Kasti Arezina N, Katsas Konstantinos, Pavlidis Dimitrios E, Stylianakis Emmanouil, Petsis Konstantinos I, Lambrinou Sophia, Nikolaki Maroulla D, Papanikolaou Ioannis S, Hatziagelaki Erifili, Papadimitriou Konstantinos, Kapolos John, Muir Jane G, Triantafyllou Konstantinos
Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece.
Department of Food Science and Technology, University of Peloponnese, 24100 Kalamata, Greece.
Nutrients. 2025 Apr 30;17(9):1545. doi: 10.3390/nu17091545.
Approximately 20% of patients with irritable bowel syndrome (IBS) link symptoms to food intake; a low-FODMAP diet is effective in managing these symptoms. To evaluate the effectiveness of the Mediterranean version of the low-FODMAP Diet (MED-LFD) compared to NICE guidelines for IBS and to assess changes in stool volatile compound levels. 108 patients with Rome IV IBS without constipation were randomized into the MED-LFD or NICE group. Primary endpoints included changes in symptom severity and responder rate (reduction of >50 IBS-SSS points) after intervention and at 6 months. Secondary endpoints assessed quality of life, symptom burden, adequate relief, anxiety/depression levels, and adherence. Volatile compound levels were measured using Gas Chromatography/Mass Spectrometry. At both time points, the MED-LFD group showed a significantly greater improvement in symptom severity (159 ± 80 vs. 253 ± 94 and 168 ± 117 vs. 245 ± 98), responder rates (84.6% vs. 60.8% and 79.1% vs. 52.3%), and adherence (75% vs. 41% and 45% vs. 7%). Similar results were observed for all secondary endpoints, with no serious adverse events reported. The MED-LFD intervention was the strongest independent predictor of being a responder at the first (OR = 6.66; 95%CI = 1.46, 30.4) and second follow-up (OR = 4.85; 95%CI = 1.31, 17.96). Short and branched-chain fatty acids were significantly reduced at both follow-ups. The MED-LFD is superior to NICE recommendations in managing non-constipated IBS symptoms and quality of life. It remains to be proven that reduced volatile compound levels might be an objective marker of response to dietary interventions. ClinicalTrials.gov ID: NCT03997708.
约20%的肠易激综合征（IBS）患者将症状与食物摄入联系起来；低可发酵寡糖、双糖、单糖和多元醇（FODMAP）饮食对控制这些症状有效。为评估地中海版低FODMAP饮食（MED-LFD）与英国国家卫生与临床优化研究所（NICE）的IBS指南相比的有效性，并评估粪便挥发性化合物水平的变化。108名无便秘的罗马IV型IBS患者被随机分为MED-LFD组或NICE组。主要终点包括干预后及6个月时症状严重程度的变化和缓解率（IBS严重程度评分量表[IBS-SSS]降低>50分）。次要终点评估生活质量、症状负担、充分缓解、焦虑/抑郁水平和依从性。使用气相色谱/质谱法测量挥发性化合物水平。在两个时间点，MED-LFD组在症状严重程度（159±80 vs. 253±94以及168±117 vs. 245±98）、缓解率（84.6% vs. 60.8%以及79.1% vs. 52.3%）和依从性（75% vs. 41%以及45% vs. 7%）方面均显示出显著更大的改善。所有次要终点均观察到类似结果，且未报告严重不良事件。MED-LFD干预是首次随访（比值比[OR]=6.66；95%置信区间[CI]=1.46，30.4）和第二次随访（OR=4.85；95%CI=1.31，17.96）时成为缓解者的最强独立预测因素。在两次随访中，短链和支链脂肪酸均显著降低。MED-LFD在管理无便秘的IBS症状和生活质量方面优于NICE推荐。挥发性化合物水平降低可能是饮食干预反应的客观标志物，这一点仍有待证实。临床试验注册号：NCT03997708。
