{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T05:28:47Z","timestamp":1782624527151,"version":"3.54.5"},"reference-count":45,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2023,11,4]],"date-time":"2023-11-04T00:00:00Z","timestamp":1699056000000},"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":["DDG n. 700\/2020"],"award-info":[{"award-number":["DDG n. 700\/2020"]}]},{"name":"Italian Ministry of Health RC 2020\u20132021, Prog. N\u00b0 16","award":["2020012064"],"award-info":[{"award-number":["2020012064"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Overweight and obesity have been suggested as significant factors in irritable bowel syndrome (IBS) development. However, the relationship between overweight\/obesity and IBS is unclear. It is known that a modified intestinal barrier, especially the permeability of the small intestine (s-IP), can play a significant role in the pathogenesis of both obesity and IBS. Moreover, dietary interventions are essential for treating both pathologies. We evaluated the gastrointestinal (GI) symptoms and the urinary and circulating markers of GI barrier function and integrity, the markers of intestinal dysbiosis and bacterial translocation, in 40 IBS patients with predominant diarrhea (IBS-D) (32 females and 8 males; mean age = 43.5 \u00b1 1.4 years), categorized using their Body Mass Index levels as normal (NW) and overweight (OW). Evaluations were performed before and after 12 weeks of a Low FODMAP Diet (LFD). At the baseline, OW patients showed a significantly higher s-IP than NW. After an LFD, a significant improvement of s-IP in OW patients occurred, along with a significant decrease in markers of epithelial integrity and bacterial translocation. Our findings highlight the close relationship between overweight and the intestinal barrier and support their involvement in IBS-D pathophysiology. Furthermore, the positive role of an LFD in managing overweight IBS-D was highlighted.<\/jats:p>","DOI":"10.3390\/nu15214683","type":"journal-article","created":{"date-parts":[[2023,11,4]],"date-time":"2023-11-04T14:51:01Z","timestamp":1699109461000},"page":"4683","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["The Role of Intestinal Barrier Function in Overweight Patients with IBS with Diarrhea Undergoing a Long-Term Low Fermentable Oligo-, Di-, and Monosaccharide and Polyol Diet"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7350-2544","authenticated-orcid":false,"given":"Michele","family":"Linsalata","sequence":"first","affiliation":[{"name":"Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS \u201cS. de Bellis\u201d, 70013 Metropolitan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Riezzo","sequence":"additional","affiliation":[{"name":"Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS \u201cS. de Bellis\u201d, 70013 Metropolitan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"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 \u201cS. de Bellis\u201d, 70013 Metropolitan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5416-3521","authenticated-orcid":false,"given":"Benedetta","family":"D\u2019Attoma","sequence":"additional","affiliation":[{"name":"Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS \u201cS. de Bellis\u201d, 70013 Metropolitan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Prospero","sequence":"additional","affiliation":[{"name":"Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS \u201cS. de Bellis\u201d, 70013 Metropolitan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Ignazzi","sequence":"additional","affiliation":[{"name":"Functional Gastrointestinal Disorders Research Group, National Institute of Gastroenterology IRCCS \u201cS. de Bellis\u201d, 70013 Metropolitan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7038-3287","authenticated-orcid":false,"given":"Giuseppe","family":"Losurdo","sequence":"additional","affiliation":[{"name":"Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2026-1200","authenticated-orcid":false,"given":"Alfredo","family":"Di Leo","sequence":"additional","affiliation":[{"name":"Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5140-8060","authenticated-orcid":false,"given":"Gianluigi","family":"Giannelli","sequence":"additional","affiliation":[{"name":"Scientific Direction, National Institute of Gastroenterology IRCCS \u201cS. de Bellis\u201d, 70013 Metropolitan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"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 \u201cS. de Bellis\u201d, 70013 Metropolitan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1001\/jama.2020.22532","article-title":"Diagnosis and Treatment of Irritable Bowel Syndrome: A Review","volume":"325","author":"Camilleri","year":"2021","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1111\/jgh.16083","article-title":"The interaction between obesity and visceral hypersensitivity","volume":"38","author":"Yanping","year":"2023","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_3","first-page":"411","article-title":"Obesity and irritable bowel syndrome: A comprehensive review","volume":"10","year":"2014","journal-title":"Gastroenterol Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1007\/s42000-019-00113-9","article-title":"Irritable bowel syndrome: A new therapeutic target when treating obesity?","volume":"18","author":"Pugliese","year":"2019","journal-title":"Hormones"},{"key":"ref_5","first-page":"205","article-title":"Obesity and irritable bowel syndrome: Coincidence or association?","volume":"27","author":"Rusu","year":"2018","journal-title":"J. Gastrointest. Liver Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1046\/j.1365-2036.2002.01254.x","article-title":"Extra-intestinal manifestations associated with irritable bowel syndrome: A twin study","volume":"16","author":"Svedberg","year":"2002","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Aasbrenn, M., H\u00f8gest\u00f8l, I., Eribe, I., Kristinsson, J., Lydersen, S., Mala, T., and Farup, P.G. (2017). Prevalence and predictors of irritable bowel syndrome in patients with morbid obesity: A cross-sectional study. BMC Obes., 4.","DOI":"10.1186\/s40608-017-0159-z"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Sherwin, L.B., Ozoji, O.M., Boulineaux, C.M., Joseph, P.V., Fourie, N.H., Abey, S.K., Zhang, X., and Henderson, W.A. (2017). Gender and Weight Influence Quality of Life in Irritable Bowel Syndrome. J. Clin. Med., 6.","DOI":"10.3390\/jcm6110103"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e13549","DOI":"10.1111\/nmo.13549","article-title":"General and abdominal obesity in relation to the prevalence of irritable bowel syndrome","volume":"31","author":"Akhondi","year":"2019","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_10","first-page":"G11","article-title":"Biomarkers for assessment of intestinal permeability in clinical practice","volume":"321","author":"Seethaler","year":"2021","journal-title":"Am. J. Physiol. Liver Physiol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Farr\u00e9, R., Fiorani, M., Abdu Rahiman, S., and Matteoli, G. (2020). Intestinal Permeability, Inflammation and the Role of Nutrients. Nutrients, 12.","DOI":"10.3390\/nu12041185"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1111\/apt.12080","article-title":"Review article: Associations between immune activation, intestinal permeability and the irritable bowel syndrome","volume":"36","author":"Matricon","year":"2012","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1756284821993586","DOI":"10.1177\/1756284821993586","article-title":"Intestinal barrier dysfunction in irritable bowel syndrome: A systematic review","volume":"14","author":"Hanning","year":"2021","journal-title":"Ther. Adv. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2886268","DOI":"10.1155\/2020\/2886268","article-title":"Noninvasive Biomarkers of Gut Barrier Function in Patients Suffering from Diarrhea Predominant-IBS: An Update","volume":"2020","author":"Linsalata","year":"2020","journal-title":"Dis. Markers"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s12276-018-0126-x","article-title":"Mechanisms regulating intestinal barrier integrity and its pathological implications","volume":"50","author":"Chelakkot","year":"2018","journal-title":"Exp. Mol. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"127","DOI":"10.3945\/ajcn.116.131110","article-title":"Gut permeability is related to body weight, fatty liver disease, and insulin resistance in obese individuals undergoing weight reduction","volume":"105","author":"Louis","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1097\/MEG.0b013e32832ffd9b","article-title":"The relationship between symptoms, body mass index, gastrointestinal transit and stool frequency in patients with irritable bowel syndrome","volume":"22","author":"Sadik","year":"2010","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1136\/gutjnl-2019-318427","article-title":"Leaky gut: Mechanisms, measurement and clinical implications in humans","volume":"68","author":"Camilleri","year":"2019","journal-title":"Gut"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1152\/physrev.00003.2008","article-title":"Zonulin and Its Regulation of Intestinal Barrier Function: The Biological Door to Inflammation, Autoimmunity, and Cancer","volume":"91","author":"Fasano","year":"2011","journal-title":"Physiol. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1016\/j.ajem.2015.01.047","article-title":"Association of plasma diamine oxidase and intestinal fatty acid\u2013binding protein with severity of disease in patient with heat stroke","volume":"33","author":"Zhang","year":"2015","journal-title":"Am. J. Emerg. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"718710","DOI":"10.3389\/fnut.2022.718710","article-title":"The Influence of Nutrition on Intestinal Permeability and the Microbiome in Health and Disease","volume":"9","author":"Inczefi","year":"2022","journal-title":"Front. Nutr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3732753","DOI":"10.1155\/2018\/3732753","article-title":"A Conservative Weight Loss Intervention Relieves Bowel Symptoms in Morbidly Obese Subjects with Irritable Bowel Syndrome: A Prospective Cohort Study","volume":"2018","author":"Aasbrenn","year":"2018","journal-title":"J. Obes."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Linsalata, M., Riezzo, G., Orlando, A., D\u2019attoma, B., Prospero, L., Tutino, V., Notarnicola, M., and Russo, F. (2021). The Relationship between Low Serum Vitamin D Levels and Altered Intestinal Barrier Function in Patients with IBS Diarrhoea Undergoing a Long-Term Low-FODMAP Diet: Novel Observations from a Clinical Trial. Nutrients, 13.","DOI":"10.3390\/nu13031011"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1007\/BF01535722","article-title":"GSRS\u2013A Clinical Rating Scale for Gastrointestinal Symptoms in Patients with Irritable Bowel Syndrome and Peptic Ulcer Disease","volume":"33","author":"Svedlund","year":"1988","journal-title":"Dig. Dis. Sci."},{"key":"ref_25","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_26","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1038\/ajg.2009.188","article-title":"Between Celiac Disease and Irritable Bowel Syndrome: The \u201cNo Man\u2019s Land\u201d of Gluten Sensitivity","volume":"104","author":"Verdu","year":"2009","journal-title":"Am. J. Gastroenterol."},{"key":"ref_27","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_28","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_29","first-page":"305","article-title":"The Bristol scale\u2014A useful system to assess stool form?","volume":"101","year":"2009","journal-title":"Rev. Esp. Enferm. Dig."},{"key":"ref_30","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_31","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_32","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_33","unstructured":"Monash University (2019, September 04). The Monash University Low FODMAP App. Available online: https:\/\/www.monashfodmap.com\/ibscentral\/i-have-ibs\/get-the-app\/."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1053\/gast.1996.v110.pm8613043","article-title":"Intestinal permeability changes in response to acetylsalicylic acid in relatives of patients with Crohn\u2019s disease","volume":"110","author":"Hilsden","year":"1996","journal-title":"Gastroenterology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2145","DOI":"10.1007\/s00394-018-1785-z","article-title":"An open-label, randomized, placebo-controlled study on the effectiveness of a novel probiotics administration protocol (ProbiotiCKD) in patients with mild renal insufficiency (stage 3a of CKD)","volume":"58","author":"Simeoni","year":"2018","journal-title":"Eur. J. Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Emerenziani, S., Guarino, M.P.L., Asensio, L.M.T., Altomare, A., Ribolsi, M., Balestrieri, P., and Cicala, M. (2019). Role of Overweight and Obesity in Gastrointestinal Disease. Nutrients, 12.","DOI":"10.3390\/nu12010111"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Mansueto, P., Soresi, M., La Blasca, F., Fayer, F., D\u2019alcamo, A., and Carroccio, A. (2019). Body Mass Index and Associated Clinical Variables in Patients with Non-Celiac Wheat Sensitivity. Nutrients, 11.","DOI":"10.3390\/nu11061220"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"827","DOI":"10.2174\/0929867327666200721160313","article-title":"Relationship between Gut Microbiota, Gut Hyperpermeability and Obesity","volume":"28","author":"Gasmi","year":"2021","journal-title":"Curr. Med. Chem."},{"key":"ref_39","first-page":"G1","article-title":"Enhanced gastrointestinal passive paracellular permeability contributes to the obesity-associated hyperoxaluria","volume":"316","author":"Bashir","year":"2019","journal-title":"Am. J. Physiol. Liver Physiol."},{"key":"ref_40","first-page":"25","article-title":"Part 2: Treatments for Chronic Gastrointestinal Disease and Gut Dysbiosis","volume":"14","author":"Bull","year":"2015","journal-title":"Integr. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1018212","DOI":"10.3389\/fnut.2022.1018212","article-title":"Gut microbiota and obesity: New insights","volume":"9","author":"Quintero","year":"2022","journal-title":"Front. Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e1901275","DOI":"10.1002\/mnfr.201901275","article-title":"Effect of Gluten Ingestion and FODMAP Restriction on Intestinal Epithelial Integrity in Patients with Irritable Bowel Syndrome and Self-Reported Non-Coeliac Gluten Sensitivity","volume":"65","author":"Ajamian","year":"2020","journal-title":"Mol. Nutr. Food Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"4632","DOI":"10.3748\/wjg.v23.i25.4632","article-title":"Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs","volume":"23","author":"Harvie","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Tahapary, D.L., Fatya, A.I., Kurniawan, F., Marcella, C., Rinaldi, I., Tarigan, T.J.E., Harbuwono, D.S., Yunir, E., Soewondo, P., and Purnamasari, D. (2023). Increased intestinal-fatty acid binding protein in obesity-associated type 2 diabetes mellitus. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0279915"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Altomare, A., Di Rosa, C., Imperia, E., Emerenziani, S., Cicala, M., and Guarino, M.P.L. (2021). Diarrhea Predominant-Irritable Bowel Syndrome (IBS-D): Effects of Different Nutritional Patterns on Intestinal Dysbiosis and Symptoms. Nutrients, 13.","DOI":"10.3390\/nu13051506"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/21\/4683\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:17:43Z","timestamp":1760131063000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/21\/4683"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,4]]},"references-count":45,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["nu15214683"],"URL":"https:\/\/doi.org\/10.3390\/nu15214683","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,4]]}}}