{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:02:11Z","timestamp":1790654531859,"version":"4.1.0"},"reference-count":41,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,6,2]],"date-time":"2022-06-02T00:00:00Z","timestamp":1654128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"ESPGHAN Research and Networking"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: The increased intake of FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyol) rich foods has been suggested as a possible trigger of functional gastrointestinal disorders (FGIDs). Despite the high FODMAP content, the Mediterranean diet (MD) appears to have beneficial effects on health. Our aim was to evaluate whether the prevalence of FGIDs in different Mediterranean countries may be influenced by FODMAP consumption and adherence to the MD. Methods: A school-based, cross-sectional, multicenter study was performed in six countries in the Mediterranean area: Croatia, Greece, Israel, Italy, Macedonia, and Serbia. Subjects 4-18 years were examined in relation to their eating habits and the presence of FGIDs, using Rome IV criteria, 3-day food diaries and Mediterranean Diet Quality Index in Children and Adolescents (KIDMED) questionnaires. Results: We enrolled 1972 subjects between 4 and 9 years old (Group A), and 2450 subjects between 10 and 18 years old (Group B). The overall prevalence of FGIDs was 16% in Group A and 26% in Group B. FODMAP intake was significantly different among countries for both age groups. In both groups, no significant association was found between FGIDs and FODMAPs. Adherence to the MD in all countries was intermediate, except for Serbia, where it was low. In both groups, we found a statistically significant association between FGIDs and the KIDMED score (Group A: OR = 0.83, p &lt; 0.001; Group B: OR = 0.93, p = 0.005). Moreover, a significant association was found between the KIDMED score and functional constipation (Group A: OR = 0.89, p = 0.008; Group B: OR = 0.93, p = 0.010) and postprandial distress syndrome (Group A: OR = 0.86, p = 0.027; Group B: OR = 0.88, p = 0.004). Conclusions: Our data suggest that the prevalence of FGIDs in the Mediterranean area is not related to FODMAP consumption, whereas adherence to the MD seems to have a protective effect.<\/jats:p>","DOI":"10.3390\/nu14112335","type":"journal-article","created":{"date-parts":[[2022,6,2]],"date-time":"2022-06-02T11:05:02Z","timestamp":1654167902000},"page":"2335","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Diet and Pediatric Functional Gastrointestinal Disorders in Mediterranean Countries"],"prefix":"10.3390","volume":"14","author":[{"given":"Caterina","family":"Strisciuglio","sequence":"first","affiliation":[{"name":"Department of Woman, Child and General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, 81100 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Cenni","sequence":"additional","affiliation":[{"name":"Department of Woman, Child and General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, 81100 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Rosaria","family":"Serra","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Science, Section of Pediatrics, University of Naples \u201cFederico II\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7588-6067","authenticated-orcid":false,"given":"Pasquale","family":"Dolce","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Naples \u201cFederico II\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2673-4590","authenticated-orcid":false,"given":"Sanja","family":"Kolacek","sequence":"additional","affiliation":[{"name":"Referral Center for Pediatric Gastroenterology and Nutrition, Children\u2019s Hospital University of Zagreb Medical School, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5998-5586","authenticated-orcid":false,"given":"Sara","family":"Sila","sequence":"additional","affiliation":[{"name":"Referral Center for Pediatric Gastroenterology and Nutrition, Children\u2019s Hospital University of Zagreb Medical School, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7357-4510","authenticated-orcid":false,"given":"Ivana","family":"Trivic","sequence":"additional","affiliation":[{"name":"Referral Center for Pediatric Gastroenterology and Nutrition, Children\u2019s Hospital University of Zagreb Medical School, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal Rozenfeld","family":"Bar Lev","sequence":"additional","affiliation":[{"name":"Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children\u2019s Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4287-3681","authenticated-orcid":false,"given":"Raanan","family":"Shamir","sequence":"additional","affiliation":[{"name":"Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children\u2019s Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aco","family":"Kostovski","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University Children Hospital, 1000 Skopje, North Macedonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Papadopoulou","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, \u201cAgia Sofia\u201d Children\u2019s Hospital, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleftheria","family":"Roma","sequence":"additional","affiliation":[{"name":"First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4474-328X","authenticated-orcid":false,"given":"Christina","family":"Katsagoni","sequence":"additional","affiliation":[{"name":"Department of Clinical Nutrition, \u201cAgia Sofia\u201d Children\u2019s Hospital, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danijela","family":"Jojkic-Pavkov","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Institute for Child and Youth Health Care of Vojvodina, Medical Faculty Novi Sad, 21000 Novi Sad, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3489-2524","authenticated-orcid":false,"given":"Angelo","family":"Campanozzi","sequence":"additional","affiliation":[{"name":"Pediatrics, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3145-6206","authenticated-orcid":false,"given":"Elena","family":"Scarpato","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Science, Section of Pediatrics, University of Naples \u201cFederico II\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erasmo","family":"Miele","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Science, Section of Pediatrics, University of Naples \u201cFederico II\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annamaria","family":"Staiano","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Science, Section of Pediatrics, University of Naples \u201cFederico II\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,2]]},"reference":[{"key":"ref_1","first-page":"193","article-title":"The pediatric Rome IV criteria: What\u2019s new?","volume":"11","author":"Koppen","year":"2017","journal-title":"Expert Rev. 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