Haghbin Hossein, Hasan Fariha, Gangwani Manesh Kumar, Zakirkhodjaev Nurruddinkhodja, Lee-Smith Wade, Beran Azizullah, Kamal Faisal, Hart Benjamin, Aziz Muhammad
Division of Gastroenterology and Hepatology, Bon Secours Mercy Health, Toledo, OH 43608, USA.
Department of Internal Medicine, Cooper University Hospital, Camden, NJ 08103, USA.
J Clin Med. 2024 Dec 11;13(24):7531. doi: 10.3390/jcm13247531.
Irritable bowel syndrome (IBS) is a common condition that alters the quality of life of patients. A variety of dietary interventions have been introduced to address this debilitating condition. The low-FODMAP diet (LFD), gluten-free diet (GFD), and Mediterranean diet are examples showing efficacy. The aim of this network meta-analysis was to compare these interventions to find the best approach. We performed a systematic review of the available literature through 14 March 2024 in the following databases: Embase, PubMed, MEDLINE OVID, Web of Science, CINAHL Plus, and Cochrane Central. We only included randomized controlled trials (RCTs). We used a random effects model and conducted a direct meta-analysis based on the DerSimonian-Laird approach and a network meta-analysis based on the frequentist approach. Mean differences (MDs) with 95% confidence interval (CI) were calculated. The primary outcomes included IBS quality of life (IBS QOL) and IBS symptom severity scale (IBS-SSS). We finalized 23 studies including 1689 IBS patients. In the direct meta-analysis, there was no statistically significant difference in any IBS score between GFD and either LFD or standard diet. Meanwhile, the LFD was statistically superior to the standard diet in the IBS-SSS (MD: -46.29, CI: -63.72--28.86, < 0.01) and IBS QOL (MD: 4.06, CI: 0.72-7.41, = 0.02). On ranking, the Mediterranean diet showed the greatest improvement in IBS-SSS, IBS-QOL, distension, dissatisfaction, and general life interference, followed by the LFD alone or in combination with the GFD. We demonstrated the efficacy of dietary interventions such as the LFD and Mediterranean diet in improving IBS. There is a need for large RCTs with head-to-head comparisons, particularly for the Mediterranean diet.
肠易激综合征（IBS）是一种常见病症，会影响患者的生活质量。人们已采用多种饮食干预措施来应对这种使人衰弱的病症。低发酵性寡糖、双糖、单糖和多元醇饮食（LFD）、无麸质饮食（GFD）以及地中海饮食都显示出了疗效。这项网状Meta分析的目的是比较这些干预措施，以找出最佳方法。我们通过检索截至2024年3月14日的以下数据库对现有文献进行了系统综述：Embase、PubMed、MEDLINE OVID、Web of Science、CINAHL Plus和Cochrane Central。我们仅纳入了随机对照试验（RCT）。我们使用随机效应模型，基于DerSimonian-Laird方法进行直接Meta分析，并基于频率学派方法进行网状Meta分析。计算了具有95%置信区间（CI）的平均差（MD）。主要结局包括IBS生活质量（IBS QOL）和IBS症状严重程度量表（IBS-SSS）。我们最终纳入了23项研究，涉及1689例IBS患者。在直接Meta分析中，GFD与LFD或标准饮食之间的任何IBS评分均无统计学显著差异。同时，在IBS-SSS（MD：-46.29，CI：-63.72--28.86，<0.01）和IBS QOL（MD：4.06，CI：0.72-7.41，=0.02）方面，LFD在统计学上优于标准饮食。在排名中，地中海饮食在IBS-SSS、IBS-QOL、腹胀、不满和总体生活干扰方面改善最大，其次是单独的LFD或LFD与GFD联合使用。我们证明了LFD和地中海饮食等饮食干预措施在改善IBS方面的疗效。需要进行更多直接对比的大型RCT，尤其是针对地中海饮食的研究。
