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

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Vol. 45; pp. 24 - 31
• Main Authors: Schumann, Dania, Klose, Petra, Lauche, Romy, Dobos, Gustav, Langhorst, Jost, Cramer, Holger
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2018
• Subjects: Abdominal Pain; Diet, Carbohydrate-Restricted; Disaccharides - administration & dosage; Disaccharides - chemistry; Fermentation; FODMAP diet; Gastrointestinal Microbiome; Gastrointestinal Tract - metabolism; Gastrointestinal Tract - microbiology; Gut microbiota; Humans; Irritable bowel syndrome; Irritable Bowel Syndrome - diet therapy; Meta-analysis; Monosaccharides - administration & dosage; Monosaccharides - chemistry; Oligosaccharides - administration & dosage; Oligosaccharides - chemistry; Polymers - administration & dosage; Polymers - chemistry; Quality of Life; Randomized Controlled Trials as Topic; Gut microbiota; FODMAP diet; Irritable bowel syndrome; Meta-analysis
• ISSN: 0899-9007; 1873-1244; 1873-1244
• DOI: 10.1016/j.nut.2017.07.004

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). 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. 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. 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. 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.