A0248 - Do Social Determinants of Health Impact Which Patients Are Referred for the Low FODMAP Diet?

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

KH

Kimberly Harer, MD

University of Michigan
Ann Arbor, Michigan

Kimberly Harer, MD¹, Jason Baker, PhD², Linsey Spence, DO³, Kayla Hopkins, MS, RD³, Eric D. Shah, MD, MBA, FACG⁴, Kate Scarlata, RD⁵
¹University of Michigan, Ann Arbor, MI; ²Anxrobotics, Foley, AL; ³Atrium Health, Charlotte, NC; ⁴Dartmouth Health, Lebanon, NH; ⁵For a Digestive Peace of Mind, LLC, Medway, MA

Introduction: The aim of this study was to explore if differences in social determinants of health in irritable bowel syndrome (IBS) patients impact access to the low FODMAP diet (LFD).

Methods: A prospective cross-sectional survey of 486 adults was performed from May – June 2022. All respondents completed a 31-question survey via Survey Monkey. The survey link was distributed via social media platforms, low FODMAP dietician blog posts, and the IFFGD newsletter. Questions consisted of social determinants, such as the number of family members in their home, education attainment, employment status, healthcare insurance, access to healthcare, housing, utilities, transportation, childcare, and food access and insecurities. Statistical analyses included the Mann-Whitney U test and chi-square test. A p-value of ≤ 0.05 was considered statistically significant.

Results: 462/486 (95.1%) respondents reported a diagnosis of IBS. Patients without a diagnosis of IBS were removed from the analysis. IBS cohort demographics consisted of 93% female, 92.5% Caucasian, and 92.7% residing in the United States. The primary IBS complaint was equally distributed: IBS-Diarrhea (35.1%), IBS-Constipation (29.1%), and IBS-Mixed (35.1%). 83.6% (n = 400) of IBS respondents were recommended the low FODMAP diet for treatment of their GI symptoms by a medical provider.

IBS respondents were divided into two groups: IBS-LFD+ (n = 400, those referred for low FODMAP diet education) and IBS-LFD- (n = 62, those not referred for low FODMAP diet education). Compared with their IBS-LFD+, IBS-LFD- respondents had a lower education level (14.8% with high school diploma or less vs. 5.8%, p =0.01), lower household income (46.7% with income ≤ $74,999 vs. 30.7%, p =0.03), and decreased access food when needed (8.1 vs. 2.8 %, p = 0.03). IBS-LFD- respondents were also less likely start a low FODMAP diet on their own compared to IBS-LFD+ counterparts (12.4% vs. 87.6%, p < 0.001).

Discussion: IBS patients with a lower socioeconomic position were less likely to be recommended the low FODMAP diet as treatment compared to patients with higher socioeconomic positioning. This raises concern socioeconomic status negatively impacts referral for low FODMAP diet for IBS management and suggests implicit referral bias. Given the increasing evidence for dietary therapy for managing GI symptoms, further investigation is needed to identify how provider perceptions of patients influence dietary treatment recommendations.

Social Determinant Variable	IBS patients recommended low FODMAP Diet [IBS-LFD+] (n = 400)	IBS patients NOT recommended low FODMAP Diet [IBS-LFD-] (n = 62)	P-Value	Cramer V Coefficient	Odds Ratio (OR)	95% Confidence Interval (CI)
Highest Level of Education Attainment
High school diploma/ GED or less	5.8%	14.8%	0.01	0.12	2.31	1.26, 4.25
≥ High School Diploma/GED	94.2%	85.2%
Household Income
$0.00 - $74,999	30.7%	46.7%	0.03	0.11	1.81	1.05, 3.11
≥ $75,000	69.3%	53.3%
Access to Food When Needed
Unable to access food when needed	2.8%	8.1%	0.03	0.10	2.45	1.14, 5.26
Likely to start low FODMAP diet on their own
Yes	87.6%	12.4%	< 0.001	0.19	0.28	0.16, 0.50
No	56.6%	44.4%
Visit a registered dietitian about the low FODMAP diet
Yes	88.2%	11.8%	0.06	0.09	0.64	0.40, 1.03
No	81.6%	18.4%

Table: Table 1: Comparison of social determinants between IBS patients recommended vs. NOT recommended the low FODMAP diet by their health provider

Disclosures:

Kimberly Harer indicated no relevant financial relationships.

Jason Baker: Anxrobotics – Employee.

Linsey Spence indicated no relevant financial relationships.

Kayla Hopkins indicated no relevant financial relationships.

Eric Shah: GI Supply – Consultant. Mahana – Consultant. Salix – Consultant.

Kate Scarlata: Enjoy Life Foods – Advisor or Review Panel Member. FODY Foods Co – Advisor or Review Panel Member. FOR A DIGESTIVE PEACE OF MIND LLC – Owner/Ownership Interest. Green Valley Creamery – Advisor or Review Panel Member. Rachel Pauls Food – Advisor or Review Panel Member. Salix Pharmaceuticals, Inc. – Advisor or Review Panel Member. The A2 Milk Company – Advisor or Review Panel Member. The Campbell Soup Company – Advisor or Review Panel Member.

Kimberly Harer, MD¹, Jason Baker, PhD², Linsey Spence, DO³, Kayla Hopkins, MS, RD³, Eric D. Shah, MD, MBA, FACG⁴, Kate Scarlata, RD⁵. A0248 - Do Social Determinants of Health Impact Which Patients Are Referred for the Low FODMAP Diet?, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.