Manning Lauren P, Tuck Caroline J, Biesiekierski Jessica R
Department of Food, Nutrition and Dietetics, La Trobe University, Melbourne, Australia.
Department of Allied Health, Swinburne University, Melbourne, Australia.
Asia Pac J Clin Nutr. 2025 Jun;34(3):373-385. doi: 10.6133/apjcn.202506_34(3).0012.
The low fermentable oligo-, di-, mono-saccharides and polyols (FODMAP) diet is an effective dietary intervention for irritable bowel syndrome (IBS), yet up to 50% of patients fail to re-spond adequately. Identifying reliable predictors of response could optimize treatment selection and improve treatment outcomes while avoiding unnecessary dietary restrictions. This narrative review examines current evidence for predictors of response to the low FODMAP diet and highlights gaps in knowledge that must be addressed to develop clinically useful indicators for routine practice.
We re-viewed the literature on the low FODMAP diet, and studies investigating factors that may predict treatment response, including clinical, diagnostic, biological, biochemical, and microbial markers.
Several po-tential predictors to the low FODMAP diet have emerged, including baseline symptom severity, psychological factors (particularly depression), hydrogen breath test results, volatile organic compounds in fecal samples, and specific gut microbiota profiles. Clinical and psychological measures show the most immediate potential for implementation due to accessibility and established measurement tools. Biological markers, including breath testing, metabolomics, and microbiome analysis, show promise but require further validation in larger, diverse populations and standardization of methodologies.
Despite promising research, signifi-cant gaps remain in developing reliable, accessible predictors of response to the low FODMAP diet. Future research should focus on validating simple clinical tools that combine symptom profiles with psychological assessment to guide treatment decisions. A personalized approach to dietary management of IBS based on reliable response predictors would optimize clinical outcomes while minimizing unnecessary dietary restriction and healthcare resource utilization.
低可发酵寡糖、双糖、单糖及多元醇（FODMAP）饮食是治疗肠易激综合征（IBS）的一种有效饮食干预措施，但高达50%的患者反应欠佳。识别可靠的反应预测指标可优化治疗选择并改善治疗效果，同时避免不必要的饮食限制。本叙述性综述探讨了目前关于低FODMAP饮食反应预测指标的证据，并强调了知识空白，这些空白必须得到解决，以开发出临床实用的常规实践指标。
我们回顾了关于低FODMAP饮食的文献，以及调查可能预测治疗反应的因素的研究，包括临床、诊断、生物学、生化和微生物标志物。
已出现几个低FODMAP饮食的潜在预测指标，包括基线症状严重程度、心理因素（尤其是抑郁）、呼气氢试验结果、粪便样本中的挥发性有机化合物以及特定的肠道微生物群谱。由于易于获取且有既定的测量工具，临床和心理测量显示出最直接的实施潜力。生物学标志物，包括呼气测试、代谢组学和微生物组分析，显示出前景，但需要在更大、更多样化的人群中进一步验证，并实现方法的标准化。
尽管有前景可观的研究，但在开发可靠、易于获取的低FODMAP饮食反应预测指标方面仍存在重大差距。未来的研究应侧重于验证将症状特征与心理评估相结合以指导治疗决策的简单临床工具。基于可靠反应预测指标的IBS饮食管理个性化方法将优化临床结果，同时尽量减少不必要的饮食限制和医疗资源利用。
