Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, UK.
Community Dietetics Service, Somerset Partnership NHS Foundation Trust, Bridgwater, Somerset, UK.
Neurogastroenterol Motil. 2018 Jan;30(1). doi: 10.1111/nmo.13154. Epub 2017 Jul 14.
The low-FODMAP diet is a frequently used treatment for irritable bowel syndrome (IBS). Most research has focused on short-term FODMAP restriction; however, guidelines recommend that high-FODMAP foods are reintroduced to individual tolerance. This study aimed to assess the long-term effectiveness of the low-FODMAP diet following FODMAP reintroduction in IBS patients.
Patients with IBS were prospectively recruited to a questionnaire study following completion of dietitian-led low-FODMAP education. At baseline and following FODMAP restriction (short term) only, gastrointestinal symptoms were measured as part of routine clinical care. Following FODMAP reintroduction, (long term), symptoms, dietary intake, acceptability, food-related quality of life (QOL), and healthcare utilization were assessed. Data were reported for patients who continued long-term FODMAP restriction (adapted FODMAP) and/or returned to a habitual diet (habitual).
Of 103 patients, satisfactory relief of symptoms was reported in 12% at baseline, 61% at short-term follow-up, and 57% at long-term follow-up. At long-term follow-up, 84 (82%) patients continued an 'adapted FODMAP' diet (total FODMAP intake mean 20.6, SD 14.9 g/d) compared with 19 (18%) of patients following a 'habitual' diet (29.4, SD 22.9 g/d, P=.039). Nutritional adequacy was not compromised for either group. The 'adapted FODMAP' group reported the diet cost significantly more than the 'habitual' group (P<.001) and affected social eating (P<.01) but there was no effect on food-related QOL. Healthcare utilization was similar between both groups.
Low-FODMAP education is effective for long-term IBS management, enables a nutritionally adequate diet, and is broadly acceptable to patients.
低 FODMAP 饮食是治疗肠易激综合征（IBS）的常用方法。大多数研究都集中在短期 FODMAP 限制上；然而，指南建议将高 FODMAP 食物重新引入个体耐受。本研究旨在评估 IBS 患者在 FODMAP 再引入后低 FODMAP 饮食的长期效果。
完成营养师主导的低 FODMAP 教育后，前瞻性招募 IBS 患者进行问卷调查研究。在基线和仅 FODMAP 限制（短期）时，作为常规临床护理的一部分测量胃肠道症状。在 FODMAP 再引入后（长期），评估症状、饮食摄入、可接受性、与食物相关的生活质量（QOL）和医疗保健利用情况。报告了继续长期 FODMAP 限制（适应性 FODMAP）和/或恢复习惯性饮食（习惯性）的患者的数据。
在 103 名患者中，12%的患者在基线时报告症状得到满意缓解，61%的患者在短期随访时报告症状得到满意缓解，57%的患者在长期随访时报告症状得到满意缓解。在长期随访时，84 名（82%）患者继续接受“适应性 FODMAP”饮食（总 FODMAP 摄入量平均为 20.6，SD 为 14.9 g/d），而 19 名（18%）患者遵循“习惯性”饮食（29.4，SD 22.9 g/d，P=.039）。两组的营养充足性均未受到影响。“适应性 FODMAP”组报告该饮食的成本明显高于“习惯性”组（P<.001），并且影响社交饮食（P<.01），但对与食物相关的 QOL 没有影响。两组的医疗保健利用情况相似。
低 FODMAP 教育对长期 IBS 管理有效，可实现营养充足的饮食，并且被患者广泛接受。
