J Acad Nutr Diet. 2021 Sep;121(9):1750-1762.e8. doi: 10.1016/j.jand.2021.01.007. Epub 2021 Mar 2.
Diet plays an important role in symptom management of irritable bowel syndrome (IBS). However, current diet therapies are not optimal nor successful for everyone.
To investigate whether subgroups based on IBS subtypes or severity identify different self-reported dietary triggers, and whether these are associated with severity and psychological factors.
Online cross-sectional survey PARTICIPANTS: Patients with IBS (n = 1601) who fulfilled the Rome IV criteria or had an IBS diagnosis.
Self-reported response to 44 preselected dietary triggers, IBS quality of life, and anxiety and depression. Subgroups were based on subtypes or severity.
Response to dietary triggers was analyzed using multiple correspondence analysis. Moreover, a food score was calculated to quantify the number and severity of responses to dietary triggers.
Response to greasy foods, onions, cabbage, and spicy and fried foods were mentioned most often (ranging between 55% and 65%). Response to dietary triggers differed between subtypes and severity groups, but absolute differences were small. Multiple correspondence analysis did not reveal clustering between dietary triggers, and ellipses for the subtypes overlapped. Some clustering was seen when ellipses were drawn for severity, which indicates that severity explained a fraction of the variation in response to dietary triggers, and subtypes did not. The food score was not significantly different between subtypes but was significantly higher with higher levels of severity (mild = 20.9 ± 17, moderate = 29.2 ± 19, severe = 37.9 ± 20, P < .001), having depressive (no = 31.4 ± 20, yes = 37.4 ± 20, P < .001) or anxious symptoms (no = 30.7 ± 20, yes = 35.2 ± 20, P < .001), and lower quality of life (lower quality of life = 38.5 ± 19, higher quality of life = 26.5 ± 19, P < .001).
Patients with different IBS subtypes or IBS severity do not identify different self-reported dietary triggers. Patients with more severe IBS and who experience anxiety or depression tend to have severe responses to more dietary triggers. IBS severity seems a better classifier than Rome IV criteria regarding diet. Dietary treatment needs to be individualized under guidance of a dietitian.
饮食在肠易激综合征（IBS）的症状管理中起着重要作用。然而，目前的饮食疗法并不适合所有人，也不是都有效。
研究根据 IBS 亚型或严重程度分组是否能识别出不同的自述饮食诱因，以及这些诱因是否与严重程度和心理因素有关。
在线横断面调查。
符合罗马 IV 标准或 IBS 诊断的 1601 名 IBS 患者。
对 44 种预先选定的饮食诱因的自述反应、IBS 生活质量以及焦虑和抑郁情况。根据亚型或严重程度进行分组。
使用多元对应分析来分析饮食诱因的反应。此外，还计算了食物评分来量化对饮食诱因的反应数量和严重程度。
对油腻食物、洋葱、白菜、辛辣和油炸食物的反应最为常见（介于 55%至 65%之间）。不同亚型和严重程度组之间对饮食诱因的反应存在差异，但绝对差异较小。多元对应分析并未显示饮食诱因之间的聚类，且亚型的椭圆相互重叠。当为严重程度绘制椭圆时，观察到一些聚类，这表明严重程度可以解释对饮食诱因反应的一部分变化，而亚型则不能。在亚型之间，食物评分没有显著差异，但随着严重程度的增加而显著升高（轻度为 20.9±17，中度为 29.2±19，重度为 37.9±20，P<0.001），存在抑郁（无=31.4±19，有=37.4±19，P<0.001）或焦虑症状（无=30.7±19，有=35.2±19，P<0.001），以及较低的生活质量（较低的生活质量=38.5±19，较高的生活质量=26.5±19，P<0.001）。
不同 IBS 亚型或 IBS 严重程度的患者不会识别出不同的自述饮食诱因。IBS 严重程度较高且伴有焦虑或抑郁的患者往往对更多的饮食诱因有严重反应。与罗马 IV 标准相比，IBS 严重程度似乎是更好的分类器。饮食治疗需要在营养师的指导下进行个体化。
