Almirall Miriam, Musté Marta, Serrat Mayte, Touriño Rafael, Espartal Esther, Marsal Sara
Rheumatology Department, University Hospital Vall d'Hebron, 08035 Barcelona, Spain.
Biomedicines. 2024 Mar 12;12(3):629. doi: 10.3390/biomedicines12030629.
Around 20-30% of Fibromyalgia patients modify their dietary habits after diagnosis, including avoiding certain food groups such as cereals. In this systematic review, we used the PRISMA guidelines to select the main studies that have evaluated the effectiveness of restrictive diets, including elimination and vegetarian diets, in patients with Fibromyalgia. Data on vegetarian/vegan diets are more consistent than data on elimination diets due to higher quality and better results of the published studies. Although the results are favorable in most of the studies, their heterogenicity and the scarce and low quality of the evidence (small number of patients included, often non-randomized and uncontrolled studies and multiple confounding factors and biases) does not allow for a positive recommendation about these restrictive diets in Fibromyalgia patients. Several factors other than food restriction could influence the symptomatic and functional improvements observed after restrictive diets, such as the placebo effect, weight loss that often occurs, coexistence with gastrointestinal diseases and positive effects of unrestricted foods. We must advance more and improve in our knowledge of the effectiveness of restrictive diets and variables related to them before recommending them systematically to all patients with Fibromyalgia. Randomized, placebo-controlled trials with large sample sizes, longer follow-up periods and standardized outcome measures that explore predictors of dietary response are needed to better understand the relationship between Fibromyalgia and nutrition.
约20%-30%的纤维肌痛患者在确诊后会改变饮食习惯，包括避免食用某些食物类别，如谷物。在本系统评价中，我们使用PRISMA指南筛选了评估限制性饮食（包括排除饮食和素食）对纤维肌痛患者有效性的主要研究。由于已发表研究的质量更高、结果更好，关于素食/纯素饮食的数据比关于排除饮食的数据更一致。尽管大多数研究结果是有利的，但由于证据的异质性以及证据稀缺且质量低（纳入患者数量少、通常为非随机和无对照研究以及存在多种混杂因素和偏倚），因此无法对纤维肌痛患者的这些限制性饮食给出肯定推荐。除食物限制外，还有几个因素可能会影响限制性饮食后观察到的症状和功能改善，如安慰剂效应、常出现的体重减轻、与胃肠道疾病共存以及非限制食物的积极作用。在向所有纤维肌痛患者系统推荐这些限制性饮食之前，我们必须进一步深入了解其有效性以及与之相关的变量。需要开展大样本量、更长随访期且采用标准化结局指标的随机、安慰剂对照试验，以探索饮食反应的预测因素，从而更好地理解纤维肌痛与营养之间的关系。
