Cuffe Melanie S, Staudacher Heidi M, Aziz Imran, Adame Enrique Coss, Krieger-Grubel Claudia, Madrid Ana Maria, Ohlsson Bodil, Black Christopher J, Ford Alexander C
Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
Monash University, Department of Medicine, School of Translational Medicine, Melbourne, VIC, Australia.
Lancet Gastroenterol Hepatol. 2025 Jun;10(6):520-536. doi: 10.1016/S2468-1253(25)00054-8. Epub 2025 Apr 18.
Patients with irritable bowel syndrome (IBS) are often interested in dietary interventions as a means of managing their symptoms. However, the relative efficacy of available diets for the management of IBS is unclear. We aimed to examine the relative efficacy of various dietary interventions in IBS.
For this systematic review and network meta-analysis we searched MEDLINE, EMBASE, EMBASE Classic, and the Cochrane Central Register of Controlled Trials from database inception to Feb 7, 2025, to identify randomised controlled trials comparing an active dietary intervention requiring changes to the intake of more than one food in IBS with either a control intervention, such as a habitual diet, sham diet, a high fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet, or alternative miscellaneous dietary advice, or any other active dietary intervention requiring changes to the intake of more than one food. We assessed efficacy using dichotomous assessments of improvement in global IBS symptoms or improvement in individual IBS symptoms, including abdominal pain, abdominal bloating or distension, and bowel habit. We pooled data using a random-effects model, with the efficacy of each intervention reported as pooled relative risks (RRs) with 95% CIs. We ranked interventions according to their P-score, which measures the mean extent of certainty that one intervention is better than another, averaged over all competing interventions.
We identified 28 eligible randomised controlled trials (comprising 2338 patients) of 11 different dietary interventions compared with four control interventions, of which six (low FODMAP diet, British Dietetic Association/National Institute for Health and Care Excellence [BDA/NICE] diet, lactose-reduced diet, starch-reduced and sucrose-reduced diet, a personalised diet, and a Mediterranean diet) were studied in more than one trial. For global IBS symptoms, assessed in 28 randomised controlled trials and when considering only the dietary interventions studied in more than one trial, a starch-reduced and sucrose-reduced diet ranked first (RR of global IBS symptoms not improving 0·41 [95% CI 0·26-0·67]; P-score 0·84; two trials), a low FODMAP diet ranked fourth (0·51 [0·37-0·70]; P-score 0·71; 24 trials), and a BDA/NICE diet ranked tenth (0·62 [0·43-0·90]; P-score 0·44; eight trials), versus a habitual diet. For abdominal pain, assessed in 26 trials and when considering only the dietary interventions studied in more than one randomised controlled trial, a starch-reduced and sucrose-reduced diet ranked second (RR of abdominal pain not improving 0·54 [95% CI 0·33-0·90]; P-score 0·73; two trials), and a low FODMAP diet ranked fifth (0·61 [0·42-0·89]; P-score 0·64; 23 trials), versus a habitual diet. For abdominal bloating or distension, assessed in 26 trials and when considering only the dietary interventions studied in more than one randomised trial, only a low FODMAP diet (RR of abdominal bloating or distension not improving 0·55 [95% CI 0·37-0·80]; P-score 0·64; 23 trials) was superior to a habitual diet and ranked fourth. For bowel habit, assessed in 23 randomised trials, none of the dietary interventions was superior to any of the control interventions, but a low FODMAP diet was superior to a BDA/NICE diet (RR of bowel habit not improving 0·79 [95% CI 0·63-0·99]). All comparisons across the network were rated as low or very low confidence, except for direct comparisons between a low FODMAP diet or a starch-reduced and sucrose-reduced diet and habitual diet, both of which were rated as moderate confidence.
In terms of dietary interventions for IBS, the most evidence exists for a low FODMAP diet, but other promising therapies are emerging and should be the subject of further study.
None.
肠易激综合征（IBS）患者常常对饮食干预作为管理其症状的一种方式感兴趣。然而，现有饮食对IBS管理的相对疗效尚不清楚。我们旨在研究各种饮食干预在IBS中的相对疗效。
对于这项系统评价和网状Meta分析，我们检索了MEDLINE、EMBASE、EMBASE经典库以及Cochrane对照试验中心注册库，检索时间从数据库建立至2025年2月7日，以识别将IBS中需要改变多种食物摄入量的积极饮食干预与对照干预（如习惯饮食、假饮食、低可发酵寡糖、双糖、单糖和多元醇[FODMAP]饮食）、替代性杂项饮食建议或任何其他需要改变多种食物摄入量的积极饮食干预进行比较的随机对照试验。我们使用二分法评估整体IBS症状的改善或个体IBS症状（包括腹痛、腹胀或腹部膨胀以及排便习惯）的改善来评估疗效。我们使用随机效应模型汇总数据，每种干预的疗效报告为汇总相对风险（RR）及95%置信区间（CI）。我们根据P值对干预进行排序，P值衡量一种干预优于另一种干预的平均确定程度，是在所有竞争干预中进行平均。
我们识别出28项符合条件的随机对照试验（包括2338例患者），涉及11种不同的饮食干预与4种对照干预的比较，其中6种（低FODMAP饮食、英国饮食协会/国家卫生与保健优化研究所[BDA/NICE]饮食、低乳糖饮食、低淀粉和低蔗糖饮食、个性化饮食以及地中海饮食）在不止一项试验中被研究。对于整体IBS症状，在28项随机对照试验中进行评估，并且仅考虑在不止一项试验中研究的饮食干预时，低淀粉和低蔗糖饮食排名第一（整体IBS症状未改善的RR为0.41[95%CI 0.26 - 0.67]；P值为0.84；两项试验），低FODMAP饮食排名第四（0.51[0.37 - 0.70]；P值为0.71；24项试验），BDA/NICE饮食排名第十（0.62[0.43 - 0.90]；P值为0.44；八项试验），与习惯饮食相比。对于腹痛，在26项试验中进行评估，并且仅考虑在不止一项随机对照试验中研究的饮食干预时，低淀粉和低蔗糖饮食排名第二（腹痛未改善的RR为0.54[95%CI 0.33 - 0.90]；P值为0.73；两项试验），低FODMAP饮食排名第五（0.61[0.42 - 0.89]；P值为0.64；23项试验），与习惯饮食相比。对于腹胀或腹部膨胀，在26项试验中进行评估，并且仅考虑在不止一项随机试验中研究的饮食干预时，只有低FODMAP饮食（腹胀或腹部膨胀未改善的RR为0.55[95%CI 0.37 - 0.80]；P值为0.64；23项试验）优于习惯饮食且排名第四。对于排便习惯，在23项随机试验中进行评估，没有一种饮食干预优于任何对照干预，但低FODMAP饮食优于BDA/NICE饮食（排便习惯未改善的RR为0.79[95%CI 0.63 - 0.99]）。除了低FODMAP饮食或低淀粉和低蔗糖饮食与习惯饮食之间的直接比较被评为中等置信度外，网络中的所有比较均被评为低或非常低的置信度。
就IBS的饮食干预而言，低FODMAP饮食的证据最多，但其他有前景的疗法正在出现，应成为进一步研究的主题。
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