{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T15:00:38Z","timestamp":1778252438720,"version":"3.51.4"},"reference-count":53,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T00:00:00Z","timestamp":1678406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health RC 2020\u20132021, Prog. N\u00b0 16","award":["700\/2020"],"award-info":[{"award-number":["700\/2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Most female patients with irritable bowel syndrome (IBS) complain of abdominal bloating rather than abdominal pain and diarrhea. The higher incidence in women could be due to the so-called dysfunctional gas handling. Since diet seems the most effective and durable strategy for managing IBS symptoms, we aimed to evaluate the effects of a 12 week diet based on a relatively new cereal, Tritordeum (TBD), on gastrointestinal (GI) symptoms, anthropometric and bioelectrical impedance parameters, and psychological profiles in 18 diarrhea-predominant IBS (IBS-D) female patients with abdominal bloating as the dominant symptom. The IBS Severity Scoring System (IBS-SSS), the Symptom Checklist-90 Revised, the Italian version of the 36-Item Short-Form Health Survey, and the IBS-Quality of Life questionnaire were administered. The TBD reduces the IBS-SSS \u201cIntensity of abdominal bloating\u201d with a concomitant improvement in the anthropometric profile. No correlation was found between \u201cIntensity of abdominal bloating\u201d and \u201cAbdominal circumference\u201d. Anxiety, depression, somatization, interpersonal sensitivity, and phobic and avoidance manifestations were significantly reduced after TBD. Lastly, anxiety was correlated with \u201cIntensity of abdominal bloating\u201d. Overall, these results suggest the possibility of lowering abdominal bloating and improving the psychological profile of female IBS-D patients using a diet based on an alternative grain such as Tritordeum.<\/jats:p>","DOI":"10.3390\/nu15061361","type":"journal-article","created":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T02:31:55Z","timestamp":1678674715000},"page":"1361","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["A Tritordeum-Based Diet for Female Patients with Diarrhea-Predominant Irritable Bowel Syndrome: Effects on Abdominal Bloating and Psychological Symptoms"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1800-4830","authenticated-orcid":false,"given":"Giuseppe","family":"Riezzo","sequence":"first","affiliation":[{"name":"Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS \u201cSaverio de Bellis\u201d, 70013 Castellana Grotte, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Prospero","sequence":"additional","affiliation":[{"name":"Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS \u201cSaverio de Bellis\u201d, 70013 Castellana Grotte, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8255-4776","authenticated-orcid":false,"given":"Antonella","family":"Orlando","sequence":"additional","affiliation":[{"name":"Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS \u201cSaverio de Bellis\u201d, 70013 Castellana Grotte, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7350-2544","authenticated-orcid":false,"given":"Michele","family":"Linsalata","sequence":"additional","affiliation":[{"name":"Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS \u201cSaverio de Bellis\u201d, 70013 Castellana Grotte, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedetta","family":"D\u2019Attoma","sequence":"additional","affiliation":[{"name":"Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS \u201cSaverio de Bellis\u201d, 70013 Castellana Grotte, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonia","family":"Ignazzi","sequence":"additional","affiliation":[{"name":"Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS \u201cSaverio de Bellis\u201d, 70013 Castellana Grotte, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianluigi","family":"Giannelli","sequence":"additional","affiliation":[{"name":"Scientific Direction, National Institute of Gastroenterology IRCCS \u201cSaverio de Bellis\u201d, 70013 Castellana Grotte, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0538-6072","authenticated-orcid":false,"given":"Francesco","family":"Russo","sequence":"additional","affiliation":[{"name":"Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS \u201cSaverio de Bellis\u201d, 70013 Castellana Grotte, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1016\/S2468-1253(20)30217-X","article-title":"Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: A systematic review and meta-analysis","volume":"5","author":"Oka","year":"2020","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"544","DOI":"10.5056\/jnm18082","article-title":"Sex-Gender Differences in Irritable Bowel Syndrome","volume":"24","author":"Kim","year":"2018","journal-title":"J. Neurogastroenterol. Motil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"6759","DOI":"10.3748\/wjg.v20.i22.6759","article-title":"Irritable bowel syndrome: Pathogenesis, diagnosis, treatment, and evidence-based medicine","volume":"20","author":"Saha","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.gtc.2021.04.002","article-title":"Latest Insights on the Pathogenesis of Irritable Bowel Syndrome","volume":"50","author":"Videlock","year":"2021","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s12955-017-0611-2","article-title":"Health-related quality of life, work productivity, and indirect costs among patients with irritable bowel syndrome with diarrhea","volume":"15","author":"Buono","year":"2017","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.cgh.2020.03.056","article-title":"Management of Chronic Abdominal Distension and Bloating","volume":"19","author":"Lacy","year":"2021","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1007\/s12325-019-00924-7","article-title":"Bloating and Abdominal Distension: Clinical Approach and Management","volume":"36","author":"Mari","year":"2019","journal-title":"Adv. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1111\/j.1365-2982.2005.00666.x","article-title":"Towards a better understanding of abdominal bloating and distension in functional gastrointestinal disorders","volume":"17","author":"Houghton","year":"2005","journal-title":"Neurogastroenterol. Motil. Off. J. Eur. Gastrointest. Motil. Soc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1038\/ajg.2017.129","article-title":"Bloating and Abdominal Distension: Old Misconceptions and Current Knowledge","volume":"112","author":"Malagelada","year":"2017","journal-title":"Am. J. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.jcmgh.2018.05.009","article-title":"Communication Between Enteric Neurons, Glia, and Nociceptors Underlies the Effects of Tachykinins on Neuroinflammation","volume":"6","author":"Delvalle","year":"2018","journal-title":"Cell. Mol. Gastroenterol. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1111\/jgh.13698","article-title":"FODMAPs: Food composition, defining cutoff values and international application","volume":"32","author":"Varney","year":"2017","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3771","DOI":"10.3748\/wjg.v23.i21.3771","article-title":"Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients!","volume":"23","author":"Loghin","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Orlando, A., Tutino, V., Notarnicola, M., Riezzo, G., Linsalata, M., Clemente, C., Prospero, L., Martulli, M., D\u2019Attoma, B., and De Nunzio, V. (2020). Improved Symptom Profiles and Minimal Inflammation in IBS-D Patients Undergoing a Long-Term Low-FODMAP Diet: A Lipidomic Perspective. Nutrients, 12.","DOI":"10.3390\/nu12061652"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Avila, C.M., Rodriguez-Suarez, C., and Atienza, S.G. (2021). Tritordeum: Creating a New Crop Species-The Successful Use of Plant Genetic Resources. Plants, 10.","DOI":"10.3390\/plants10051029"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"797192","DOI":"10.3389\/fnut.2022.797192","article-title":"Managing Symptom Profile of IBS-D Patients with Tritordeum-Based Foods: Results From a Pilot Study","volume":"9","author":"Russo","year":"2022","journal-title":"Front. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Russo, F., Riezzo, G., Orlando, A., Linsalata, M., D\u2019Attoma, B., Prospero, L., Ignazzi, A., and Giannelli, G. (2022). A Comparison of the Low-FODMAPs Diet and a Tritordeum-Based Diet on the Gastrointestinal Symptom Profile of Patients Suffering from Irritable Bowel Syndrome-Diarrhea Variant (IBS-D): A Randomized Controlled Trial. Nutrients, 14.","DOI":"10.3390\/nu14081544"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"151","DOI":"10.5056\/jnm16214","article-title":"What Is New in Rome IV","volume":"23","author":"Schmulson","year":"2017","journal-title":"J. Neurogastroenterol. Motil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/1477-7525-6-12","article-title":"Reliability and validity of the Gastrointestinal Symptom Rating Scale (GSRS) and Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire in dyspepsia: A six-country study","volume":"6","author":"Kulich","year":"2008","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1111\/apt.13746","article-title":"Validity and reliability of the Bristol Stool Form Scale in healthy adults and patients with diarrhoea-predominant irritable bowel syndrome","volume":"44","author":"Blake","year":"2016","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1046\/j.1365-2036.1997.142318000.x","article-title":"The irritable bowel severity scoring system: A simple method of monitoring irritable bowel syndrome and its progress","volume":"11","author":"Francis","year":"1997","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"10895","DOI":"10.3390\/s140610895","article-title":"The theory and fundamentals of bioimpedance analysis in clinical status monitoring and diagnosis of diseases","volume":"14","author":"Khalil","year":"2014","journal-title":"Sensors"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1186\/1477-7525-11-208","article-title":"Evaluation of the Irritable Bowel Syndrome Quality of Life (IBS-QOL) questionnaire in diarrheal-predominant irritable bowel syndrome patients","volume":"11","author":"Andrae","year":"2013","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.dhjo.2016.04.008","article-title":"Measurement characteristics for two health-related quality of life measures in older adults: The SF-36 and the CDC Healthy Days items","volume":"9","author":"Barile","year":"2016","journal-title":"Disabil. Health J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"540134","DOI":"10.1155\/2013\/540134","article-title":"Scl-90-R symptom profiles and outcome of short-term psychodynamic group therapy","volume":"2013","author":"Jensen","year":"2013","journal-title":"ISRN Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/S0033-3182(71)71479-0","article-title":"A rating instrument for anxiety disorders","volume":"12","author":"Zung","year":"1971","journal-title":"Psychosomatics"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1001\/archpsyc.1965.01720310065008","article-title":"A Self-Rating Depression Scale","volume":"12","author":"Zung","year":"1965","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2449","DOI":"10.2147\/NDT.S86855","article-title":"Metric qualities of the cognitive behavioral assessment for outcome evaluation to estimate psychological treatment effects","volume":"11","author":"Bertolotti","year":"2015","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"4009","DOI":"10.3748\/wjg.v22.i15.4009","article-title":"Follow-up of patients with functional bowel symptoms treated with a low FODMAP diet","volume":"22","author":"Maagaard","year":"2016","journal-title":"World J. Gastroenterol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2201","DOI":"10.1002\/jsfa.8705","article-title":"Tritordeum: A novel cereal for food processing with good acceptability and significant reduction in gluten immunogenic peptides in comparison with wheat","volume":"98","author":"Vaquero","year":"2018","journal-title":"J. Sci. Food Agric."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1023\/A:1005554103531","article-title":"Abdominal pain, bloating, and diarrhea in the United States: Prevalence and impact","volume":"45","author":"Sandler","year":"2000","journal-title":"Dig. Dis. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1136\/gut.2007.142810","article-title":"Prevalence and risk factors for abdominal bloating and visible distention: A population-based study","volume":"57","author":"Jiang","year":"2008","journal-title":"Gut"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1136\/gut.42.5.690","article-title":"Identification of distinct upper and lower gastrointestinal symptom groupings in an urban population","volume":"42","author":"Talley","year":"1998","journal-title":"Gut"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1080\/00365520310004209","article-title":"An irritable bowel syndrome-specific symptom questionnaire: Development and validation","volume":"38","author":"Wiklund","year":"2003","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1080\/003655299750025093","article-title":"Division of the irritable bowel syndrome into subgroups on the basis of daily recorded symptoms in two outpatients samples","volume":"34","author":"Ragnarsson","year":"1999","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"14407","DOI":"10.3748\/wjg.v20.i39.14407","article-title":"Bloating and functional gastro-intestinal disorders: Where are we and where are we going?","volume":"20","author":"Iovino","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1007\/s10620-018-5352-5","article-title":"Bloating in Irritable Bowel Syndrome Is Associated with Symptoms Severity, Psychological Factors, and Comorbidities","volume":"64","author":"Hod","year":"2019","journal-title":"Dig. Dis. Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"433","DOI":"10.5056\/jnm.2013.19.4.433","article-title":"Abdominal bloating: Pathophysiology and treatment","volume":"19","author":"Seo","year":"2013","journal-title":"J. Neurogastroenterol. Motil."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s12958-021-00719-y","article-title":"Characterization of polycystic ovary syndrome among Flo app users around the world","volume":"19","author":"Jain","year":"2021","journal-title":"Reprod. Biol. Endocrinol. RBE"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1007\/BF02285200","article-title":"Daily gastrointestinal symptoms in women with and without a diagnosis of IBS","volume":"40","author":"Heitkemper","year":"1995","journal-title":"Dig. Dis. Sci."},{"key":"ref_40","first-page":"89","article-title":"Sex difference in irritable bowel syndrome: Do gonadal hormones play a role?","volume":"17","author":"Mulak","year":"2010","journal-title":"Gastroenterol. Pol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.genm.2009.03.004","article-title":"Do fluctuations in ovarian hormones affect gastrointestinal symptoms in women with irritable bowel syndrome?","volume":"6","author":"Heitkemper","year":"2009","journal-title":"Gend. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e14339","DOI":"10.1111\/nmo.14339","article-title":"Mast cell mediation of visceral sensation and permeability in irritable bowel syndrome","volume":"34","author":"Hasler","year":"2022","journal-title":"Neurogastroenterol. Motil. Off. J. Eur. Gastrointest. Motil. Soc."},{"key":"ref_43","first-page":"976","article-title":"Gut microbiota dysbiosis in functional gastrointestinal disorders: Underpinning the symptoms and pathophysiology","volume":"5","author":"Wei","year":"2021","journal-title":"JGH Open Open Access J. Gastroenterol. Hepatol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Chlebicz-Wojcik, A., and Slizewska, K. (2021). Probiotics, Prebiotics, and Synbiotics in the Irritable Bowel Syndrome Treatment: A Review. Biomolecules, 11.","DOI":"10.3390\/biom11081154"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e21502","DOI":"10.1097\/MD.0000000000021502","article-title":"Probiotics, prebiotics, antibiotic, Chinese herbal medicine, and fecal microbiota transplantation in irritable bowel syndrome: Protocol for a systematic review and network meta-analysis","volume":"99","author":"He","year":"2020","journal-title":"Medicine"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1002\/nur.20237","article-title":"Psychological distress and GI symptoms are related to severity of bloating in women with irritable bowel syndrome","volume":"31","author":"Park","year":"2008","journal-title":"Res. Nurs. Health"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"3341","DOI":"10.1111\/j.1572-0241.2001.05336.x","article-title":"Sensation of bloating and visible abdominal distension in patients with irritable bowel syndrome","volume":"96","author":"Chang","year":"2001","journal-title":"Am. J. Gastroenterol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s13030-016-0070-8","article-title":"Abdominal bloating is the most bothersome symptom in irritable bowel syndrome with constipation (IBS-C): A large population-based Internet survey in Japan","volume":"10","author":"Kanazawa","year":"2016","journal-title":"BioPsychoSoc. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1053\/j.gastro.2015.11.010","article-title":"Depression and Somatization Are Associated With Increased Postprandial Symptoms in Patients With Irritable Bowel Syndrome","volume":"150","author":"Tornblom","year":"2016","journal-title":"Gastroenterology"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1097\/00004850-200211000-00007","article-title":"Somatization as a predictor of medication discontinuation due to adverse events","volume":"17","author":"Agosti","year":"2002","journal-title":"Int. Clin. Psychopharmacol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1111\/j.1365-2036.2008.03918.x","article-title":"Amitriptyline modifies the visceral hypersensitivity response to acute stress in the irritable bowel syndrome","volume":"29","author":"Thoua","year":"2009","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2550","DOI":"10.1111\/j.1572-0241.2008.02066.x","article-title":"Contributions of pain sensitivity and colonic motility to IBS symptom severity and predominant bowel habits","volume":"103","author":"Kanazawa","year":"2008","journal-title":"Am. J. Gastroenterol."},{"key":"ref_53","first-page":"385","article-title":"Association between early adverse life events and irritable bowel syndrome","volume":"10","author":"Bradford","year":"2012","journal-title":"Clin. Gastroenterol. Hepatol. Off. Clin. Pract. J. Am. Gastroenterol. Assoc."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/6\/1361\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:52:15Z","timestamp":1760122335000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/6\/1361"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,10]]},"references-count":53,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["nu15061361"],"URL":"https:\/\/doi.org\/10.3390\/nu15061361","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,10]]}}}