Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis.
Study Goal
The researchers aimed to evaluate the efficacy of a low-FODMAP diet in improving global and individual IBS symptoms compared to other dietary interventions through a network meta-analysis.
Results Summary
The low-FODMAP diet ranked first for improving global IBS symptoms, abdominal pain, bloating/distension, and bowel habit, outperforming other interventions like habitual diet and BDA/NICE dietary advice, though it was not superior for bowel habit compared to other interventions.
Population
Patients with irritable bowel syndrome (IBS) in secondary or tertiary care settings.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
low FODMAP diet | decrease | improvement in global IBS symptoms | patients with IBS | RR of symptoms not improving=0.67; 95% CI 0.48 to 0.91 | ranked first vs habitual diet | #1 |
low FODMAP diet | decrease | improvement in global IBS symptoms | patients with IBS | - | was superior to all other interventions | #2 |
low FODMAP diet | decrease | abdominal pain severity | patients with IBS | - | ranked first | #3 |
low FODMAP diet | decrease | abdominal bloating or distension severity | patients with IBS | - | ranked first | #4 |
low FODMAP diet | decrease | bowel habit | patients with IBS | - | ranked first | #5 |
low FODMAP diet | decrease | abdominal bloating or distension | patients with IBS | RR=0.72; 95% CI 0.55 to 0.94 | was superior to British Dietetic Association (BDA)/National Institute for Health and Care Excellence (NICE) dietary advice | #6 |
British Dietetic Association (BDA)/National Institute for Health and Care Excellence (NICE) dietary advice | no change | improvement in global IBS symptoms | patients with IBS | - | was not superior to any other intervention in any analysis | #7 |
low FODMAP diet | decrease | global IBS symptoms, abdominal pain, bloating, bowel habit | patients with IBS | - | ranked first for all endpoints studied | #8 |
OBJECTIVE: A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) is recommended for irritable bowel syndrome (IBS), if general lifestyle and dietary advice fails. However, although the impact of a low FODMAP diet on individual IBS symptoms has been examined in some randomised controlled trials (RCTs), there has been no recent systematic assessment, and individual trials have studied numerous alternative or control interventions, meaning the best comparator is unclear. We performed a network meta-analysis addressing these uncertainties. DESIGN: We searched the medical literature through to 2 April 2021 to identify RCTs of a low FODMAP diet in IBS. Efficacy was judged using dichotomous assessment of improvement in global IBS symptoms or improvement in individual IBS symptoms, including abdominal pain, abdominal bloating or distension, and bowel habit. Data were pooled using a random effects model, with efficacy reported as pooled relative risks (RRs) with 95% CIs, and interventions ranked according to their P-score. RESULTS: We identified 13 eligible RCTs (944 patients). Based on failure to achieve an improvement in global IBS symptoms, a low FODMAP diet ranked first vs habitual diet (RR of symptoms not improving=0.67; 95% CI 0.48 to 0.91, P-score=0.99), and was superior to all other interventions. Low FODMAP diet ranked first for abdominal pain severity, abdominal bloating or distension severity and bowel habit, although for the latter it was not superior to any other intervention. A low FODMAP diet was superior to British Dietetic Association (BDA)/National Institute for Health and Care Excellence (NICE) dietary advice for abdominal bloating or distension (RR=0.72; 95% CI 0.55 to 0.94). BDA/NICE dietary advice was not superior to any other intervention in any analysis. CONCLUSION: In a network analysis, low FODMAP diet ranked first for all endpoints studied. However, most trials were based in secondary or tertiary care and did not study effects of FODMAP reintroduction and personalisation on symptoms.