Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.
Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
Clin Gastroenterol Hepatol. 2022 Dec;20(12):2876-2887.e15. doi: 10.1016/j.cgh.2022.02.045. Epub 2022 Feb 28.
BACKGROUND & AIMS: Various diets are proposed as first-line therapies for non-constipated irritable bowel syndrome (IBS) despite insufficient or low-quality evidence. We performed a randomized trial comparing traditional dietary advice (TDA) against the low FODMAP diet (LFD) and gluten-free diet (GFD). METHODS: Patients with Rome IV-defined non-constipated IBS were randomized to TDA, LFD, or GFD (the latter allowing for minute gluten cross-contamination). The primary end point was clinical response after 4 weeks of dietary intervention, as defined by ≥50-point reduction in IBS symptom severity score (IBS-SSS). Secondary end points included (1) changes in individual IBS-SSS items within clinical responders, (2) acceptability and food-related quality of life with dietary therapy, (3) changes in nutritional intake, (4) alterations in stool dysbiosis index, and (5) baseline factors associated with clinical response. RESULTS: The primary end point of ≥50-point reduction in IBS-SSS was met by 42% (n = 14/33) undertaking TDA, 55% (n = 18/33) for LFD, and 58% (n = 19/33) for GFD (P = .43). Responders had similar improvements in IBS-SSS items regardless of their allocated diet. Individuals found TDA cheaper (P < .01), less time-consuming to shop (P < .01), and easier to follow when eating out (P = .03) than the GFD and LFD. TDA was also easier to incorporate into daily life than the LFD (P = .02). Overall reductions in micronutrient and macronutrient intake did not significantly differ across the diets. However, the LFD group had the greatest reduction in total FODMAP content (27.7 g/day before intervention to 7.6 g/day at week 4) compared with the GFD (27.4 g/day to 22.4 g/day) and TDA (24.9 g/day to 15.2 g/day) (P < .01). Alterations in stool dysbiosis index were similar across the diets, with 22%-29% showing reduced dysbiosis, 35%-39% no change, and 35%-40% increased dysbiosis (P = .99). Baseline clinical characteristics and stool dysbiosis index did not predict response to dietary therapy. CONCLUSIONS: TDA, LFD, and GFD are effective approaches in non-constipated IBS, but TDA is the most patient-friendly in terms of cost and convenience. We recommend TDA as the first-choice dietary therapy in non-constipated IBS, with LFD and GFD reserved according to specific patient preferences and specialist dietetic input. CLINICALTRIALS: gov: NCT04072991.
背景与目的：尽管证据不足或质量较低，仍有多种饮食被提议作为非便秘型肠易激综合征（IBS）的一线治疗方法。我们进行了一项随机试验，比较了传统饮食建议（TDA）与低 FODMAP 饮食（LFD）和无麸质饮食（GFD）。
方法：罗马 IV 标准定义的非便秘型 IBS 患者被随机分配至 TDA、LFD 或 GFD 组（后者允许微量的麸质交叉污染）。主要终点为饮食干预 4 周后的临床应答，定义为 IBS 严重程度评分（IBS-SSS）至少降低 50 分。次要终点包括：（1）临床应答者中 IBS-SSS 各单项的变化；（2）饮食治疗的可接受性和与食物相关的生活质量；（3）营养摄入的变化；（4）粪便菌群失调指数的改变；（5）与临床应答相关的基线因素。
结果：TDA、LFD 和 GFD 组分别有 42%（n=14/33）、55%（n=18/33）和 58%（n=19/33）的患者达到 IBS-SSS 降低≥50 分（P=.43）。无论分配到哪种饮食，应答者的 IBS-SSS 单项均有类似的改善。与 GFD 和 LFD 相比，TDA 组患者认为饮食更便宜（P<.01）、购物耗时更少（P<.01）、外出就餐时更容易遵循（P=.03）。TDA 也比 LFD 更容易融入日常生活（P=.02）。三种饮食的微量营养素和宏量营养素摄入总体减少无显著差异。然而，与 GFD（27.4 g/天降至 22.4 g/天）和 TDA（24.9 g/天降至 15.2 g/天）相比，LFD 组的总 FODMAP 含量降低最多（干预前 27.7 g/天降至 4 周时的 7.6 g/天）（P<.01）。粪便菌群失调指数的改变在三种饮食中相似，22%-29%的患者菌群失调减少，35%-39%的患者无变化，35%-40%的患者菌群失调增加（P=.99）。基线临床特征和粪便菌群失调指数均不能预测饮食治疗的应答。
结论：TDA、LFD 和 GFD 均为非便秘型 IBS 的有效治疗方法，但 TDA 在成本和便利性方面对患者最友好。我们建议将 TDA 作为非便秘型 IBS 的首选饮食治疗方法，根据特定患者的偏好和专科营养师的建议，保留 LFD 和 GFD。
临床试验：gov：NCT04072991。
Curr Opin Gastroenterol. 2023-5-1
J Gastrointestin Liver Dis. 2018-9
World J Gastroenterol. 2017-5-14
Transl Med UniSa. 2023-12-22
Nat Rev Gastroenterol Hepatol. 2025-4-25
J Neurogastroenterol Motil. 2025-4-30
Zotero 插件