western population. Restriction of a group of fermentable carbohydrates (FODMAPs) has been shown to significantly improve GI symptoms in patients with IBS. Currently there are no New Zealand data on the frequency and nature of GI symptoms and FODMAP intake of long-term aged care residents. Objectives: The overarching aim of this study is to assess the number of residents in a residential care facility who are suffering from IBS-like symptoms, particularly residents with diarrhoea or incontinence and to understand whether FODMAP intake is associated with IBS symptoms. Specific objectives are as follows: - To describe the frequency of GI symptoms in rest home (RH), hospital level care (H) and free-living (FL) residents of a retirement village. - To determine the nature and quantity of commonly consumed high FODMAP foods by RH and H residents. - To assess individual FODMAP intake of RH and H residents. - To investigate any associations between FODMAP intake and IBS symptoms in RH and H residents. Design: One hundred and sixteen eligible RH and H residents and 133 eligible FL, or independent residents living in a retirement village were invited to take part in the study. The Gastrointestinal Symptom Rating Score questionnaire modified for patients with IBS (GSRS-IBS) with six additional questions looking at upper GI symptoms was used and differences in responses between gender and level of care were compared. Dietary FODMAP intake was assessed for 30 RH or H residents with highest total GSRS-IBS score (symptomatic group) and 30 age, sex, and level of care matched asymptomatic residents with low total GSRS-IBS score. Comparisons were made between symptomatic and asymptomatic groups for macronutrient, micronutrient and FODMAP intakes. A simple regression analysis was conducted to determine the relationship between total FODMAP intake and GSRS-IBS score. Results: 74 (64%) RH and H residents and 51 (38%) FL residents completed the GI symptom questionnaire. Just over half of RH and H residents reported perceived discomfort of bloating-related and upper GI-related symptoms while most common symptoms reported by FL residents were diarrhoea-related (59%) and bloating-related (57%) discomforts. However, no significant differences were observed by gender or level of care for individual or total GI symptom scores. Dietary analysis was completed in 27 symptomatic and 27 asymptomatic RH and H residents who had all three main meals at the facility during data collection. A large quantity of lactose (16g/d consumed on average) from milk and milk products contributed to the total FODMAP intake. Wheat-based products, dried fruit, and homemade soups (containing onion, other high FODMAP vegetables and flour) contributed to high oligosaccharide intake, prunes, canned fruit, mushroom, onion and corn contributed to high polyol intake and fruit salad, orange juice and apple based dishes contributed towards fructose in excess of glucose intake. There were no significant differences in nutrient intake between the symptomatic and asymptomatic groups and there was no significant relationship between FODMAP intake and total GSRS-IBS score. Conclusion: This novel study has produced data on GI symptoms and FODMAP intake in older adults living in a retirement village in New Zealand. A larger study with a bigger sample size and residents from multiple facilities across New Zealand is required to produce more representative data.
Advisor: Skidmore, Paula; Gearry, Richard; Wilkinson, Tim; O'Brien, Leigh
Degree Name: Master of Science
Degree Discipline: Human Nutrition
Publisher: University of Otago
Keywords: FODMAPs, "gastrointestinal symptom", "irritable bowel syndrome", "older people"
Research Type: Thesis