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Meta-Analysis
. 2021 Sep;60(6):3505-3522.
doi: 10.1007/s00394-020-02473-0. Epub 2021 Feb 14.

Efficacy of a low-FODMAP diet in adult irritable bowel syndrome: a systematic review and meta-analysis

Anne-Sophie van Lanen  1   2 , Angelika de Bree  3 , Arno Greyling  3
Affiliations
Meta-Analysis

Efficacy of a low-FODMAP diet in adult irritable bowel syndrome: a systematic review and meta-analysis

Anne-Sophie van Lanen et al. Eur J Nutr. 2021 Sep.

Erratum in

Abstract

Purpose: This review provides an updated overview of observational and intervention studies investigating the effect of a low-FODMAP (fermentable oligo-, di- and monosaccharides, and polyols) diet (LFD) on gastrointestinal (GI) symptoms, quality of life (QoL), nutritional adequacy, and gut microbiome in irritable bowel syndrome (IBS) patients.

Methods: We systematically searched available literature until October 2020 for studies that investigated the effect of LFDs on GI symptoms, QoL, nutritional adequacy, and the gut microbiome in IBS patients. The data were represented as standardized mean differences (SMD) for IBS severity, and as mean differences (MD) for IBS-QoL. Meta-analyses were performed for the quantitative analyses using random effects models with inverse variance weighing.

Results: Twelve papers (nine parallel trials, three crossover studies) were included for the meta-analysis. The LFD reduced IBS severity by a moderate-to-large extent as compared to a control diet (SMD - 0.66, 95% CI - 0.88, - 0.44, I2 = 54%). When analyzing only studies that used the validated IBS-SSS questionnaire, a mean reduction of 45 points (95% CI - 77, - 14; I2 = 89%) was observed. Subgroup analyses on adherence, age, intervention duration, IBS subtype, outcome measure, and risk of bias revealed no significantly different results. The LFD also increased IBS-QoL scores, when compared with a control diet (MD 4.93; 95% CI 1.77, 8.08; I2 = 42%).

Conclusions: The low-FODMAP diet reduces GI symptoms and improves quality of life in IBS subjects as compared to control diets. Future work is required to obtain definitive answers regarding potential long-term effects of such diets on nutritional adequacy and the gut microbiome.

Prospero registration number: CRD42020175157.

Keywords: Exclusion diet; Gastrointestinal symptoms; Irritable bowel syndrome; Low-FODMAP diet.

PubMed Disclaimer

Conflict of interest statement

Unilever is a company that manufactures food and beverages, of which some may be considered low-FODMAP.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of the study selection procedure
Fig. 2
Fig. 2
Forest plot showing standardized mean differences for IBS severity outcome measures
Fig. 3
Fig. 3
Forest plot showing mean IBS-SSS scores for studies that used IBS-SSS as outcome
Fig. 4
Fig. 4
Forest plot showing mean IBS-QoL values
Fig. 5
Fig. 5
Funnel plot used to assess risk of publication bias for IBS severity outcome measures
See this image and copyright information in PMC

References

    1. Defrees DN, Bailey J. Irritable bowel syndrome: epidemiology, pathophysiology, diagnosis, and treatment. Prim Care Clin Off Pract. 2017;44(4):655–671. doi: 10.1016/j.pop.2017.07.009. - DOI - PubMed
    1. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2012;10(7):712–721.e714. doi: 10.1016/j.cgh.2012.02.029. - DOI - PubMed
    1. Lovell RM, Ford AC. Effect of gender on prevalence of irritable bowel syndrome in the community: systematic review and meta-analysis. Am J Gastroenterol. 2012;107(7):991–1000. doi: 10.1038/ajg.2012.131. - DOI - PubMed
    1. Bohn L, Storsrud S, Tornblom H, Bengtsson U, Simren M. Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol. 2013;108(5):634–641. doi: 10.1038/ajg.2013.105. - DOI - PubMed
    1. Monnikes H. Quality of life in patients with irritable bowel syndrome. J Clin Gastroenterol. 2011;45(Suppl):S98–101. doi: 10.1097/MCG.0b013e31821fbf44. - DOI - PubMed

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