文献类型： 外文期刊

作者： Zhang, Yawen ¹ ; Feng, Lijun ² ; Wang, Xin ³ ; Fox, Mark ⁴ ; Luo, Liang ¹ ; Du, Lijun ¹ ; Chen, Binrui ¹ ; Chen, Xiaoli ¹ ;

作者机构： 1.Zhejiang Univ, Sir Run Run Shaw Hosp, Dept Gastroenterol, Sch Med, Hangzhou, Zhejiang, Peoples R China

2.Zhejiang Univ, Sir Run Run Shaw Hosp, Dept Nutr, Sch Med, Hangzhou, Zhejiang, Peoples R China

3.Zhejiang Acad Agr Sci, Inst Plant Protect & Microbiol, State Microbial Technol Zhejiang Prov, Hangzhou, Zhejiang, Peoples R China

4.Klin Arlesheim, Digest Funct Basel Lab & Clin Disorders Gastroint, Ctr Integrat Gastroenterol, Arlesheim, Switzerland

5.Univ Zurich, Zurich Univ Hosp, Dept Gastroenterol & Hepatol, Zurich, Switzerland

6.Zhejiang Canc Hosp, Dept Gastroenterol, Hangzhou, Zhejiang, Peoples R China

7.Univ Bern, Dept Visceral Surg & Med, Inselspital, Bern, Switzerland

8.Swiss Fed Inst Technol, Dept Biosyst Sci & Engn, Basel, Switzerland

9.Univ Bern, Dept Biomed Res, Maurice Muller Labs, Bern, Switzerland

10.Loma Linda Univ Hlth, Div Gastroenterol, Loma Linda, CA USA

11.Univ Michigan, Dept Internal Med, Div Gastroenterol & Hepatol, Michigan Med, Ann Arbor, MI 48109 USA

12.Zhejiang Univ City Coll, Sch Med, Hangzhou, Zhejiang, Peoples R China

关键词： irritable bowel syndrome; low FODMAP diet; intestinal microbiology; short-chain fatty acids; fermentation index

期刊名称：AMERICAN JOURNAL OF CLINICAL NUTRITION （ 影响因子：7.047； 五年影响因子：8.407 ）

ISSN： 0002-9165

年卷期： 2021 年 113 卷 6 期

页码：

收录情况： SCI

摘要： Background: The efficacy and factors associated with patient outcomes for a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (LFD) compared with traditional dietary advice (TDA) based on modified National Institute for Clinical Excellence guidelines for irritable bowel syndrome with diarrhea (IBS-D) in regions consuming a non-Western diet are unclear. Objectives: We aimed to determine the efficacy of an LFD compared with TDA for the treatment of IBS-D in Chinese patients and to investigate the factors associated with favorable outcomes. Methods: One hundred and eight Chinese IBS-D patients (Rome III criteria) were randomly assigned to an LFD or TDA. The primary endpoint was a >= 50-point reduction in the IBS Severity Scoring System at 3 wk. Fecal samples collected before and after the dietary intervention were assessed for changes in SCFAs and microbiota profiles. A logistic regression model was used to identify predictors of outcomes. Results: Among the 100 patients who completed the study, the primary endpoint was met in a similar number of LFD (30 of 51, 59%) and TDA (26 of 49, 53%) patients (Delta 6%; 95% CI: -13%, 24%). Patients in the LFD group achieved earlier symptomatic improvement in stool frequency and excessive wind than those following TDA. LFD reduced carbohydrate-fermenting bacteria such as Bifidobacterium and Bacteroides, and decreased saccharolytic fermentation activity. This was associated with symptomatic improvement in the responders. High saccharolytic fermentation activity at baseline was associated with a higher symptom burden (P = 0.01) and a favorable therapeutic response to the LFD (log OR: 4.9; 95% CI: -0.1, 9.9; P = 0.05). Conclusions: An LFD and TDA each reduced symptoms in Chinese IBS-D patients; however, the LFD achieved earlier symptomatic improvements in stool frequency and excessive wind. The therapeutic effect of the LFD was associated with changes in the fecal microbiota and the fecal fermentation index. At baseline, the presence of severe symptoms and microbial metabolic dysbiosis characterized by high saccharolytic capability predicted favorable outcomes to LFD intervention.