The low-FODMAP diet | Anales de Pediatría

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The osmotic load that they produce increases the volume of water in the colonic lumen, which in turn causes symptoms such as abdominal distension and pain.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>The foods that contain FODMAPs are numerous and ubiquitous in Western diets: dairy products, fruits, vegetables, legumes and beans, cereals, baked goods, sauces, candies, beverages, jams or frozen treats, among others. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> presents the different FODMAP categories, examples of the main sources, the digestion and absorption process and their effects on the gastrointestinal (GI) tract.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>On one hand, fructose is absorbed by the small intestine via the GLUT5 (high-affinity) or GLUT2 (low-affinity) transporter. Physiological fructose malabsorption occurs if the GLUT5 transporter is saturated, when the fructose intake exceeds 20 g in a single eating episode.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Glucose aids the absorption of fructose via GLUT2, so foods containing fructose and glucose in a 1:1 ratio are better tolerated. However, when there is an excess of fructose relative to glucose (fructose excess = free fructose – free glucose), the former is not well absorbed, producing an increase in the water influx into the lumen. The fruits with fructose excess include pear, apple, mango and melon, and the vegetables, asparagus.<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a>When it comes to sorbitol and fructose, when consumed together, the former hinders the absorption of the latter, as they compete for GLUT5 uptake. The consequence of a fructose excess is the development of GI problems. Fruits with fructose excess combined with sorbitol exacerbate the GI symptoms (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).Lactose, once ingested, undergoes hydrolysation by lactase, (β-galactosidase).<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a> Following digestion (hydrolysis), the resulting glucose and galactose are absorbed through active transport. In humans, lactase activity peaks around age 2 years and decreases from age 3–4 years in a variable percentage of the population, depending on ethnicity (lactase activity is greater in the Mediterranean Basin compared to Asia, for example).<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Lactase deficiency tends to manifest from age 5–7 years, although in some populations the onset is delayed to adolescence, and entails the development of a constellation of symptoms such as flatulence, abdominal pain and distension and/or diarrhoea due to the arrival of lactose that has not been hydrolysed to the colon.As regards fructooligosaccharides (FOS) and galactooligosaccharides (GOS), their malabsorption is due to humans not producing the enzymes required to hydrolyse them, so they are not absorbed.On the other hand, polyols (see <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) are absorbed through passive diffusion along the length of the small intestine. The degree of absorption varies depending on the size of the molecule and of the intestinal pores, the time in the small bowel in relation to the absorption time window and the presence of GI disorders.<a class="elsevierStyleCrossRefs" href="#bib0020">4–6</a>The aim of this document is to establish a protocol for the use of the low-FODMAP diet in paediatric patients and to review the current evidence on the efficacy of this diet.Material and methodsWe conducted a narrative review of sources obtained through the PubMed and Web of Science databases, Google Scholar and websites of agencies and other official institutions.In the search conducted in PubMed, we applied selection criteria such as “human” and “child”, limiting the search to sources published in the past 5 years in English or Spanish language. In this search, we used the key words “fodmap” and “low fodmap diet” and the operator AND to combine either with the additional key word “children”.On the other hand, in the search conducted in Web of Science, we applied selection criteria such as “human” and “children”, limiting the search to sources published in the past 5 years in English or Spanish language. we used the key words “fodmap” and “the low fodmap diet” and the operator AND to combine either with the additional key word “children”.Evidence on the use of the low-FODMAP diet in paediatric patientsThe low-FODMAP diet is a therapeutic tool that can improve symptoms and nutrition in multiple GI disorders, such as irritable bowel syndrome (IBS),<a class="elsevierStyleCrossRefs" href="#bib0025">5,7</a> inflammatory bowel disease (IBD),<a class="elsevierStyleCrossRef" href="#bib0040">8</a> small intestinal bacterial overgrowth (SIBO),<a class="elsevierStyleCrossRefs" href="#bib0045">9–11</a> non-coeliac gluten sensitivity (NCGS)<a class="elsevierStyleCrossRef" href="#bib0040">8</a> or coeliac disease (CE).<a class="elsevierStyleCrossRef" href="#bib0040">8</a> It has been found to be effective not only against IBS,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> but also in patients with fibromyalgia, sclerosis and endometriosis.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> Most studies in patients with IBS (and without CE) have been conducted in the adult population, demonstrating that dietary intake of gluten can cause symptoms. This suggests that individuals with IBS may either have NCGS or respond poorly to wheat fructans, which would explain why adherence to a low-FODMAP diet, which excludes them, can have beneficial effects.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>The evidence on the use of the low-FODMAP diet in the paediatric population is scarce.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> Notwithstanding, a significant improvement in symptoms related to gas production and abdominal pain and distention has been observed in paediatric patients on this diet.<a class="elsevierStyleCrossRefs" href="#bib0055">11,13</a> Constipation is the symptom that improves the least, which could be related to the low fibre intake in this dietary approach. In a study conducted by Baranguán Castro et al. in children aged 5–15 years (2019),<a class="elsevierStyleCrossRef" href="#bib0070">14</a> most considered that the diet was easy to follow and there was a high proportion of adherence, associated with improved symptom control. Patients have also reported a decrease in abdominal pain associated with an improved quality of life.<a class="elsevierStyleCrossRefs" href="#bib0055">11,14</a>Final products of digestion that are not absorbed may produce gases, swelling, gastro-oesophageal reflux, heartburn, decreased appetite, abdominal distension /meteorism, borborygmus, colicky abdominal pain, epigastric pain and changes in bowel movements ranging from softer or more frequent stools to diarrhoea or even constipation.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> These symptoms have a deleterious impact on quality of life, so alleviating them is a priority.For now, the efficacy of the diet in children with IBS has not been fully proven. However, there is evidence that suggests that implementation and adherence of the diet can improve its symptoms.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>In order to improve adherence to the low-FODMAP diet and its effectiveness, it is essential to perform a rigorous evaluation of abnormal dietary habits before and during the intervention. The reason is that there are complex psychosocial factors at play that are particularly significant in children and/or adolescents.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>The efficacy of the low-FODMAP diet is related to the baseline composition of the gut microbiota and its metabolic capacity. There are studies that suggest that the response ot the diet is better in children with IBS and a microbiota with a greater saccharolytic metabolic capacity. Therefore, this could be a predictive biomarker of the responsiveness to a low-FODMAP diet.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>Analyses of the gut microbiota after the implementation of the diet have revealed a decrease in microbial fermentation, evincing the efficacy in improving GI symptoms, especially abdominal pain, in children with IBS.<a class="elsevierStyleCrossRefs" href="#bib0025">5,11,15</a>The limitation of the duration of the elimination phase to 2 weeks in the paediatric population reduces the associated nutritional risks and facilitates adherence, which could contribute to the efficacy of the diet.<a class="elsevierStyleCrossRefs" href="#bib0065">13,14</a>As regards the total duration of the diet, previous studies suggest that issues with adherence emerge with a duration longer than 2 months, which reduces its efficacy.<a class="elsevierStyleCrossRefs" href="#bib0055">11,15</a> Determining the appropriate duration of this diet in children entails considering the minimum time required for efficacy, maximum time accepted for feasibility, and nutritional risks.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>Steps preceding initiation of the low-FODMAP dietTo identify diseases for which the low-FODMAP diet can be considered an appropriate dietary treatment, the Rome III and IV criteria can be applied.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> Furthermore, performance of certain tests before initiation of the diet is recommended to rule out certain parasitic infections or diseases that may require specific treatment.<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020">1Clinical evaluation/diagnostic tests. The evaluation is based on 2 screening tests:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0025">-The hydrogen breath test using specific substrates that allow diagnosis of intolerance to certain carbohydrates (lactose, sucrose, sorbitol or fructose).<a class="elsevierStyleCrossRef" href="#bib0025">5</a></li><li class="elsevierStyleListItem" id="lsti0030">-Oral tolerance tests. The most appropriate approach has to be discussed, given the possibility of false positive results due to the interaction with the oral microbiota, a different CO2 production rate or a lower CO2 distribution volume in younger children.<a class="elsevierStyleCrossRef" href="#bib0030">6</a></li></ul></li><li class="elsevierStyleListItem" id="lsti0035">2Physical examination, anthropometric measurement and testing for biomarkers of malnutrition (serum levels of calcium, iron, vitamin B12 and D, etc).</li><li class="elsevierStyleListItem" id="lsti0040">3Psychological evaluation. The patient must be willing to collaborate and report truthful information.</li><li class="elsevierStyleListItem" id="lsti0045">4Food and symptom diary (Appendix A-I in Supplementary material). The parents/guardians record for 3 days the foods consumed by the child following the usual diet, documenting any associated symptoms and the characteristics of the stools using the Brussels Infants and Toddlers Stool Scale (BITSS)<a class="elsevierStyleCrossRef" href="#bib0080">16</a> in infants and toddlers or the Bristol stool chart in older children. Parents are provided with tables to help them estimate the amounts of food consumed. This document helps assess/determine the dietary preferences, unusual dietary habits and symptoms of the patient.<a class="elsevierStyleCrossRef" href="#bib0025">5</a></li></ul>Phases of treatmentThe outcomes of the low-FODMAP diet improve when it is managed by a multidisciplinary team consisting, essentially, by a dietitian/nutritionist, GI doctor and mental health professional with specific training in this area. In many cases, symptoms improve within 2 weeks, so if there is no improvement after 3 or 4 weeks, the patient should not continue on the diet.The diet is structured into 3 phases. In studies in paediatric patients,<a class="elsevierStyleCrossRef" href="#bib0070">14</a> phase 1 lasts 2–3 weeks, phase 2–8 weeks and phase 3 has a variable duration. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> summarises the phases of the diet, which has an approximate duration of 2–3 months in most patients.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>First phase: elimination of FODMAP-containing foodsFoods with a high FODMAP content are eliminated for 2–3 weeks while monitoring changes in symptoms. If symptoms persist, both the proposed diet and the patient’s adherence to it need to be evaluated.A duration of 2 weeks in the paediatric population may be as effective as 3 weeks in adults while decreasing the potential risks and facilitating adherence. In fact, some studies<a class="elsevierStyleCrossRef" href="#bib0070">14</a> found that the majority of patients in the sample considered the diet easy to follow and a high adherence, which is associated with improved symptom control. At 2 weeks, patients exhibited an improvement in symptoms.<a class="elsevierStyleCrossRef" href="#bib0065">13</a><a class="elsevierStyleCrossRefs" href="#tbl0015">Tables 3 and 4</a> present lists of the foods that are allowed and not allowed and the potential nutrient deficiencies associated with the low-FODMAP diet.<a class="elsevierStyleCrossRefs" href="#bib0030">6,7,17,18</a> We ought to highlight that the allowed foods differ between studies, which complicates the implementation of the diet.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Second phase: reintroduction of FODMAP-containing foodsBefore starting the second phase, the team considers whether the previous phase has succeeded in alleviating the symptoms; if it has, FODMAP-rich foods are reintroduced in a planned schedule to determine which cause symptoms and which do not. The order in which the different FODMAP groups are reintroduced in children is the same as in adults and is presented in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>.<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>Each week, the indicated FODMAP is introduced for 3 days. For each FODMAP, the patient is given two choices of foods containing it and must pick only one of them, gradually increasing the amount consumed.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> During those days, a food and symptoms diary must be kept, recording the food item and the amount consumed per the prescription, in addition to any symptoms developed during or after its intake. This allows patients and/or the parents/guardians to identify specific FODMAP triggers and the dose at which they cause symptoms.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>After the 3 reintroduction days, the reintroduced foods are maintained in the diet at the tolerated dose for the remaining 4 days of the week while continuing with the previously prescribed low-FODMAP diet.In patients that develop symptoms at any point in those 3 days, the dose should not be increased further or consumption of that food should be discontinued. After 4–7 days, once the symptoms resolve, another FODMAP can be introduced. Another possible approach is to continue reintroduction of the same food item the next day at half the dose or switching it to a different food containing the same FODMAP. If symptoms develop again after reducing the dose, it is likely that the patient will not be able to tolerate any foods in that FODMAP group well, so the patient should be advised to avoid them whenever possible.<a class="elsevierStyleCrossRefs" href="#bib0040">8,14</a><a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> presents an algorithm for this process.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Thus, once the level of tolerance to different FODMAPs is established, their contents in the diet are adjusted to create a plan with the minimum possible restrictions to reduce the potential adverse effects on the gut microbiota, colonocyte metabolism and the patient’s long-term nutritional status.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> Anthropometric measurement during the follow-up is recommended, as patients tend to lose weight during this phase of treatment.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a>Appendix A-II (Supplementary material) shows low-FODMAP plates to facilitate adherence during the reintroduction phaseWe recommend starting with foods with the lowest FODMAP content. Appendix A-III (Supplementary material) details the amounts of FODMAP in some fruits and vegetables<a class="elsevierStyleCrossRef" href="#bib0005">1</a> in increasing order. Using this information, patients can choose fruits that only have an excess of fructose, sorbitol, mannitol, fructose + sorbitol, etc. This is particularly helpful for the reintroduction of fructose, polyols and fructose + sorbitol.<a class="elsevierStyleCrossRef" href="#bib0015">3</a><a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> presents a list of typical Spanish dishes that can be used to reintroduce foods after the elimination phase.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> However, the current evidence on the use of the low-FODMAP diet in Spain is scarce and hardly any local studies have estimated the feasibility and effectiveness of this strategy in reducing symptoms and improving health-related symptom reduction and quality of life in patients in Hispanic countries (Spain and Spanish-speaking countries in Latin America).<a class="elsevierStyleCrossRef" href="#bib0060">12</a><elsevierMultimedia ident="tbl0030"></elsevierMultimedia>Third phase: personalizationThis phase concerns the use of a long-term dietary plan individualised according to the needs, tolerance, culture and preferences of the patient that is more varied and less restrictive and excludes only those FODMAPs that cause symptoms.If there is no improvement in symptoms, other possible causes need to be considered.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> It is important that the patient remains in follow-up during this phase, although keeping a food and symptoms diary is no longer necessary.Challenges of the low-FODMAP dietSince the low-FODMAP diet is quite restrictive, one of the associated risks is compromised nutrition; there is also evidence that patients may lose weight.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Due to the decreased consumption of dairy, calcium levels and bone health should be monitored. However, calcium levels can be maintained through the consumption of lactose-free dairy products<a class="elsevierStyleCrossRef" href="#bib0050">10</a> and/or consumption of other foods (such as sesame).<a class="elsevierStyleCrossRef" href="#bib0090">18</a>The evidence regarding fibre intake is contradictory, as some studies show that it decreases due to the restriction of cereals, legumes and beans, while others have found no changes in fibre intake. As is the case of other restrictive diets, patients may end up having low or deficient levels of some micronutrients, such as vitamins (vitamin D or B vitamins) and natural antioxidants (flavonoids and carotenoids).<a class="elsevierStyleCrossRef" href="#bib0090">18</a>RecommendationsThere is no question that the role played by a specialist, the dietitian/nutritionist, is crucial for the successful management of the patient, as it promotes the implementation of and adherence to a more balanced diet.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> The dietary plan must be personalised based on the individual tolerance of each patient aiming at achieving balanced nutrition. While treatment is ongoing, it is important to assess and promote adherence.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Long-term adherence may be harder to achieve and can cause difficulties in the social life of the patient. Thus, it is important to provide guidance through nutritional and dietary education, with an emphasis on lifestyle and dietary habits and the identified needs of the patient, helping the patient learn and develop skills that will allow them to improve their own quality of life. Keeping daily records of dietary intake and symptoms can help identify foods that worsen clinical manifestations.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> Appendix A-IV (Supplementary material) provides dietary advice and recommendations for eating outside the home.ConclusionThe narrative review allowed drawing the following conclusions:<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0050">none-The low-FODMAP diet is restrictive and must be supervised by a multidisciplinary team of experts in child nutrition.</li><li class="elsevierStyleListItem" id="lsti0055">none-If there is no clinical response within 3 weeks, the diet should not continue.</li><li class="elsevierStyleListItem" id="lsti0060">none-The tolerance to each food may vary between individuals and based on the clinical picture. In consequence, dietary recommendations must be personalised in terms of the type, amount and cooking/preparation of the foods.</li><li class="elsevierStyleListItem" id="lsti0065">none-The diet is structured into 3 phases; phase 1 lasts 2–3 weeks; phase 2 lasts 8 weeks and, lastly, phase 3 (the personalization phase) is of variable duration. The total duration of the diet is usually of 2–3 months.</li><li class="elsevierStyleListItem" id="lsti0070">none-Although several studies have shown that the low-FODMAP diet can improve symptoms in certain GI disorders, there is little evidence in the paediatric population. Therefore, high-quality studies need to be conducted before a consensus can be reached on the use of this diet in paediatric clinical practice.</li><li class="elsevierStyleListItem" id="lsti0075">none-Further studies with controls need to be conducted to assess the prolonged use (several months or longer) of the low-FODMAP diet and its impact on GI symptoms and physiology and gut microbiota composition and function. Such studies are essential to guarantee the long-term efficacy and safety of this dietary intervention.</li></ul>FundingThis research project did not receive specific financial support from funding agencies in the public, private or not-for-profit sectors.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres2205422" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1850298" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2205423" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1850297" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Evidence on the use of the low-FODMAP diet in paediatric patients" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Steps preceding initiation of the low-FODMAP diet" ] 1 => array:3 [ "identificador" => "sec0025" "titulo" => "Phases of treatment" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "First phase: elimination of FODMAP-containing foods" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Second phase: reintroduction of FODMAP-containing foods" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Third phase: personalization" ] ] ] ] ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Challenges of the low-FODMAP diet" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Recommendations" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusion" ] 10 => array:2 [ "identificador" => "sec0060" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-10-08" "fechaAceptado" => "2024-04-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1850298" "palabras" => array:5 [ 0 => "Diet" 1 => "FODMAP" 2 => "Food" 3 => "Symptoms" 4 => "Treatment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1850297" "palabras" => array:5 [ 0 => "Dieta" 1 => "FODMAP" 2 => "Alimentos" 3 => "Síntomas" 4 => "Tratamiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "In this article we present a protocol for the use of the low-FODMAP diet in paediatric patients and review of the current evidence on its efficacy. These short-chain carbohydrates, which can be fermented by the intestinal microbiota, are found in a wide variety of foods, mainly of plant origin. The low-FODMAP diet is a therapeutic tool used for the management of gastrointestinal disorders such as irritable bowel syndrome. The sources we used were PubMed, Web of Science, Google Scholar and institutional websites. Following consumption of FODMAP-rich foods, a series of end products are generated that are not absorbed, giving rise to symptoms. Before starting a low-FODMAP diet, it is important to carry out a diagnostic evaluation including any applicable tests. Treatment is structured in 3 phases: elimination, reintroduction and personalization phase. In the first phase, FODMAP-rich foods are eliminated for 2–3 weeks. In the second phase, lasting 8 weeks, FODMAP-rich foods are gradually reintroduced. The last phase consists in customizing the diet according to individual tolerance. This article details which foods contain FODMAPs and possible substitutes. In addition, specific food diary/intake tracking and educational materials are provided in a series of appendices to facilitate adherence to the diet. Although most studies have been conducted in adults, there is also some evidence on the beneficial effects in the paediatric age group, with a reduction of symptoms, especially in patients with functional gastrointestinal disorders. Nevertheless, more research is required on the subject." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "En este artículo presentamos un protocolo para el uso de la dieta baja en FODMAPs en pacientes pediátricos y una revisión sobre la evidencia actual de su eficacia. Estos hidratos de carbono de cadena corta, fermentables por el microbiota intestinal, se encuentran fundamentalmente en gran variedad de alimentos de origen vegetal. La dieta baja en FODMAPs es una herramienta terapéutica utilizada en trastornos digestivos como el síndrome del intestino irritable. Los recursos utilizados han sido PubMed, Web of Science, Google Scholar y páginas web oficiales. Tras el consumo de alimentos ricos en FODMAPs, se generan unos productos finales que no se absorben, causando sintomatología. Antes de comenzar dicha dieta, es importante realizar una aproximación diagnóstica a través de las pruebas complementarias pertinentes. El tratamiento se divide en 3 fases: eliminación, reintroducción y personalización. En la primera se eliminan los alimentos ricos en FODMAPs durante 2–3 semanas. La segunda dura 8 semanas, y en ese período se introducen de nuevo de forma gradual alimentos ricos en FODMAPs. La última fase consiste en personalizar la dieta según la tolerancia individual. En este artículo se detallan aquellos alimentos que contienen dichos compuestos y los posibles sustitutos. Además, en una serie de Anexos se incluyen registros dietéticos específicos, y material didáctico para facilitar el cumplimiento de la dieta. Pese a que la mayoría de estudios se han realizado en población adulta, se ha observado que en edad pediátrica también tiene efectos beneficiosos. No obstante, se requiere más investigación al respecto." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following is Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0075" ] ] ] ] "multimedia" => array:9 [ 0 => array:9 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: adapted from Grez et al.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>" "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 531 "Ancho" => 2175 "Tamanyo" => 74383 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Chart of the low-FODMAP diet phases." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2661 "Ancho" => 2508 "Tamanyo" => 290769 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Algorithm for the FODPAM reintroduction phase." ] ] 2 => array:9 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: adapted from Muir et al.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>" "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fermentable: short-chain carbohydrates \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oligosaccharides: fructans or fructooligosaccharides (FOS) and galactans or galactooligosaccharides (GOS) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Disaccharides: lactose \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monosaccharides: fructose \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">And \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Polyols: sorbitol, mannitol (naturally present in certain fruits) and synthetic polyols (xylitol, maltitol, isomalt and anything ending in -ol in food labels) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3598404.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Description of the FODMAP acronym with examples." ] ] 3 => array:9 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: adapted from Whelan et al.,<a class="elsevierStyleCrossRef" href="#bib0020">4</a> Grez et al.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> and Broekaert et al.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>" "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">FODMAP categories \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Main sources<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Absorption and digestion process \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Effect on GI tract \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oligosaccharides</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fructans or FOS (oligofructose, inulin) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wheat, rye, onion, garlic, artichoke, asparagus, leek, peas, low-fat dairy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Humans lack the necessary enzymes to hydrolyse oligosaccharides, so they are not absorbed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increased gas production due to fermentation of undigested oligosaccharides in the colon \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Galactans or GOS (raffinose, stachyose) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Legumes/beans (chickpeas, beans and peas) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Disaccharides</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lactose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Milk and dairy products \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The enzyme lactase is necessary for hydrolysis of lactose in the small intestine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increase inflow of water in the bowel due to the osmotic effect of undigested lactose. Increased gas in colon due to undigested lactose fermentation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monosaccharides</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fructose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mango, figs.Honey, corn syrup, marmalade/jam and other syrups.Sweeteners in dairy.Sugary/carbonated drinks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fructose malabsorption due to different causes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increase inflow of water in the bowel due to the osmotic effect of fructose with or without malabsorption. Increased gas in colon due to fermentation of unabsorbed substrates. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Polyols</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sorbitol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stone fruit (cherries, plums, peaches, avocado), apple \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Passive absorption throughout the small intestine based on molecular size, intestinal pore size, bowel transit time and the presence of GI disorders \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increase inflow of water in the bowel due to the osmotic effect of fructose with or without malabsorption. Increased gas in colon due to fermentation of unabsorbed substrates. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Manitol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mushrooms, cauliflower \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lactitol, xylitol, erythritol, maltitol, isomalt \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">“sugar-free” products with sweeteners finished in -ol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3598406.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "The table only provides examples of the main sources of different FODMAPs. The list is not exhaustive and is insufficient to implement the FODMAP elimination phase." ] ] ] "descripcion" => array:1 [ "en" => "FODMAPs and their effects on the gastrointestinal tract." ] ] 4 => array:9 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: adapted from Broekaert et al.,<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Huysentruyt et al.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> and IBS Research.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>" "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Alimentos \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Not allowed \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Allowed \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vegetables and roots \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Garlic, onion, artichoke, asparagus, leek, celery, green pepper, okra, aubergine, common tomato, baby spinach, heart of lettuce, endive, chicory leaves, common cabbage, beets (root), button mushrooms (champiñón), other mushrooms (except oyster mushroom), spring onions (green part), peanut squash, sweet potato (in large amounts), Brussels sprouts, broccoli, bok choy, cauliflower, bean sprouts (in large quantities), sweet corn (in large quantities), fennel \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pumpkin, courgette (65 g), carrot, cherry tomato, turnip, unpeeled cucumber and pickled gherkins, red pepper, chard, spinach, borage, collards, thistle, arugula, kale, chicory, lettuce in general (preferably choose the tender leafy type and avoid the “white” core), endives, chives, radish, alfalfa, corn (in small amounts), ginger, bambooPotato, sweet potato (in small amounts), cassava (in small amounts), yams (in small amounts) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fruits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mango, cherries, nectarine, peach, plum, avocado, pear, apricot, persimmon, lychee, melon, watermelon, apple, grapefruit, raisins, prunes, canned fruit in juice, natural fruit juice (of not allowed fruits), fruit concentrates \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Banana (unripe), orange, tangerine, kiwi, star fruit, lemon/lime, papaya, pineapple, raspberry, strawberries, passion fruit, loquat, cantaloupe melon, grapes (5−6), custard apple, quince, dragon fruit, guava, coconut<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a>, blueberries<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a>, pomegranate<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a>. Lemon juice (lemonade) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cereals and derivates \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wheat, whole wheat, semolina, couscous, barley, rye, (bread, flour and pasta based on these cereals). Oats<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a>, spelt flour<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a>, brown rice, millet, amaranth, muesli, breakfast cereals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rice, corn, quinoa, buckwheat, breakfast cereals, bread and pasta based on these cereals. Gluten-free products, buckwheat flour, cornstarch \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Legumes/beans \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">White, pinto and black beans; fava beans, frijoles, lentils, chickpeas, peas, soybeans (and derived products) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bean sprouts \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nuts and seeds \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pistachios, hazelnuts, chestnuts, cashews, dates \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peanuts and peanut butter, walnuts (small amounts), almonds (small amounts), pine nuts (1 tablespoon), pumpkin and sunflower seeds, chia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Milk and dairy products \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fresh milk (cow's, goat's and sheep's) and derivate dairy products, powdered milk, condensed milk, yoghurt, kefir, curd, butter and margarine, semi-cured and fresh cheeses, cream cheese, cream, ice cream, custards and cream fillings, desserts based on milk or cream \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lactose-free milk, lactose-free yogurt, lactose-free cheese, aged cheese (small amounts) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Meat and meat products \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cold cuts, processed meat products (check labelling), processed hamburgers (of any kind), sausages (of all kinds), cured meats \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">This food group does not naturally contain FODMAPs; however, it is important to read the labels \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fish, shellfish, mollusks, other seafood and derivates \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fish substitutes (check additives) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">This food group does not naturally contain FODMAPs; however, it is important to read the labels \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other beverages \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Commercial fruit juices, alcoholic beverages, soft drinks, chamomile, infusions containing FODMAP-rich fruits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Plant-based drinks made of almond, rice, hazelnut, quinoa, macadamia, oats and coconut (all in small amounts), horchata, canned coconut milk (in small amounts), coconut-based nondairy yogurt, tea (based on tolerance), coffee (based on tolerance), chocolate powder (mixed with water), kombucha (180 mL) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Garlic and onion powder, and all the spices that contain them. Keep in mind that many processed foods contain onions (herb salt, powdered vegetables, dried vegetables, broths, meat sauces, soups, marinades, and other sauces), even if it is not stated on the label. Pastries (milk chocolate, white chocolate, biscuits and sugary cereals, whole-grain biscuits, ice cream, cakes) and candies.Fibre supplements: inulin, FOS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">All spices except garlic and onion powder, popcorn, dark chocolate, pure cocoa powder \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Artificial sweeteners<a class="elsevierStyleCrossRef" href="#tblfn0020">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Isomaltose E953.Any ending in -ol: lactitol E966, maltitol E965, mannitol E421, sorbitol E420i, sorbitol syrup (E-420ii), xylitol E967, erythritol E968.Corn or fructose syrup, agave, honey \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acesulfame K E950, aspartame E951, cyclamate E952, steviol glycosides E960, neohesperidin DC E959, neotame E961, saccharine E954, aspartame-acesulfame salt E962, thaumatin E957, sucralose E955.Moderate consumption: white sugar (sucrose), brown sugar, dextrose (glucose), maple syrup \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3598407.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "Moderate consumption." ] 1 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "b" "nota" => "Tolerance of these cereals varies between individuals; personal tolerance must be assessed." ] 2 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "c" "nota" => "Check the labelling. Avoid light or "sugar-free" products and commercial sauces such as ketchup, barbecue sauce." ] ] ] "descripcion" => array:1 [ "en" => "Lists of foods that are not recommended (“not allowed”) and recommended (“allowed”) in the low-FODMAP diet." ] ] 5 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Nutrients and compounds \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Nutritional deficiency \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fermentable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oligosaccharides: fructans, FOS (oligofructose) and GOS (raffinose, stachyose)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reduced consumption of vegetables leads to a decreased intake of: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Fibre and natural antioxidants, such as flavonoids, carotenoids, and vitamin C, or phenolic acid (eg, wheat) and anthocyanins</li><li class="elsevierStyleListItem" id="lsti0010">•Carbohydrates (eg, wheat products)</li><li class="elsevierStyleListItem" id="lsti0015">•Iron (eg, due to reduced consumption of legumes)</li></ul> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Disaccharides (lactose) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Excluding dairy may result in vitamin D and calcium deficiency \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monosaccharides (fructose-free or with glucose excess) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Excluding fruits can lead to a reduction in natural antioxidants, such as flavonoids or vitamin C \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">And \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Polyols (sorbitol, xylitol, maltitol) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Excluding vegetables and fruits can result in a reduction in natural antioxidants, such as flavonoids, carotenoids, and vitamin C, or phenolic acid and anthocyanins \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3598408.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Possible nutrient deficits associated with the low-FODMAP diet." ] ] 6 => array:9 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: adapted from Grez et al.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> to fit the dietary patterns of the Spanish population." "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Week \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">FODMAP<a class="elsevierStyleCrossRef" href="#tblfn0025">a</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Recommended food choices<a class="elsevierStyleCrossRef" href="#tblfn0030">b</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 1<a class="elsevierStyleCrossRef" href="#tblfn0035">c</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 2<a class="elsevierStyleCrossRef" href="#tblfn0035">c</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 3<a class="elsevierStyleCrossRef" href="#tblfn0035">c</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rest (low-FODMAP diet) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lactose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MilkYoghurt (without sweetener or other FODMAP) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/2 glass1 single-serve container \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 glass1.5 single-serve containers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 glass and a half2 single-serve containers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 consecutive days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fructose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MangoHoney \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">½ mango1 Tbsp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intermediate amount1,5 Tbsp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 mango2 Tbsp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 consecutive days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Polyols: sorbitol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BlackberriesAvocado \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 berries½ avocado \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 berriesIntermediate amount \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 berries1 avocado \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 consecutive days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Polyols: mannitol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CauliflowerButton mushrooms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">½ cup½ cup \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intermediate amountIntermediate amount \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 cup1 cup \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 consecutive days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fructose + sorbitol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ApplePear \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">½apple½ pear \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intermediate amountIntermediate amount \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 apple1 pear \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 consecutive days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FOS (wheat) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Whole wheat breadWhole wheat pasta (cooked) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 slice½ cup \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.5 slices1 cup \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 slices1 ½ cup \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 consecutive days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FOS (onion/garlic) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onion (raw)Garlic (raw) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">½ cup½ clove \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intermediate amountIntermediate amount \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">½ onion1 clove \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 consecutive days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Galactans \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chickpeas (cooked)Almonds \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">½ cup5 almonds \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intermediate amountIntermediate amount \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 cup10 almonds \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 consecutive days \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3598403.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "a" "nota" => "Appendix A-III details the total FODMAP content of fruits and vegetables." ] 1 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "b" "nota" => "Choose one of the two options." ] 2 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "c" "nota" => "If symptoms worsen during the challenge, do not increase the dose and wait 3–7 days to introduce a new food." ] ] ] "descripcion" => array:1 [ "en" => "Order of FODMAP reintroduction." ] ] 7 => array:9 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: adapted from Garicano et al.<a class="elsevierStyleCrossRef" href="#bib0060">12</a>" "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Food \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dish \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wheat \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Toasted wheat bread with serrano ham and tomato \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asparagus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grilled vegetables (asparagus, courgette, aubergine, fresh tomato) with cubed serrano ham \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Onion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spanish omelette with potato and onion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lentils \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lentils stewed with potato and carrot \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3598405.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Examples of typical Spanish dishes that can be reintroduced after the elimination phase of the low-FODMAP diet." ] ] 8 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 236661 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Measurement of short-chain carbohydrates in common Australian vegetables and fruits by High-Performance Liquid Chromatography (HPLC)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.G. 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Special article

The low-FODMAP diet

Dieta baja en FODMAP

Paula Lucas Zapata

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paulalucaszapata@gmail.com

Corresponding author.

, Esther García Navarro, Carmen Ribes Koninckx

Hospital Universitario y Politécnico La Fe, Valencia, Spain

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butyrate or propionate&#46; The osmotic load that they produce increases the volume of water in the colonic lumen&#44; which in turn causes symptoms such as abdominal distension and pain&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The foods that contain FODMAPs are numerous and ubiquitous in Western diets&#58; dairy products&#44; fruits&#44; vegetables&#44; legumes and beans&#44; cereals&#44; baked goods&#44; sauces&#44; candies&#44; beverages&#44; jams or frozen treats&#44; among others&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> presents the different FODMAP categories&#44; examples of the main sources&#44; the digestion and absorption process and their effects on the gastrointestinal &#40;GI&#41; tract&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">On one hand&#44; fructose is absorbed by the small intestine via the GLUT5 &#40;high-affinity&#41; or GLUT2 &#40;low-affinity&#41; transporter&#46; Physiological fructose malabsorption occurs if the GLUT5 transporter is saturated&#44; when the fructose intake exceeds 20&#8239;g in a single eating episode&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Glucose aids the absorption of fructose via GLUT2&#44; so foods containing fructose and glucose in a 1&#58;1 ratio are better tolerated&#46; However&#44; when there is an excess of fructose relative to glucose &#40;fructose excess&#8239;&#61;&#8239;free fructose &#8211; free glucose&#41;&#44; the former is not well absorbed&#44; producing an increase in the water influx into the lumen&#46; The fruits with fructose excess include pear&#44; apple&#44; mango and melon&#44; and the vegetables&#44; asparagus&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">When it comes to sorbitol and fructose&#44; 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although in some populations the onset is delayed to adolescence&#44; and entails the development of a constellation of symptoms such as flatulence&#44; abdominal pain and distension and&#47;or diarrhoea due to the arrival of lactose that has not been hydrolysed to the colon&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">As regards fructooligosaccharides &#40;FOS&#41; and galactooligosaccharides &#40;GOS&#41;&#44; their malabsorption is due to humans not producing the enzymes required to hydrolyse them&#44; so they are not absorbed&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">On the other hand&#44; polyols &#40;see <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41; are absorbed through passive diffusion along the length of the small intestine&#46; The degree of absorption varies depending on the size of the molecule and of the intestinal pores&#44; the time in the small bowel in relation to the absorption time window and the presence of GI disorders&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The aim of this document is to establish a protocol for the use of the low-FODMAP diet in paediatric patients and to review the current evidence on the efficacy of this diet&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Material and methods</span><p id="par0065" class="elsevierStylePara elsevierViewall">We conducted a narrative review of sources obtained through the PubMed and Web of Science databases&#44; Google Scholar and websites of agencies and other official institutions&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In the search conducted in PubMed&#44; we applied selection criteria such as &#8220;human&#8221; and &#8220;child&#8221;&#44; limiting the search to sources published in the past 5 years in English or Spanish language&#46; In this search&#44; we used the key words &#8220;fodmap&#8221; and &#8220;low fodmap diet&#8221; and the operator AND to combine either with the additional key word &#8220;children&#8221;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">On the other hand&#44; in the search conducted in Web of Science&#44; we applied selection criteria such as &#8220;human&#8221; and &#8220;children&#8221;&#44; limiting the search to sources published in the past 5 years in English or Spanish language&#46; we used the key words &#8220;fodmap&#8221; and &#8220;the low fodmap diet&#8221; and the operator AND to combine either with the additional key word &#8220;children&#8221;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Evidence on the use of the low-FODMAP diet in paediatric patients</span><p id="par0080" class="elsevierStylePara elsevierViewall">The low-FODMAP diet is a therapeutic tool that can improve symptoms and nutrition in multiple GI disorders&#44; such as irritable bowel syndrome &#40;IBS&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7</span></a> inflammatory bowel disease &#40;IBD&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> small intestinal bacterial overgrowth &#40;SIBO&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;11</span></a> non-coeliac gluten sensitivity &#40;NCGS&#41;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> or coeliac disease &#40;CE&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It has been found to be effective not only against IBS&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> but also in patients with fibromyalgia&#44; sclerosis and endometriosis&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Most studies in patients with IBS &#40;and without CE&#41; have been conducted in the adult population&#44; demonstrating that dietary intake of gluten can cause symptoms&#46; This suggests that individuals with IBS may either have NCGS or respond poorly to wheat fructans&#44; which would explain why adherence to a low-FODMAP diet&#44; which excludes them&#44; can have beneficial effects&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The evidence on the use of the low-FODMAP diet in the paediatric population is scarce&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Notwithstanding&#44; a significant improvement in symptoms related to gas production and abdominal pain and distention has been observed in paediatric patients on this diet&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;13</span></a> Constipation is the symptom that improves the least&#44; which could be related to the low fibre intake in this dietary approach&#46; In a study conducted by Barangu&#225;n Castro et al&#46; in children aged 5&#8211;15 years &#40;2019&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> most considered that the diet was easy to follow and there was a high proportion of adherence&#44; associated with improved symptom control&#46; Patients have also reported a decrease in abdominal pain associated with an improved quality of life&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;14</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Final products of digestion that are not absorbed may produce gases&#44; swelling&#44; gastro-oesophageal reflux&#44; heartburn&#44; decreased appetite&#44; abdominal distension &#47;meteorism&#44; borborygmus&#44; colicky abdominal pain&#44; epigastric pain and changes in bowel movements ranging from softer or more frequent stools to diarrhoea or even constipation&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> These symptoms have a deleterious impact on quality of life&#44; so alleviating them is a priority&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">For now&#44; the efficacy of the diet in children with IBS has not been fully proven&#46; However&#44; there is evidence that suggests that implementation and adherence of the diet can improve its symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In order to improve adherence to the low-FODMAP diet and its effectiveness&#44; it is essential to perform a rigorous evaluation of abnormal dietary habits before and during the intervention&#46; The reason is that there are complex psychosocial factors at play that are particularly significant in children and&#47;or adolescents&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The efficacy of the low-FODMAP diet is related to the baseline composition of the gut microbiota and its metabolic capacity&#46; There are studies that suggest that the response ot the diet is better in children with IBS and a microbiota with a greater saccharolytic metabolic capacity&#46; Therefore&#44; this could be a predictive biomarker of the responsiveness to a low-FODMAP diet&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Analyses of the gut microbiota after the implementation of the diet have revealed a decrease in microbial fermentation&#44; evincing the efficacy in improving GI symptoms&#44; especially abdominal pain&#44; in children with IBS&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;11&#44;15</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The limitation of the duration of the elimination phase to 2 weeks in the paediatric population reduces the associated nutritional risks and facilitates adherence&#44; which could contribute to the efficacy of the diet&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">As regards the total duration of the diet&#44; previous studies suggest that issues with adherence emerge with a duration longer than 2 months&#44; which reduces its efficacy&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;15</span></a> Determining the appropriate duration of this diet in children entails considering the minimum time required for efficacy&#44; maximum time accepted for feasibility&#44; and nutritional risks&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Steps preceding initiation of the low-FODMAP diet</span><p id="par0125" class="elsevierStylePara elsevierViewall">To identify diseases for which the low-FODMAP diet can be considered an appropriate dietary treatment&#44; the Rome III and IV criteria can be applied&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Furthermore&#44; performance of certain tests before initiation of the diet is recommended to rule out certain parasitic infections or diseases that may require specific treatment&#46;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1</span><p id="par0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Clinical evaluation&#47;diagnostic tests&#46;</span> The evaluation is based on 2 screening tests&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0135" class="elsevierStylePara elsevierViewall">The hydrogen breath test using specific substrates that allow diagnosis of intolerance to certain carbohydrates &#40;lactose&#44; sucrose&#44; sorbitol or fructose&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0140" class="elsevierStylePara elsevierViewall">Oral tolerance tests&#46; The most appropriate approach has to be discussed&#44; given the possibility of false positive results due to the interaction with the oral microbiota&#44; a different CO<span class="elsevierStyleInf">2</span> production rate or a lower CO<span class="elsevierStyleInf">2</span> distribution volume in younger children&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">2</span><p id="par0145" class="elsevierStylePara elsevierViewall">Physical examination&#44; anthropometric measurement and testing for biomarkers of malnutrition &#40;serum levels of calcium&#44; iron&#44; vitamin B<span class="elsevierStyleInf">12</span> and D&#44; etc&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">3</span><p id="par0150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Psychological evaluation&#46;</span> The patient must be willing to collaborate and report truthful information&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">4</span><p id="par0155" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Food and symptom diary</span> &#40;Appendix A-I in Supplementary material&#41;&#46; The parents&#47;guardians record for 3 days the foods consumed by the child following the usual diet&#44; documenting any associated symptoms and the characteristics of the stools using the Brussels Infants and Toddlers Stool Scale &#40;BITSS&#41;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> in infants and toddlers or the Bristol stool chart in older children&#46; Parents are provided with tables to help them estimate the amounts of food consumed&#46; This document helps assess&#47;determine the dietary preferences&#44; unusual dietary habits and symptoms of the patient&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Phases of treatment</span><p id="par0160" class="elsevierStylePara elsevierViewall">The outcomes of the low-FODMAP diet improve when it is managed by a multidisciplinary team consisting&#44; essentially&#44; by a dietitian&#47;nutritionist&#44; GI doctor and mental health professional with specific training in this area&#46; In many cases&#44; symptoms improve within 2 weeks&#44; so if there is no improvement after 3 or 4 weeks&#44; the patient should not continue on the diet&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The diet is structured into 3 phases&#46; In studies in paediatric patients&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> phase 1 lasts 2&#8211;3 weeks&#44; phase 2&#8211;8 weeks and phase 3 has a variable duration&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> summarises the phases of the diet&#44; which has an approximate duration of 2&#8211;3 months in most patients&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">First phase&#58; elimination of FODMAP-containing foods</span><p id="par0170" class="elsevierStylePara elsevierViewall">Foods with a high FODMAP content are eliminated for 2&#8211;3 weeks while monitoring changes in symptoms&#46; If symptoms persist&#44; both the proposed diet and the patient&#8217;s adherence to it need to be evaluated&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">A duration of 2 weeks in the paediatric population may be as effective as 3 weeks in adults while decreasing the potential risks and facilitating adherence&#46; In fact&#44; some studies<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> found that the majority of patients in the sample considered the diet easy to follow and a high adherence&#44; which is associated with improved symptom control&#46; At 2 weeks&#44; patients exhibited an improvement in symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRefs" href="#tbl0015">Tables 3 and 4</a> present lists of the foods that are allowed and not allowed and the potential nutrient deficiencies associated with the low-FODMAP diet&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7&#44;17&#44;18</span></a> We ought to highlight that the allowed foods differ between studies&#44; which complicates the implementation of the diet&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Second phase&#58; reintroduction of FODMAP-containing foods</span><p id="par0185" class="elsevierStylePara elsevierViewall">Before starting the second phase&#44; the team considers whether the previous phase has succeeded in alleviating the symptoms&#59; if it has&#44; FODMAP-rich foods are reintroduced in a planned schedule to determine which cause symptoms and which do not&#46; The order in which the different FODMAP groups are reintroduced in children is the same as in adults and is presented in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall">Each week&#44; the indicated FODMAP is introduced for 3 days&#46; For each FODMAP&#44; the patient is given two choices of foods containing it and must pick only one of them&#44; gradually increasing the amount consumed&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> During those days&#44; a food and symptoms diary must be kept&#44; recording the food item and the amount consumed per the prescription&#44; in addition to any symptoms developed during or after its intake&#46; This allows patients and&#47;or the parents&#47;guardians to identify specific FODMAP triggers and the dose at which they cause symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">After the 3 reintroduction days&#44; the reintroduced foods are maintained in the diet at the tolerated dose for the remaining 4 days of the week while continuing with the previously prescribed low-FODMAP diet&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">In patients that develop symptoms at any point in those 3 days&#44; the dose should not be increased further or consumption of that food should be discontinued&#46; After 4&#8211;7 days&#44; once the symptoms resolve&#44; another FODMAP can be introduced&#46; Another possible approach is to continue reintroduction of the same food item the next day at half the dose or switching it to a different food containing the same FODMAP&#46; If symptoms develop again after reducing the dose&#44; it is likely that the patient will not be able to tolerate any foods in that FODMAP group well&#44; so the patient should be advised to avoid them whenever possible&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;14</span></a><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> presents an algorithm for this process&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0205" class="elsevierStylePara elsevierViewall">Thus&#44; once the level of tolerance to different FODMAPs is established&#44; their contents in the diet are adjusted to create a plan with the minimum possible restrictions to reduce the potential adverse effects on the gut microbiota&#44; colonocyte metabolism and the patient&#8217;s long-term nutritional status&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Anthropometric measurement during the follow-up is recommended&#44; as patients tend to lose weight during this phase of treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">Appendix A-II &#40;Supplementary material&#41; shows low-FODMAP plates to facilitate adherence during the reintroduction phase</p><p id="par0215" class="elsevierStylePara elsevierViewall">We recommend starting with foods with the lowest FODMAP content&#46; Appendix A-III &#40;Supplementary material&#41; details the amounts of FODMAP in some fruits and vegetables<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in increasing order&#46; Using this information&#44; patients can choose fruits that only have an excess of fructose&#44; sorbitol&#44; mannitol&#44; fructose&#8239;&#43;&#8239;sorbitol&#44; etc&#46; This is particularly helpful for the reintroduction of fructose&#44; polyols and fructose&#8239;&#43;&#8239;sorbitol&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> presents a list of typical Spanish dishes that can be used to reintroduce foods after the elimination phase&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> However&#44; the current evidence on the use of the low-FODMAP diet in Spain is scarce and hardly any local studies have estimated the feasibility and effectiveness of this strategy in reducing symptoms and improving health-related symptom reduction and quality of life in patients in Hispanic countries &#40;Spain and Spanish-speaking countries in Latin America&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Third phase&#58; personalization</span><p id="par0225" class="elsevierStylePara elsevierViewall">This phase concerns the use of a long-term dietary plan individualised according to the needs&#44; tolerance&#44; culture and preferences of the patient that is more varied and less restrictive and excludes only those FODMAPs that cause symptoms&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">If there is no improvement in symptoms&#44; other possible causes need to be considered&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It is important that the patient remains in follow-up during this phase&#44; although keeping a food and symptoms diary is no longer necessary&#46;</p></span></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Challenges of the low-FODMAP diet</span><p id="par0235" class="elsevierStylePara elsevierViewall">Since the low-FODMAP diet is quite restrictive&#44; one of the associated risks is compromised nutrition&#59; there is also evidence that patients may lose weight&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Due to the decreased consumption of dairy&#44; calcium levels and bone health should be monitored&#46; However&#44; calcium levels can be maintained through the consumption of lactose-free dairy products<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and&#47;or consumption of other foods &#40;such as sesame&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">The evidence regarding fibre intake is contradictory&#44; as some studies show that it decreases due to the restriction of cereals&#44; legumes and beans&#44; while others have found no changes in fibre intake&#46; As is the case of other restrictive diets&#44; patients may end up having low or deficient levels of some micronutrients&#44; such as vitamins &#40;vitamin D or B vitamins&#41; and natural antioxidants &#40;flavonoids and carotenoids&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Recommendations</span><p id="par0245" class="elsevierStylePara elsevierViewall">There is no question that the role played by a specialist&#44; the dietitian&#47;nutritionist&#44; is crucial for the successful management of the patient&#44; as it promotes the implementation of and adherence to a more balanced diet&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The dietary plan must be personalised based on the individual tolerance of each patient aiming at achieving balanced nutrition&#46; While treatment is ongoing&#44; it is important to assess and promote adherence&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Long-term adherence may be harder to achieve and can cause difficulties in the social life of the patient&#46; Thus&#44; it is important to provide guidance through nutritional and dietary education&#44; with an emphasis on lifestyle and dietary habits and the identified needs of the patient&#44; helping the patient learn and develop skills that will allow them to improve their own quality of life&#46; Keeping daily records of dietary intake and symptoms can help identify foods that worsen clinical manifestations&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Appendix A-IV &#40;Supplementary material&#41; provides dietary advice and recommendations for eating outside the home&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conclusion</span><p id="par0250" class="elsevierStylePara elsevierViewall">The narrative review allowed drawing the following conclusions&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">none-</span><p id="par0255" class="elsevierStylePara elsevierViewall">The low-FODMAP diet is restrictive and must be supervised by a multidisciplinary team of experts in child nutrition&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">none-</span><p id="par0260" class="elsevierStylePara elsevierViewall">If there is no clinical response within 3 weeks&#44; the diet should not continue&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">none-</span><p id="par0265" class="elsevierStylePara elsevierViewall">The tolerance to each food may vary between individuals and based on the clinical picture&#46; In consequence&#44; dietary recommendations must be personalised in terms of the type&#44; amount and cooking&#47;preparation of the foods&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">none-</span><p id="par0270" class="elsevierStylePara elsevierViewall">The diet is structured into 3 phases&#59; phase 1 lasts 2&#8211;3 weeks&#59; phase 2 lasts 8 weeks and&#44; lastly&#44; phase 3 &#40;the personalization phase&#41; is of variable duration&#46; The total duration of the diet is usually of 2&#8211;3 months&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">none-</span><p id="par0275" class="elsevierStylePara elsevierViewall">Although several studies have shown that the low-FODMAP diet can improve symptoms in certain GI disorders&#44; there is little evidence in the paediatric population&#46; Therefore&#44; high-quality studies need to be conducted before a consensus can be reached on the use of this diet in paediatric clinical practice&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">none-</span><p id="par0280" class="elsevierStylePara elsevierViewall">Further studies with controls need to be conducted to assess the prolonged use &#40;several months or longer&#41; of the low-FODMAP diet and its impact on GI symptoms and physiology and gut microbiota composition and function&#46; Such studies are essential to guarantee the long-term efficacy and safety of this dietary intervention&#46;</p></li></ul></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Funding</span><p id="par0285" class="elsevierStylePara elsevierViewall">This research project did not receive specific financial support from funding agencies in the public&#44; private or not-for-profit sectors&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0290" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "titulo" => "Introduction"
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          "titulo" => "Material and methods"
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          "identificador" => "sec0060"
          "titulo" => "Funding"
        ]
        11 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Conflicts of interest"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2023-10-08"
    "fechaAceptado" => "2024-04-22"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1850298"
          "palabras" => array:5 [
            0 => "Diet"
            1 => "FODMAP"
            2 => "Food"
            3 => "Symptoms"
            4 => "Treatment"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1850297"
          "palabras" => array:5 [
            0 => "Dieta"
            1 => "FODMAP"
            2 => "Alimentos"
            3 => "S&#237;ntomas"
            4 => "Tratamiento"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">In this article we present a protocol for the use of the low-FODMAP diet in paediatric patients and review of the current evidence on its efficacy&#46; These short-chain carbohydrates&#44; which can be fermented by the intestinal microbiota&#44; are found in a wide variety of foods&#44; mainly of plant origin&#46; The low-FODMAP diet is a therapeutic tool used for the management of gastrointestinal disorders such as irritable bowel syndrome&#46; The sources we used were PubMed&#44; Web of Science&#44; Google Scholar and institutional websites&#46; Following consumption of FODMAP-rich foods&#44; a series of end products are generated that are not absorbed&#44; giving rise to symptoms&#46; Before starting a low-FODMAP diet&#44; it is important to carry out a diagnostic evaluation including any applicable tests&#46; Treatment is structured in 3 phases&#58; elimination&#44; reintroduction and personalization phase&#46; In the first phase&#44; FODMAP-rich foods are eliminated for 2&#8211;3 weeks&#46; In the second phase&#44; lasting 8 weeks&#44; FODMAP-rich foods are gradually reintroduced&#46; The last phase consists in customizing the diet according to individual tolerance&#46; This article details which foods contain FODMAPs and possible substitutes&#46; In addition&#44; specific food diary&#47;intake tracking and educational materials are provided in a series of appendices to facilitate adherence to the diet&#46; Although most studies have been conducted in adults&#44; there is also some evidence on the beneficial effects in the paediatric age group&#44; with a reduction of symptoms&#44; especially in patients with functional gastrointestinal disorders&#46; Nevertheless&#44; more research is required on the subject&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">En este art&#237;culo presentamos un protocolo para el uso de la dieta baja en FODMAPs en pacientes pedi&#225;tricos y una revisi&#243;n sobre la evidencia actual de su eficacia&#46; Estos hidratos de carbono de cadena corta&#44; fermentables por el microbiota intestinal&#44; se encuentran fundamentalmente en gran variedad de alimentos de origen vegetal&#46; La dieta baja en FODMAPs es una herramienta terap&#233;utica utilizada en trastornos digestivos como el s&#237;ndrome del intestino irritable&#46; Los recursos utilizados han sido PubMed&#44; Web of Science&#44; Google Scholar y p&#225;ginas web oficiales&#46; Tras el consumo de alimentos ricos en FODMAPs&#44; se generan unos productos finales que no se absorben&#44; causando sintomatolog&#237;a&#46; Antes de comenzar dicha dieta&#44; es importante realizar una aproximaci&#243;n diagn&#243;stica a trav&#233;s de las pruebas complementarias pertinentes&#46; El tratamiento se divide en 3 fases&#58; eliminaci&#243;n&#44; reintroducci&#243;n y personalizaci&#243;n&#46; En la primera se eliminan los alimentos ricos en FODMAPs durante 2&#8211;3 semanas&#46; La segunda dura 8 semanas&#44; y en ese per&#237;odo se introducen de nuevo de forma gradual alimentos ricos en FODMAPs&#46; La &#250;ltima fase consiste en personalizar la dieta seg&#250;n la tolerancia individual&#46; En este art&#237;culo se detallan aquellos alimentos que contienen dichos compuestos y los posibles sustitutos&#46; Adem&#225;s&#44; en una serie de Anexos se incluyen registros diet&#233;ticos espec&#237;ficos&#44; y material did&#225;ctico para facilitar el cumplimiento de la dieta&#46; Pese a que la mayor&#237;a de estudios se han realizado en poblaci&#243;n adulta&#44; se ha observado que en edad pedi&#225;trica tambi&#233;n tiene efectos beneficiosos&#46; No obstante&#44; se requiere m&#225;s investigaci&#243;n al respecto&#46;</p></span>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0300" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0075"
          ]
        ]
      ]
    ]
    "multimedia" => array:9 [
      0 => array:9 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Source&#58; adapted from Grez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>"
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          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 531
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            "rol" => "short"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chart of the low-FODMAP diet phases&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Algorithm for the FODPAM reintroduction phase&#46;</p>"
        ]
      ]
      2 => array:9 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Source&#58; adapted from Muir et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>"
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Fermentable</span>&#58; short-chain carbohydrates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Oligosaccharides</span>&#58; fructans or fructooligosaccharides &#40;FOS&#41; and galactans or galactooligosaccharides &#40;GOS&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Disaccharides</span>&#58; lactose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Monosaccharides</span>&#58; fructose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">And</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Polyols</span>&#58; sorbitol&#44; mannitol &#40;naturally present in certain fruits&#41; and synthetic polyols &#40;xylitol&#44; maltitol&#44; isomalt and anything ending in -<span class="elsevierStyleItalic">ol</span> in food labels&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3598404.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Description of the FODMAP acronym with examples&#46;</p>"
        ]
      ]
      3 => array:9 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Source&#58; adapted from Whelan et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Grez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and Broekaert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>"
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Table "
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        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">FODMAP categories&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Main sources<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Absorption and digestion process&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Effect on GI tract&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Oligosaccharides</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fructans or FOS &#40;oligofructose&#44; inulin&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wheat&#44; rye&#44; onion&#44; garlic&#44; artichoke&#44; asparagus&#44; leek&#44; peas&#44; low-fat dairy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Humans lack the necessary enzymes to hydrolyse oligosaccharides&#44; so they are not absorbed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Increased gas production due to fermentation of undigested oligosaccharides in the colon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Galactans or GOS &#40;raffinose&#44; stachyose&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Legumes&#47;beans &#40;chickpeas&#44; beans and peas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Disaccharides</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lactose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Milk and dairy products&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The enzyme lactase is necessary for hydrolysis of lactose in the small intestine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Increase inflow of water in the bowel due to the osmotic effect of undigested lactose&#46; Increased gas in colon due to undigested lactose fermentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Monosaccharides</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fructose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mango&#44; figs&#46;Honey&#44; corn syrup&#44; marmalade&#47;jam and other syrups&#46;Sweeteners in dairy&#46;Sugary&#47;carbonated drinks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fructose malabsorption due to different causes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Increase inflow of water in the bowel due to the osmotic effect of fructose with or without malabsorption&#46; Increased gas in colon due to fermentation of unabsorbed substrates&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Polyols</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sorbitol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Stone fruit &#40;cherries&#44; plums&#44; peaches&#44; avocado&#41;&#44; apple&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Passive absorption throughout the small intestine based on molecular size&#44; intestinal pore size&#44; bowel transit time and the presence of GI disorders&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Increase inflow of water in the bowel due to the osmotic effect of fructose with or without malabsorption&#46; Increased gas in colon due to fermentation of unabsorbed substrates&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Manitol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mushrooms&#44; cauliflower&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lactitol&#44; xylitol&#44; erythritol&#44; maltitol&#44; isomalt&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8220;sugar-free&#8221; products with sweeteners finished in -<span class="elsevierStyleItalic">ol</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3598406.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The table only provides examples of the main sources of different FODMAPs&#46; The list is not exhaustive and is insufficient to implement the FODMAP elimination phase&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">FODMAPs and their effects on the gastrointestinal tract&#46;</p>"
        ]
      ]
      4 => array:9 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Source&#58; adapted from Broekaert et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Huysentruyt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and IBS Research&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>"
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Alimentos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Not allowed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Allowed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vegetables and roots&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Garlic&#44; onion&#44; artichoke&#44; asparagus&#44; leek&#44; celery&#44; green pepper&#44; okra&#44; aubergine&#44; common tomato&#44; baby spinach&#44; heart of lettuce&#44; endive&#44; chicory leaves&#44; common cabbage&#44; beets &#40;root&#41;&#44; button mushrooms &#40;<span class="elsevierStyleItalic">champi&#241;&#243;n</span>&#41;&#44; other mushrooms &#40;except oyster mushroom&#41;&#44; spring onions &#40;green part&#41;&#44; peanut squash&#44; sweet potato &#40;in large amounts&#41;&#44; Brussels sprouts&#44; broccoli&#44; bok choy&#44; cauliflower&#44; bean sprouts &#40;in large quantities&#41;&#44; sweet corn &#40;in large quantities&#41;&#44; fennel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pumpkin&#44; courgette &#40;65&#8239;g&#41;&#44; carrot&#44; cherry tomato&#44; turnip&#44; unpeeled cucumber and pickled gherkins&#44; red pepper&#44; chard&#44; spinach&#44; borage&#44; collards&#44; thistle&#44; arugula&#44; kale&#44; chicory&#44; lettuce in general &#40;preferably choose the tender leafy type and avoid the &#8220;white&#8221; core&#41;&#44; endives&#44; chives&#44; radish&#44; alfalfa&#44; corn &#40;in small amounts&#41;&#44; ginger&#44; bambooPotato&#44; sweet potato &#40;in small amounts&#41;&#44; cassava &#40;in small amounts&#41;&#44; yams &#40;in small amounts&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fruits&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mango&#44; cherries&#44; nectarine&#44; peach&#44; plum&#44; avocado&#44; pear&#44; apricot&#44; persimmon&#44; lychee&#44; melon&#44; watermelon&#44; apple&#44; grapefruit&#44; raisins&#44; prunes&#44; canned fruit in juice&#44; natural fruit juice &#40;of not allowed fruits&#41;&#44; fruit concentrates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Banana &#40;unripe&#41;&#44; orange&#44; tangerine&#44; kiwi&#44; star fruit&#44; lemon&#47;lime&#44; papaya&#44; pineapple&#44; raspberry&#44; strawberries&#44; passion fruit&#44; loquat&#44; cantaloupe melon&#44; grapes &#40;5&#8722;6&#41;&#44; custard apple&#44; quince&#44; dragon fruit&#44; guava&#44; coconut<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&#44; blueberries<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&#44; pomegranate<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&#46; Lemon juice &#40;lemonade&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cereals and derivates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wheat&#44; whole wheat&#44; semolina&#44; couscous&#44; barley&#44; rye&#44; &#40;bread&#44; flour and pasta based on these cereals&#41;&#46; Oats<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&#44; spelt flour<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&#44; brown rice&#44; millet&#44; amaranth&#44; muesli&#44; breakfast cereals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rice&#44; corn&#44; quinoa&#44; buckwheat&#44; breakfast cereals&#44; bread and pasta based on these cereals&#46; Gluten-free products&#44; buckwheat flour&#44; cornstarch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Legumes&#47;beans&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">White&#44; pinto and black beans&#59; fava beans&#44; <span class="elsevierStyleItalic">frijoles</span>&#44; lentils&#44; chickpeas&#44; peas&#44; soybeans &#40;and derived products&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bean sprouts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nuts and seeds&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pistachios&#44; hazelnuts&#44; chestnuts&#44; cashews&#44; dates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peanuts and peanut butter&#44; walnuts &#40;small amounts&#41;&#44; almonds &#40;small amounts&#41;&#44; pine nuts &#40;1 tablespoon&#41;&#44; pumpkin and sunflower seeds&#44; chia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Milk and dairy products&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fresh milk &#40;cow&#39;s&#44; goat&#39;s and sheep&#39;s&#41; and derivate dairy products&#44; powdered milk&#44; condensed milk&#44; yoghurt&#44; kefir&#44; curd&#44; butter and margarine&#44; semi-cured and fresh cheeses&#44; cream cheese&#44; cream&#44; ice cream&#44; custards and cream fillings&#44; desserts based on milk or cream&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lactose-free milk&#44; lactose-free yogurt&#44; lactose-free cheese&#44; aged cheese &#40;small amounts&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Meat and meat products&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cold cuts&#44; processed meat products &#40;check labelling&#41;&#44; processed hamburgers &#40;of any kind&#41;&#44; sausages &#40;of all kinds&#41;&#44; cured meats&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">This food group does not naturally contain FODMAPs&#59; however&#44; it is important to read the labels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fish&#44; shellfish&#44; mollusks&#44; other seafood and derivates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fish substitutes &#40;check additives&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">This food group does not naturally contain FODMAPs&#59; however&#44; it is important to read the labels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Other beverages&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Commercial fruit juices&#44; alcoholic beverages&#44; soft drinks&#44; chamomile&#44; infusions containing FODMAP-rich fruits&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Plant-based drinks made of almond&#44; rice&#44; hazelnut&#44; quinoa&#44; macadamia&#44; oats and coconut &#40;all in small amounts&#41;&#44; horchata&#44; canned coconut milk &#40;in small amounts&#41;&#44; coconut-based nondairy yogurt&#44; tea &#40;based on tolerance&#41;&#44; coffee &#40;based on tolerance&#41;&#44; chocolate powder &#40;mixed with water&#41;&#44; kombucha &#40;180&#8239;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Garlic and onion powder&#44; and all the spices that contain them&#46; Keep in mind that many processed foods contain onions &#40;herb salt&#44; powdered vegetables&#44; dried vegetables&#44; broths&#44; meat sauces&#44; soups&#44; marinades&#44; and other sauces&#41;&#44; even if it is not stated on the label&#46; Pastries &#40;milk chocolate&#44; white chocolate&#44; biscuits and sugary cereals&#44; whole-grain biscuits&#44; ice cream&#44; cakes&#41; and candies&#46;Fibre supplements&#58; inulin&#44; FOS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">All spices except garlic and onion powder&#44; popcorn&#44; dark chocolate&#44; pure cocoa powder&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Artificial sweeteners<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Isomaltose E953&#46;Any ending in -<span class="elsevierStyleItalic">ol</span>&#58; lactitol E966&#44; maltitol E965&#44; mannitol E421&#44; sorbitol E420i&#44; sorbitol syrup &#40;E-420ii&#41;&#44; xylitol E967&#44; erythritol E968&#46;Corn or fructose syrup&#44; agave&#44; honey&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acesulfame K E950&#44; aspartame E951&#44; cyclamate E952&#44; steviol glycosides E960&#44; neohesperidin DC E959&#44; neotame E961&#44; saccharine E954&#44; aspartame-acesulfame salt E962&#44; thaumatin E957&#44; sucralose E955&#46;Moderate consumption&#58; white sugar &#40;sucrose&#41;&#44; brown sugar&#44; dextrose &#40;glucose&#41;&#44; maple syrup&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3598407.png"
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          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Moderate consumption&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Tolerance of these cereals varies between individuals&#59; personal tolerance must be assessed&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Check the labelling&#46; Avoid <span class="elsevierStyleItalic">light</span> or &#34;sugar-free&#34; products and commercial sauces such as ketchup&#44; barbecue sauce&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Lists of foods that are not recommended &#40;&#8220;not allowed&#8221;&#41; and recommended &#40;&#8220;allowed&#8221;&#41; in the low-FODMAP diet&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Nutrients and compounds&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Nutritional deficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fermentable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">O</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oligosaccharides&#58; fructans&#44; FOS &#40;oligofructose&#41; and GOS &#40;raffinose&#44; stachyose&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reduced consumption of vegetables leads to a decreased intake of&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0005" class="elsevierStylePara elsevierViewall">Fibre and natural antioxidants&#44; such as flavonoids&#44; carotenoids&#44; and vitamin C&#44; or phenolic acid &#40;eg&#44; wheat&#41; and anthocyanins</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0010" class="elsevierStylePara elsevierViewall">Carbohydrates &#40;eg&#44; wheat products&#41;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0015" class="elsevierStylePara elsevierViewall">Iron &#40;eg&#44; due to reduced consumption of legumes&#41;</p></li></ul>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disaccharides &#40;lactose&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excluding dairy may result in vitamin D and calcium deficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Monosaccharides &#40;fructose-free or with glucose excess&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excluding fruits can lead to a reduction in natural antioxidants&#44; such as flavonoids or vitamin C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">And&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polyols &#40;sorbitol&#44; xylitol&#44; maltitol&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excluding vegetables and fruits can result in a reduction in natural antioxidants&#44; such as flavonoids&#44; carotenoids&#44; and vitamin C&#44; or phenolic acid and anthocyanins&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3598408.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Possible nutrient deficits associated with the low-FODMAP diet&#46;</p>"
        ]
      ]
      6 => array:9 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Source&#58; adapted from Grez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> to fit the dietary patterns of the Spanish population&#46;"
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0035"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">FODMAP<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Recommended food choices<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 1<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 2<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day 3<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rest &#40;low-FODMAP diet&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lactose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MilkYoghurt &#40;without sweetener or other FODMAP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;2 glass1 single-serve container&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 glass1&#46;5 single-serve containers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 glass and a half2 single-serve containers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 consecutive days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fructose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MangoHoney&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#189; mango1 Tbsp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intermediate amount1&#44;5 Tbsp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 mango2 Tbsp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 consecutive days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polyols&#58; sorbitol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BlackberriesAvocado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 berries&#189; avocado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 berriesIntermediate amount&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 berries1 avocado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 consecutive days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polyols&#58; mannitol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CauliflowerButton mushrooms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#189; cup&#189; cup&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intermediate amountIntermediate amount&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 cup1 cup&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 consecutive days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fructose&#8239;&#43;&#8239;sorbitol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ApplePear&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#189;apple&#189; pear&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intermediate amountIntermediate amount&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 apple1 pear&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 consecutive days&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 slice&#189; cup&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;5 slices1 cup&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 slices1 &#189; cup&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 consecutive days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FOS &#40;onion&#47;garlic&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Onion &#40;raw&#41;Garlic &#40;raw&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#189; cup&#189; clove&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intermediate amountIntermediate amount&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#189; onion1 clove&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 consecutive days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Galactans&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chickpeas &#40;cooked&#41;Almonds&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Intermediate amountIntermediate amount&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 cup10 almonds&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 consecutive days&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Measurement of short-chain carbohydrates in common Australian vegetables and fruits by High-Performance Liquid Chromatography &#40;HPLC&#41;"
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                            2 => "O&#46; Rosella"
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                            4 => "J&#46;S&#46; Barrett"
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                        "volumen" => "57"
                        "paginaInicial" => "554"
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                      "titulo" => "Consumo de fructosa y sus implicaciones para la salud"
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                            0 => "M&#46;L&#46; L&#243;pez Ponce"
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                            2 => "A&#46; Aguirre Robles"
                            3 => "M&#46;A&#46; G&#243;mez Cardoso"
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Medicina e Investigaci&#243;n Universidad Aut&#243;noma del Estado de M&#233;xico"
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                      "titulo" => "Fructan and free fructose content of common Australian vegetables and fruit"
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Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2024.06.005

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