Sultan Nessmah, Varney Jane E, Halmos Emma P, Biesiekierski Jessica R, Yao Chu K, Muir Jane G, Gibson Peter R, Tuck Caroline J
Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, Australia.
Department of Gastroenterology, Monash University, Melbourne, Australia.
J Neurogastroenterol Motil. 2022 Jul 30;28(3):343-356. doi: 10.5056/jnm22035.
BACKGROUND/AIMS: The 3-phase fermentable oligo-, di-, mono-saccharides, and polyols (FODMAP) diet has shown a high level of efficacy in irritable bowel syndrome, largely based on dietitian delivered education. However, access to dietitians can be limited, and challenges exist when applying the diet to a wide range of cultures, such as limited FODMAP analysis of local foods. This review aims to discuss ways to optimally use the FODMAP diet in practice in a wide range of cultures, directed at gastroenterologists from a dietitian's perspective.
Recent literature was analysed via search databases including Medline, CINAHL, PubMed and Scopus.
The dietetic process involves detailed assessment and follow-up through the 3 stages of the FODMAP diet (restriction, re-introduction, and long-term maintenance). Emerging evidence suggests the diet can be delivered by other health professionals such as the gastroenterologist or nurse, but training on how to do so successfully would be needed. Self-guided approaches through use of technology or specialised food delivery services may be an alternative when dietitians are not available, but efficacy data is limited. Regardless of delivery mode, nutritional and psychological risks of the diet must be mitigated. Additionally, culturally appropriate education must be provided, with accommodations necessary when the FODMAP content of local foods are unknown.
While the diet has shown improved irritable bowel syndrome outcomes across studies, it is important to acknowledge the essential role of dietitians in implementing, tailoring, and managing the diet to achieve the best outcome for each individual.
背景/目的：三相可发酵低聚糖、二糖、单糖及多元醇（FODMAP）饮食已被证明对肠易激综合征有很高的疗效，这很大程度上基于营养师提供的指导。然而，获得营养师服务的机会可能有限，并且在将该饮食应用于广泛的文化背景时存在挑战，例如当地食物的FODMAP分析有限。本综述旨在从营养师的角度，探讨在广泛的文化背景下如何在实践中优化使用FODMAP饮食，面向胃肠病学家。
通过检索包括Medline、CINAHL、PubMed和Scopus在内的数据库对近期文献进行分析。
饮食过程包括通过FODMAP饮食的三个阶段（限制、重新引入和长期维持）进行详细评估和随访。新出现的证据表明，该饮食可由其他健康专业人员（如胃肠病学家或护士）提供，但需要关于如何成功提供的培训。当无法获得营养师服务时，通过使用技术或专业食品配送服务的自我指导方法可能是一种选择，但疗效数据有限。无论采用何种提供方式，都必须减轻该饮食的营养和心理风险。此外，必须提供适合文化背景的教育，当当地食物的FODMAP含量未知时，需要进行相应调整。
虽然在各项研究中该饮食已显示出改善肠易激综合征的效果，但必须认识到营养师在实施、调整和管理该饮食以实现每个个体最佳效果方面的重要作用。
