Department of Nutritional Sciences, King's College London, London, UK.
Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Neurogastroenterol Motil. 2023 Oct;35(10):e14640. doi: 10.1111/nmo.14640. Epub 2023 Jul 21.
A diet low in fermentable oligo-saccharides, di-saccharides, mono-saccharides and polyols (low FODMAP diet) is complex and clinical effectiveness is achieved with dietitian-led education, although dietitian availability in clinical practice varies. This study aimed to assess the feasibility of undertaking a trial to investigate the clinical and cost-effectiveness of different education delivery methods of the low FODMAP diet in patients with disorders of gut-brain interaction (DGBI).
In this feasibility randomized controlled trial, patients with DGBI requiring the low FODMAP diet were randomized to receive one of the following education delivery methods: booklet, app, or dietitian. Recruitment and retention rates, acceptability, symptoms, stool output, quality of life, and dietary intake were assessed.
Fifty-one patients were randomized with a recruitment rate of 2.4 patients/month and retention of 48 of 51 (94%). Nobody in the booklet group strongly agreed that this education delivery method enabled them to self-manage symptoms without further support, compared to 7 of 14 (50%) in the dietitian group (p = 0.013). More patients reported adequate relief of symptoms in the dietitian group (12, 80%) compared with the booklet group (7, 39%; p = 0.026), but not when compared to the app group (10, 63%, p > 0.05). There was a greater decrease in the IBS-SSS score in the dietitian group (mean -153, SD 90) compared with the booklet group (mean -90, SD 56; p = 0.043), but not when compared with the app group (mean -120, SD 62; p = 0.595).
CONCLUSIONS & INFERENCES: Booklets were the least acceptable education delivery methods. Dietitian-led consultations led to high levels of clinical effectiveness, followed by the app, while the dietitian was superior to booklets alone. However, an adequately powered clinical trial is needed to confirm clinical effectiveness of these education delivery methods.
低发酵寡糖、双糖、单糖和多元醇饮食（低 FODMAP 饮食）较为复杂，通过营养师主导的教育可实现临床疗效，但营养师在临床实践中的可及性存在差异。本研究旨在评估开展一项试验的可行性，以调查不同低 FODMAP 饮食教育方法在肠-脑互动障碍（DGBI）患者中的临床和成本效益。
在这项可行性随机对照试验中，需要低 FODMAP 饮食的 DGBI 患者被随机分配接受以下一种教育方法：手册、应用程序或营养师。评估招募和保留率、可接受性、症状、粪便排出量、生活质量和饮食摄入。
51 例患者被随机分组，每月招募率为 2.4 例，保留率为 51 例中的 48 例（94%）。与营养师组的 7 例（50%）相比，手册组没有患者强烈认为这种教育方法可以使他们无需进一步支持即可自我管理症状（p=0.013）。营养师组（12 例，80%）报告症状缓解充分的患者多于手册组（7 例，39%；p=0.026），但与应用程序组（10 例，63%）相比则没有差异（p>0.05）。营养师组的 IBS-SSS 评分下降幅度更大（平均-153，SD 90），而手册组（平均-90，SD 56；p=0.043）和应用程序组（平均-120，SD 62；p=0.595）则没有差异。
手册是最不受欢迎的教育方法。营养师主导的咨询可带来较高的临床疗效，其次是应用程序，而营养师优于单独使用手册。然而，需要一项充分有力的临床试验来证实这些教育方法的临床疗效。
