Whelan Kevin, Staudacher Heidi
Department of Nutritional Sciences, King's College London, London, UK.
Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, Geelong, Victoria, Australia.
Curr Opin Clin Nutr Metab Care. 2022 Sep 1;25(5):341-347. doi: 10.1097/MCO.0000000000000854. Epub 2022 Jul 16.
PURPOSE OF REVIEW: The low fermentable oligosaccharides, disaccharides, monosaccharides and polyol (FODMAP) diet is widely used in the dietary management of irritable bowel syndrome (IBS). The aim of this review is to summarize recent evidence regarding the use of the low FODMAP diet in IBS and other gastrointestinal disorders from recent clinical trials and meta-analyses. RECENT FINDINGS: Several recent systematic reviews and meta-analyses support the use of low FODMAP restriction for global symptoms in IBS in the short term. Uncontrolled follow-up studies show that at least 50% of individuals experience symptom relief following restriction, reintroduction and personalization in the long term. Although evidence from comparative trials in IBS suggests potential benefit of less burdensome approaches (e.g. standard IBS diet and low lactose diet) many studies are insufficiently powered. One established mechanism is colonic gas production that may induce pain signalling measurable in the brain, however altered gastrointestinal epithelial integrity and shifts in microbiome composition and function may also be involved. SUMMARY: Quality trials of the low FODMAP diet are emerging and have been transformational in supporting the widespread application to IBS management in some areas (e.g. short-term effectiveness), whereas other areas still require considerable improvements in research evidence (e.g. long-term effectiveness, mechanisms and educational delivery).
综述目的:低可发酵寡糖、双糖、单糖和多元醇(FODMAP)饮食广泛用于肠易激综合征(IBS)的饮食管理。本综述旨在总结近期临床试验和荟萃分析中关于低FODMAP饮食用于IBS及其他胃肠道疾病的证据。 近期发现:近期多项系统评价和荟萃分析支持短期内对IBS整体症状采用低FODMAP限制饮食。非对照随访研究表明,从长期来看,至少50%的患者在进行限制、重新引入和个性化饮食后症状得到缓解。尽管IBS比较试验的证据表明,采用负担较小的方法(如标准IBS饮食和低乳糖饮食)可能有益,但许多研究的样本量不足。一种已确定的机制是结肠气体产生,这可能会诱发大脑中可测量的疼痛信号,不过胃肠道上皮完整性的改变以及微生物群组成和功能的变化也可能与之有关。 总结:低FODMAP饮食的高质量试验正在涌现,并且在支持其在某些领域(如短期有效性)广泛应用于IBS管理方面具有变革性,而其他领域仍需要在研究证据方面有相当大的改进(如长期有效性、机制和教育传播)。
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