Elsevier

Nutrition

Volume 45, January 2018, Pages 24-31
Nutrition

Review
Low fermentable, oligo-, di-, mono-saccharides and polyol diet in the treatment of irritable bowel syndrome: A systematic review and meta-analysis

https://doi.org/10.1016/j.nut.2017.07.004Get rights and content

Highlights

What is already known about this subject

  • Certain food components trigger symptoms in many patients with IBS.

  • Diets low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) seem to improve symptoms.

  • Low FODMAP diets appear to induce a change in the hosts gut microbiota.

What are the findings of this meta-analysis
  • Methodological robust effects showed that a low FODMAP diet reduced gastrointestinal symptoms and abdominal pain.

  • Low FODMAP diet increased quality of life in patients.

Abstract

Objectives

The aim of this review was to systematically assess and meta-analyze the effects of a low fermentable, oligo-, di-, mono-saccharides and polyol (FODMAP) diet (LFD) on the severity of symptoms, quality of life, and safety in patients with irritable bowel syndrome (IBS).

Methods

The MEDLINE/PubMed, Scopus, and Cochrane Library databases were screened through January 19, 2016. Randomized controlled trials (RCTs) that compared LFD to other diets were included if they assessed symptoms of IBS or abdominal pain in patients with IBS. Safety, quality of life, anxiety, depression, and effect on gut microbiota were defined as secondary outcomes. Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated.

Results

Nine RCTs with a total of 596 subjects were included. Three RCTs compared LFD with a habitual diet, two RCTs provided all meals and compared LFD with a western diet, one RCT each compared LFD with a diet high in FODMAPs or a sham diet, and two RCTs compared with other diet recommendations for IBS. A meta-analysis revealed significant group differences for LFD compared with other diets with regard to gastrointestinal symptoms (SMD = −0.62; 95% CI = −0.93 to −0.31; P = 0.0001), abdominal pain (SMD = −0.50; 95% CI = −0.77 to −0.22; P = 0.008), and health-related quality of life (SMD = 0.36; 95% CI = 0.10–0.62; P = 0.007). Three studies reported a significant reduction in luminal bifidobacteria after LFD. Adverse events were assessed in three RCTs only and no intervention-related adverse events were reported.

Conclusions

This meta-analysis found evidence of the short-term efficacy and safety of LFD in patients with IBS. However, only a preliminary recommendation for LFD can be made until long-term effects are investigated.

Section snippets

Background

Irritable bowel syndrome (IBS) describes a group of symptoms that include abdominal pain or discomfort and changes in bowel movement patterns and defecation. Although a correlation between pathophysiology and symptoms lacks for most cases, patients experience abdominal pain and a negative impact on their quality of life. IBS is the most common functional gastrointestinal (GI) disease [1] and a diagnosis of IBS is based on the Rome criteria [2].

Although nearly 60% of patients claim that certain

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews and meta-analyses [6] and the recommendations by the Cochrane Collaboration [7] were followed.

Literature search

The literature search retrieved 179 records of which 113 non-duplicate records were screened and 105 records were excluded because they did not use an RCT design and/or a low FODMAP diet was not an intervention. One RCT was excluded because it used the low FODMAP diet only to wash out symptoms in the initial stage of the investigation on the effects of diets that were high or low in gluten [14]. Nine full-text articles on RCTs with a total of 596 subjects were included for the qualitative

Summary of evidence

In this systematic review of nine randomized trials, significant evidence for short-term benefits of diets that are low in FODMAPs was found for GI symptoms, abdominal pain, and quality of life in patients with IBS and no side effects were reported. Effects were robust against potential methodological bias.

Despite the evidence that supports LFD efficacy, more than 25% of patients with IBS do not improve on the diet [25]. This meta-analysis shows that adherence to LFD significantly improves GI

Conclusion

This meta-analysis found evidence that the low-FODMAP diet is effective to relieve symptoms and improve the quality of life of patients with IBS. Still, long-term outcomes and the safety of low-FODMAP diets remain to be investigated. Further studies are required to evaluate its long-term effects on gut microbiota, cost effectiveness, and efficacy compared with other modalities.

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    Sources of support: No external funding was received for this review.

    Conflicts of interest: The authors have declared that no competing interests exist.

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