Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Belgium.
Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Nutrition. 2020 May;73:110719. doi: 10.1016/j.nut.2020.110719. Epub 2020 Jan 7.
Dietary interventions in irritable bowel syndrome (IBS) include a traditional IBS diet following the guidelines from the National Institute for Health and Clinical Excellence and a diet low in fermentable oligo-, di-, monosaccharides and polyols (FODMAPs). The aim of this study was to evaluate the adherence to these diets, food groups difficult to replace, and dietary determinants of symptom improvement.
Sixty-six patients with IBS were randomized to a 4-wk low FODMAP or traditional IBS diet. Participants completed 4-d diet diaries before and during the intervention and reported symptoms on the IBS severity scoring system. We described adherence to the diets on the food group and product level and investigated the association between adherence and symptom improvement.
Adherence to the low FODMAP diet was good and consistent: All participants had a comparable shift in the diet's principal components compatible with the guidelines. Most high FODMAP products were well replaced with low FODMAP equivalents. However, total energy intake fell by 25%, mainly owing to a 69% decreased intake of snacks (P < 0.001). The traditional IBS diet did not shift the diet's principal components, and despite the guidelines, consumption of coffee and alcoholic beverages remained rather high (>50% of baseline). Total energy intake fell by 11% (P = 0.15). For both diets, there was a trend toward an association between adherence and symptom improvement (P < 0.10).
In both the low FODMAP and traditional IBS diet, certain food groups were difficult to replace. Because adherence may predict symptom improvement, close dietary guidance might enhance the efficacy of both diets.
肠易激综合征（IBS）的饮食干预包括遵循国家卫生与临床优化研究所指南的传统 IBS 饮食和低可发酵寡糖、二糖、单糖和多元醇（FODMAPs）饮食。本研究旨在评估对这些饮食的依从性、难以替代的食物组以及改善症状的饮食决定因素。
66 例 IBS 患者随机分为 4 周低 FODMAP 或传统 IBS 饮食组。参与者在干预前后完成了 4 天的饮食日记，并使用 IBS 严重程度评分系统报告了症状。我们在食物组和产品水平上描述了对饮食的依从性，并调查了依从性与症状改善之间的关系。
低 FODMAP 饮食的依从性良好且一致：所有参与者的饮食主要成分都发生了类似的变化，符合指南要求。大多数高 FODMAP 产品都被低 FODMAP 等效物很好地替代。然而，总能量摄入量下降了 25%，主要是由于零食摄入量减少了 69%（P < 0.001）。传统 IBS 饮食没有改变饮食的主要成分，尽管有指南，但咖啡和酒精饮料的消耗量仍然相当高（> 50%的基线）。总能量摄入量下降了 11%（P = 0.15）。对于两种饮食，依从性与症状改善之间存在趋势关联（P < 0.10）。
在低 FODMAP 和传统 IBS 饮食中，某些食物组都难以替代。由于依从性可能预测症状改善，因此密切的饮食指导可能会增强这两种饮食的疗效。
