Efficacy of dietary interventions in irritable bowel syndrome: a systematic review and network meta-analysis.

However, the relative efficacy of available diets for the management of IBS is unclear.

然而，目前可用的饮食对IBS管理的相对有效性尚不明确。

We aimed to examine the relative efficacy of various dietary interventions in IBS.

我们的目标是检查各种饮食干预在肠易激综合征(IBS)中的相对疗效。

Methods

For this systematic reviewand network meta-analysiswe searched MEDLINE, EMBASE, EMBASE Classic, and the Cochrane Central Register of Controlled Trials from database inception to Feb 7, 2025, to identify randomised controlled trials comparing an active dietary intervention requiring changes to the intake of more than one food in IBS with either a control intervention, such as a habitual diet, sham diet, a high fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet, or alternative miscellaneous dietary advice, or any other active dietary intervention requiring changes to the intake of more than one food.

在这项系统评价和网络荟萃分析中，我们从数据库开始到2025年2月7日，检索了MEDLINE、EMBASE、EMBASE Classic和Cochrane中央控制试验登记处，以确定比较活跃饮食干预与控制干预（如习惯性饮食、模拟饮食、高发酵寡糖、双糖、单糖和多糖（FODMAP）饮食或任何其他活跃饮食干预（需要改变多种食物摄入）的随机对照试验。

We assessed efficacy using dichotomous assessments of improvement in global IBS symptoms or improvement in individual IBS symptoms, including abdominal pain, abdominal bloating or distension, and bowel habit.

我们采用对全球肠易激综合症症状改善或对个别肠易激综合症症状改善的二分法评估来评估疗效，包括腹痛、腹胀或腹部膨胀以及排便习惯。

We pooled data using a random-effects model, with the efficacy of each intervention reported as pooled relative risks (RRs) with 95% CIs.

我们使用随机效应模型汇总数据，每种干预措施的疗效报告为汇总相对风险（RRs）及其95%置信区间。

We ranked interventions according to their P-score, which measures the mean extent of certainty that one intervention is better than another, averaged over all competing interventions.

我们根据干预措施的P分数进行排名，该分数衡量了一个干预措施优于另一个干预措施的平均确定性程度，平均值是所有竞争性干预措施的平均值。

Results

We identified 28 eligible randomised controlled trials (comprising 2338 patients) of 11 different dietary interventions compared with four control interventions, of which six (low FODMAP diet, British Dietetic Association/National Institute for Health and Care Excellence [BDA/NICE] diet, lactose-reduced diet, starch-reduced and sucrose-reduced diet, a personalised diet, and a Mediterranean diet) were studied in more than one trial. For global IBS symptoms, assessed in 28 randomised controlled trials and when considering only the dietary interventions studied in more than one trial, a starch-reduced and sucrose-reduced diet ranked first (RR of global IBS symptoms not improving 0·41 [95% CI 0·26-0·67]; P-score 0·84; two trials), a low FODMAP diet ranked fourth (0·51 [0·37-0·70]; P-score 0·71; 24 trials), and a BDA/NICE diet ranked tenth (0·62 [0·43-0·90]; P-score 0·44; eight trials), versus a habitual diet.

我们确定了28项符合条件的随机对照试验（包括2338名患者），涉及11种不同的饮食干预措施与四种对照干预措施的比较，其中六种（低FODMAP饮食、英国饮食协会/国家卫生与护理卓越研究院[BDA/NICE]饮食、减少乳糖饮食、减少淀粉和蔗糖饮食、个性化饮食和地中海饮食）在多于一项试验中进行了研究。对于全球肠易激综合症状，评估了28项随机对照试验，并且只考虑在多于一项试验中研究的饮食干预措施，减少淀粉和蔗糖的饮食排名第一（全球肠易激综合症状未改善的相对风险为0.41 [95%置信区间0.26-0.67]；P分数为0.84；两项试验），低FODMAP饮食排名第四（0.51 [0.37-0.70]；P分数为0.71；24项试验），BDA/NICE饮食排名第十（0.62 [0.43-0.90]；P分数为0.44；八项试验），与习惯性饮食相比。

For abdominal pain, assessed in 26 trials and when considering only the dietary interventions studied in more than one randomised controlled trial, a starch-reduced and sucrose-reduced diet ranked second (RR of abdominal pain not improving 0·54 [95% CI 0·33-0·90]; P-score 0·73; two trials), and a low FODMAP diet ranked fifth (0·61 [0·42-0·89]; P-score 0·64; 23 trials), versus a habitual diet.

在评估了26项试验中的腹痛情况，并且仅考虑在两项或以上随机对照试验中研究的饮食干预措施，减少淀粉和蔗糖的饮食排名第二（腹痛未改善的相对风险为0.54 [95%置信区间0.33-0.90]；P分数为0.73；两项试验），而低FODMAP饮食排名第五（0.61 [0.42-0.89]；P分数为0.64；23项试验），与常规饮食相比。

For abdominal bloating or distension, assessed in 26 trials and when considering only the dietary interventions studied in more than one randomised trial, only a low FODMAP diet (RR of abdominal bloating or distension not improving 0·55 [95% CI 0·37-0·80]; P-score 0·64; 23 trials) was superior to a habitual diet and ranked fourth.

在评估了26项试验中的腹胀或腹部膨胀情况，并且仅考虑在两项或以上随机试验中研究的饮食干预措施，只有低FODMAP饮食（腹胀或腹部膨胀未改善的相对风险为0.55 [95%置信区间0.37-0.80]；P分数为0.64；23项试验）优于常规饮食，并排名第四。

For bowel habit, assessed in 23 randomised trials, none of the dietary interventions was superior to any of the control interventions, but a low FODMAP diet was superior to a BDA/NICE diet (RR of bowel habit not improving 0·79 [95% CI 0·63-0·99]).

在23项随机试验中对肠道习惯进行了评估，结果显示没有任何一种饮食干预措施优于对照干预措施，但低FODMAP饮食在改善肠道习惯方面优于BDA/NICE饮食（未改善肠道习惯的相对风险为0.79 [95%置信区间0.63-0.99]）

All comparisons across the network were rated as low or very low confidence, except for direct comparisons between a low FODMAP diet or a starch-reduced and sucrose-reduced diet and habitual diet, both of which were rated as moderate confidence.

网络中所有比较的置信度被评为低或非常低，除了低FODMAP饮食或减少淀粉和蔗糖饮食与习惯性饮食之间的直接比较，这两者都被评为中等置信度。

interpretation

In terms of dietary interventions for IBS, the most evidence exists for a low FODMAP diet, but other promising therapies are emerging and should be the subject of further study.

在肠易激综合症的饮食干预方面，低FODMAP饮食的证据最为充分，但其他有前景的治疗方法正在出现，应成为进一步研究的主题。

funding

None.

无。