A Starch- and Sucrose-Reduced Diet Has Similar Efficiency as Low FODMAP in IBS-A Randomized Non-Inferiority Study

Abstract

A diet with low content of fermentable oligo-, di-, and monosaccharides and polyols (FODMAP) is established treatment for irritable bowel syndrome (IBS), with well-documented efficiency. A starch- and sucrose-reduced diet (SSRD) has shown similar promising effects. The primary aim of this randomized, non-inferiority study was to test SSRD against low FODMAP and compare the responder rates (RR = ∆Total IBS-SSS ≥ -50) to a 4-week dietary intervention of either diet. Secondary aims were to estimate responders of ≥100 score and 50% reduction; effects on extraintestinal symptoms; saturation; sugar craving; anthropometric parameters; and blood pressure. 155 IBS patients were randomized to SSRD (n = 77) or low FODMAP (n = 78) for 4 weeks, with a follow-up 5 months later without food restrictions. The questionnaires Rome IV, IBS-severity scoring system (IBS-SSS), and visual analog scale for IBS (VAS-IBS) were completed at baseline and after 2 and 4 weeks and 6 months. Weight, height, waist circumference, and blood pressures were measured. Comparisons were made within the groups and between changes in the two groups. There were no differences between groups at baseline. The responder rate of SSRD was non-inferior compared with low FODMAPs at week 2 (79.2% vs. 73.1%; p = 0.661;95% confidence interval (CI) = -20-7.2) and week 4 (79.2% vs. 78.2%; p = 1.000;95%CI = -14-12). Responder rate was still high when defined stricter. All gastrointestinal and extraintestinal symptoms were equally improved (p < 0.001 in most variables). SSRD rendered greater reductions in weight (p = 0.006), body mass index (BMI) (p = 0.005), and sugar craving (p = 0.05), whereas waist circumference and blood pressure were equally decreased. Weight and BMI were regained at follow-up. In the SSRD group, responders at 6 months still had lowered weight (-0.7 (-2.5-0.1) vs. 0.2 (-0.7-2.2) kg; p = 0.005) and BMI (-0.25 (-0.85-0.03) vs. 0.07 (-0.35-0.77) kg/m²; p = 0.009) compared with baseline in contrast to non-responders. Those who had tested both diets preferred SSRD (p = 0.032). In conclusion, a 4-week SSRD intervention was non-inferior to low FODMAP regarding responder rates of gastrointestinal IBS symptoms. Furthermore, strong reductions of extraintestinal symptoms were found in both groups, whereas reductions in weight, BMI, and sugar craving were most pronounced following SSRD.

Keywords: SSRD; dietary intervention; irritable bowel syndrome; low FODMAP; randomized trial.

Figure 1

Responder rates given in percentage and calculated as intention-to-treat with (A) ≥50 decrease of total IBS-SSS score, (B) ≥100 decrease of total IBS-SSS score, and (C) ≥50% decrease of total IBS-SSS score. SSRD = starch- and sucrose-reduced diet with 72 patients at week 2 and 4 and 53 at month 6, out of 77. Low FODMAP = low content of fermentable oligo-, di-, and monosaccharides and polyols with 72 patients at week 2 and 4 and 49 at month 6. Fisher’s exact test. p ≤ 0.05 was considered statistically significant.

Figure 2

The differences in weight (kg) between 6 months and baseline in the group with starch-and sucrose-reduced diet (SSRD) divided into non-responders and responders with (A) ≥50 decrease of total IBS-SSS score (n = 28) and (B) ≥50% decrease of total IBS-SSS score (n = 13). 53 patients in the SSRD group completed the study. Median and interquartile range are given. Mann Whitney U-test. p ≤ 0.05 was considered statistically significant.