Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
Department of Nutritional Sciences, King's College London, Stamford Street, London, UK.
Proc Nutr Soc. 2024 Feb;83(1):17-27. doi: 10.1017/S0029665123003579. Epub 2023 Jul 7.
A diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) improves functional bowel symptoms and is a second-line dietary management strategy for the treatment of irritable bowel syndrome (IBS). The diet is complex and involves three stages: restriction, reintroduction and personalisation and clinical effectiveness is achieved with dietitian-led education; however, this is not always available. The aim of this review is to provide an update on the evidence for using the low FODMAP diet, with a focus on the impact of FODMAP restriction and reintroduction considering long-term management of IBS in a clinical setting. Randomised controlled trials have assessed symptom response, quality of life, dietary intake and changes to the gut microbiota during FODMAP restriction. Systematic reviews and meta-analyses consistently report that FODMAP restriction has a better symptom response compared with control diets and a network analysis reports the low FODMAP diet is superior to other dietary treatments for IBS. Research focused on FODMAP reintroduction and personalisation is limited and of lower quality, however common dietary triggers include wheat, onion, garlic, pulses and milk. Dietitian-led delivery of the low FODMAP diet is not always available and alternative education delivery methods, e.g. webinars, apps and leaflets, are available but remove the personalised approach and may be less acceptable to patients and may introduce safety concerns in terms of nutritional adequacy. Predicting response to the low FODMAP diet using symptom severity or a biomarker is of great interest. More evidence on less restrictive approaches and non-dietitian-led education delivery methods are needed.
低可发酵寡糖、双糖、单糖和多元醇(FODMAP)饮食可改善肠功能症状,是治疗肠易激综合征(IBS)的二线饮食管理策略。该饮食方案复杂,分为限制、再引入和个性化三个阶段,通过营养师主导的教育实现临床疗效;但并非始终可行。本综述旨在提供低 FODMAP 饮食的最新证据,重点关注 FODMAP 限制和再引入对 IBS 临床长期管理的影响。随机对照试验评估了 FODMAP 限制期间症状反应、生活质量、饮食摄入和肠道微生物群的变化。系统评价和荟萃分析一致报告,与对照饮食相比,FODMAP 限制具有更好的症状反应,网络分析报告低 FODMAP 饮食优于其他 IBS 饮食治疗方法。关注 FODMAP 再引入和个性化的研究有限且质量较低,但常见的饮食触发因素包括小麦、洋葱、大蒜、豆类和牛奶。营养师主导的低 FODMAP 饮食并非始终可行,其他教育提供方法,如网络研讨会、应用程序和传单,虽然可用,但会去除个性化方法,可能不太受患者欢迎,并可能在营养充足方面引起安全问题。使用症状严重程度或生物标志物预测对低 FODMAP 饮食的反应非常重要。需要更多关于限制较少的方法和非营养师主导的教育提供方法的证据。
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