Hill Peta, Muir Jane G, Gibson Peter R
Ms Hill is a research dietitian, Dr Muir is head of Translational Nutrition Science, and Dr Gibson is a professor in the Department of Gastroenterology at Monash University and Alfred Hospital in Melbourne, Victoria, Australia.
Gastroenterol Hepatol (N Y). 2017 Jan;13(1):36-45.
The low-fermentable oligo-, di-, and monosaccharide and polyol (FODMAP) diet is a 2-phased intervention, with strict reduction of all slowly absorbed or indigestible short-chain carbohydrates (ie, FODMAPs) followed by reintroduction of specific FODMAPs according to tolerance. The efficacy of the elimination phase of the FODMAP diet is well established, but the success of maintaining this diet has been shown in only a few observational studies. How the efficacy of the low-FODMAP diet compares with that of other therapies has received limited attention, but recent studies have shown this diet to be comparable or superior to diets that address eating style and choice of food as well as to gut hypnotherapy. There has been no comparison between the low-FODMAP diet and the gluten-free diet, which moderately reduces FODMAP intake. Mechanistically, dietary FODMAPs have very limited effects on the consistency of bowel actions but seem to suppress the release of histamine. Neither symptom pattern nor breath hydrogen testing for fructose or polyol malabsorption is a useful predictor of efficacy, but analysis of gut microbiota has potential. As a restrictive diet, the low-FODMAP diet carries risks of nutritional inadequacy and of fostering disordered eating, which has received little attention. Strict FODMAP restriction induces a potentially unfavorable gut microbiota, although the impact of this consequence upon health is unknown. This observation puts additional impetus on the reintroduction of FODMAPs according to tolerance during the maintenance phase of the diet. Studies of the low-FODMAP diet in children are few but do suggest benefit. However, such a strategy should be implemented with care due to the psychological and nutritional risks of a restrictive diet. Clinical wisdom is required in utilizing the low-FODMAP diet.
低可发酵寡糖、双糖、单糖和多元醇（FODMAP）饮食是一种分两阶段的干预措施，首先严格减少所有吸收缓慢或难以消化的短链碳水化合物（即FODMAPs），然后根据耐受性重新引入特定的FODMAPs。FODMAP饮食消除阶段的疗效已得到充分证实，但只有少数观察性研究表明维持这种饮食的成功率。低FODMAP饮食与其他疗法的疗效比较受到的关注有限，但最近的研究表明，这种饮食与解决饮食方式和食物选择的饮食以及肠道催眠疗法相当或更优。低FODMAP饮食与适度减少FODMAP摄入量的无麸质饮食之间尚未进行比较。从机制上讲，饮食中的FODMAPs对排便的稠度影响非常有限，但似乎会抑制组胺的释放。症状模式或果糖或多元醇吸收不良的呼气氢测试都不是疗效的有用预测指标，但肠道微生物群分析具有潜力。作为一种限制性饮食，低FODMAP饮食存在营养不足和导致饮食紊乱的风险，而这一点很少受到关注。严格限制FODMAP会诱导潜在不利的肠道微生物群，尽管这种结果对健康的影响尚不清楚。这一观察结果为在饮食维持阶段根据耐受性重新引入FODMAPs提供了额外的动力。关于低FODMAP饮食在儿童中的研究很少，但确实表明有好处。然而，由于限制性饮食存在心理和营养风险，应谨慎实施这种策略。在使用低FODMAP饮食时需要临床智慧。
