Percorrer por autor "Marum, Ana Paula"
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- Diet therapy with fodmaps restriction has benefits in fibromyalgiaPublication . Marum, Ana Paula; Moreira, Ana Catarina; Tomas-Carus, T.; Saraiva, F.; Guerreiro, Catarina SousaThe effects of a diet restriction in FODMAPs (Fermentable oligo-di-monosaccharides polyols) is being studied on the symptoms of Fibromyalgia (FM) and its impact on quality of life (QOL) besides the effect on gastrointestinal (GI) symptoms. High prevalence of functional GI disorders is found in FM and Low FODMAP Diet has growing scientific evidence as IBS (Irritable Bowel Syndrome) therapy.
- Uma intervenção nutricional com restrição de Fodmaps integrada no tratamento da fibromialgia: uma realidade com benefícios?Publication . Marum, Ana Paula; Guerreiro, Catarina Sousa; Saraiva, Fernando DiamantinoIntrodução: A Fibromialgia (FM) é uma doença reumática crónica caracterizada por dor generalizada de etiologia desconhecida, com distúrbios gastrointestinais funcionais muito prevalentes e com farmacoterapia pouco eficaz. A dieta restrita em FODMAPS tem tido crescente evidência científica como dietoterapia na SII, comorbilidade comum na FM. Objetivos: Estudar os efeitos de uma dieta com restrição em FODMAPs nos sintomas associados à FM, o seu impacto na vida diária, qualidade de vida (QOL) e distress para além dos efeitos nos sintomas gastrointestinais e ainda estudar o efeito no estado nutricional dos participantes. Metodologia: Estudo intervencional com 38 pacientes com Fibromialgia de acordo com critérios ACR de 2011, com dieta restrita em FODMAPs (LFD) durante 4 semanas e reintrodução faseada durante outras 4 semanas. Foram feitas avaliações repetidas nos momentos 1, 2 e 3, antes e após intervenção dietética com a restrição dos FODMAPs e posterior à reintrodução. Foi feita uma anamnese clínica e dietética. Utilizado o método VAS e aplicados questionários FSQ, RFIQ, IBS_SSS, Euro-QOL, Core-OM. Foi estudado o estado nutricional através do peso, IMC, perímetro cintura e composição corporal e foram quantificados os consumos diários em FODMAPs e restantes nutrientes da dieta. Foram aplicados os testes estatísticos ANOVA e Friedman e o Coeficiente de Pearson utilizando o SPSS 22. Resultados: No início do estudo, a nossa amostra apresentou scores de gravidade e de impacto da FM de 22 (0-31) e 62 (0-100) respetivamente. O score IBS inicial foi de 275 (0-500) e demonstrou-se melhoria significativa no score IBS (p <0.01), o qual reduziu 50% em 4 semanas de LFD. Observou-se igualmente uma melhoria significativa nos scores de gravidade e de impacto da FM (RFIQ e FSQ: p <0.01). De destacar evidente melhoria nos sintomas de hipersensibilidade dolorosa visceral e somática (VAS Dor p <0.01). A qualidade de vida tendeu a melhorar mas sem significância no período em que decorreu o estudo. Houve redução significativa do score distress (p <0.01)). Observaram-se interessantes correlações positivas entre: “melhoria do score RFIQ” e “melhoria do score IBS” (rs=0.36;p <0.05); “melhoria do score RFIQ” e “melhoria do VAS Dor abdominal” (rs=0.448;p <0.01); “taxa de satisfação pela melhoria sintomática” e a “taxa de adesão à dieta” (r=0.65;p <0.01). Descrevemos uma taxa de satisfação geral com a dieta de 77% com uma taxa de adesão relatada de 85%. Esta adesão foi confirmada comparando os valores médios de FODMAPs consumido e prescrito no plano. O consumo médio habitual de FODMAPs foi 25 g/dia vs 2,5 g/dia com LFD. A diferença foi significativa (p <0.01). A LFD reduziu significativamente o estado ponderal mas sem efeito significativo na composição corporal. Conclusões: Verificou-se um impacto muito positivo, não só na sintomatologia gastrointestinal associada à FM como também na gravidade da FM e no impacto da FM na vida diária deste grupo de pacientes aquando de uma dietoterapia restrita em FODMAPs. Verificou-se ainda que a LFD pode ter efeito na redução ponderal. Estes dados preliminares estimulam a continuidade de estudos na área da dietoterapia com restrição em FODMAPS como terapia adjuvante na Fibromialgia.
- A low fermentable oligo-di-mono saccharides and polyols (FODMAP) diet reduced pain and improved daily life in fibromyalgia patientsPublication . Marum, Ana Paula; Moreira, Cátia; Saraiva, Fernando; Tomas-Carus, Pablo; Guerreiro, Catarina SousaBackground and aims - Fibromyalgia (FM) is a chronic, rheumatic disease characterized by widespread myofascial pain, of unknown aetiology, having a major impact on quality of life (QOL). Available pharmacotherapy for FM is marginally effective. FM is associated with co-morbidities of gastrointestinal (GI) disorders and Irritable Bowel Syndrome (IBS). There is growing evidence that diets low in FODMAPs, “fermentable oligo-, di- or mono-saccharides and polyols” [Low FODMAP Diet (LFD)], are effective in treating IBS. The aim of this pilot study was to examine the effects of LFDs on symptoms of FM, especially with regard to pain, QOL and GI disorders. Methods - A longitudinal study using LFD intervention was performed on 38, 51 ± 10 year-old, female patients diagnosed with FM for an average of 10 years, based on ACR (American College of Rheumatology) 2010 criteria. The study was conducted from January through May, 2015, using a four-week, repeated-assessment model, as follows: Moment 0 – introduction of the protocol to participants; Moment 1 – first assessment and delivery of individual LFD dietary plans; Moment 2 – second assessment and reintroduction of FODMAPs; Moment 3 – last assessment and final nutritional counselling. Assessment tools used were the following: RFIQ (Revised Fibromyalgia Impact Questionnaire), FSQ (Fibromyalgia Survey Questionnaire), IBS-SSS (Severity Score System), EQ-5D (Euro-QOL quality of life instrument), and VAS (Visual Analogue Scale). Daily consumption of FODMAPs was quantified based on published food content analyses. Statistical analyses included ANOVA, non-parametric Friedman, t-student and Chi-square tests, using SPSS 22 software. Results - The mean scores of the 38 participants at the beginning of the study were: FSQ (severity of FM, 0–31) – 22 ± 4.4; RFIQ (0–100) – 65 ± 17; IBS-SSS (0–500) – 275 ± 101; and EQ-5D (0–100) – 48 ± 19. Mean adherence to dietary regimens was 86%, confirmed by significant difference in FODMAP intakes (25 g/day vs. 2.5 g/day; p < 0.01). Comparisons between the three moments of assessment showed significant (p < 0.01) declines in scores in VAS, FSQ, and RFIQ scores, in all domains measured. An important improvement was observed with a reduction in the severity of GI symptoms, with 50% reduction in IBS scores to 138 ± 117, following LFD therapy. A significant correlation (r = 0.36; p < 0.05) was found between improvements in FM impact (declined scores) and gastrointestinal scores. There was also a significant correlation (r = 0.65; p < 0.01) between “satisfaction with improvement” after introduction of LFDs and “diet adherence”, with satisfaction of the diet achieving 77% among participants. A significant difference was observed between patients who improved as compared to those that did not improve (Chi-square χ2 = 6.16; p < .05), showing that the probability of improvement, depends on the severity of the RFIQ score. Conclusions - Implementation of diet therapy involving FODMAP restrictions, in this cohort of FM patients, resulted in a significant reduction in GI disorders and FM symptoms, including pain scores. These results need to be extended in future larger studies on dietary therapy for treatment of FM.
- A low fermentable oligo-di-mono-saccharides and polyols (FODMAP) diet is a balanced therapy for fibromyalgia with nutritional and symptomatic benefitsPublication . Marum, Ana Paula; Moreira, Cátia; Tomas-Carus, Pablo; Saraiva, Fernando; Guerreiro, Catarina SousaIntroduction: Fibromyalgia is a chronic rheumatic disease producing widespread pain, associated to a major comorbidity -irritable bowel syndrome. Low FODMAPS diet (low fermentable oligo-di-mono-saccharides and polyols diet) has been effective in controlling irritable bowel syndrome symptoms. Overweight is an aggravating factor for fibromyalgia. We studied effects of low fermentable oligo-di-mono-saccharides and polyols diets on fibromyalgia symptoms and weight status. Methods: A longitudinal study was performed on 38 fibromyalgia patients using a four-week, repeated assessment as follow: M1 = first assessments/presentation of individual low fermentable oligo-di-mono-saccharides and polyols diet; M2 = second assessments/reintroduction of FODMAPs; M3 = final assessments/nutritional counseling. The assessment instruments applied were: Fibromyalgia Survey Questionnaire (FSQ); Severity Score System (IBS-SSS); visual analogic scale (VAS). Body mass-index/composition and waist circumference (WC) were also measured. Daily macro-micronutrients and FODMAP intake were quantified at each moment of the study. Results: The studied cohort was 37% overweight, 34% obese (average body-mass-index 27.4 ± 4.6; excess fat mass 39.4 ± 7%). Weight, body-mass-index and waist circumference decreased significantly (p < 0.01) with low fermentable oligo-di-mono-saccharides and polyols diet, but no significant effect on body composition was observed. All fibromyalgia symptoms, including somatic pain, declined significantly post-LFD (p < 0.01); as well for severity of fibromyalgia [Fibromyalgia survey questionnaire: M1 = 21.8; M2 = 16.9; M3 = 17.0 (p < 0.01)]. The intake of essential nutrients (fiber, calcium, magnesium and vitamin D) showed no significant difference. The significant reduction in FODMAP intake (M1 = 24.4 g; M2 = 2.6g; p < 0.01) reflected the "Diet adherence" (85%). "Satisfaction with improvement of symptoms" (76%), showed correlating with "diet adherence" (r = 0.65; p < 0.01). Conclusions: Results are highly encouraging, showing low fermentable oligo-di-mono-saccharides and polyols diets as a nutritionally balanced approach, contributing to weight loss and reducing the severity of FM fibromyalgia symptoms.