Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, UK; Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, UK.
Aliment Pharmacol Ther. 2015 Feb;41(3):262-75. doi: 10.1111/apt.13041. Epub 2014 Dec 3.
Food intolerance is non-immunological and is often associated with gastrointestinal symptoms.
To focus on food intolerance associated with gastrointestinal symptoms and critically appraise the literature in relation to aetiology, diagnosis, mechanisms and clinical evidence.
A search using the terms and variants of food intolerance, lactose, FODMAP, gluten, food chemicals within Pubmed, Embase and Scopus was carried out and restricted to human studies published in English. Additionally, references from relevant papers were hand searched for other appropriate studies.
Food intolerance affects 15-20% of the population and may be due to pharmacological effects of food components, noncoeliac gluten sensitivity or enzyme and transport defects. There have been significant advances in understanding the scientific basis of gastrointestinal food intolerance due to short-chain fermentable carbohydrates (FODMAPs). The most helpful diagnostic test for food intolerance is food exclusion to achieve symptom improvement followed by gradual food reintroduction. A low FODMAP diet is effective, however, it affects the gastrointestinal microbiota and FODMAP reintroduction to tolerance is part of the management strategy.
There is increasing evidence for using a low FODMAP diet in the management of functional gastrointestinal symptoms where food intolerance is suspected. Exclusion diets should be used for as short a time as possible to induce symptom improvement, and should be followed by gradual food reintroduction to establish individual tolerance. This will increase dietary variety, ensure nutritional adequacy and minimise impact on the gastrointestinal microbiota.
食物不耐受是非免疫性的，常与胃肠道症状有关。
专注于与胃肠道症状相关的食物不耐受，并批判性地评价与病因、诊断、机制和临床证据相关的文献。
使用食物不耐受、乳糖、FODMAP、麸质和食物化学物质等术语及其变体，在 Pubmed、Embase 和 Scopus 中进行检索，并限制在英语发表的人类研究中。此外，还从相关论文的参考文献中手动搜索其他合适的研究。
食物不耐受影响 15-20%的人群，可能是由于食物成分的药理作用、非麸质敏感性肠病或酶和转运缺陷所致。由于短链可发酵碳水化合物（FODMAPs），人们对胃肠道食物不耐受的科学基础有了重大的理解进展。诊断食物不耐受最有用的测试是通过禁食以改善症状，然后逐渐重新引入食物。低 FODMAP 饮食有效，然而，它会影响胃肠道微生物群，并且 FODMAP 再耐受是管理策略的一部分。
在怀疑功能性胃肠道症状与食物不耐受有关时，越来越多的证据支持使用低 FODMAP 饮食进行管理。应尽可能缩短禁食时间以诱导症状改善，然后逐渐重新引入食物以建立个体耐受。这将增加饮食多样性，确保营养充足，并最大程度地减少对胃肠道微生物群的影响。
