Effects of a low FODMAP diet on the symptom management of patients with irritable bowel syndrome: a systematic umbrella review with the meta-analysis of clinical trials.
Study Goal
The researchers aimed to evaluate the effects of a Low-FODMAP Diet (LFD) on IBS symptoms, quality of life, microbiome diversity, and stool short-chain fatty acids through a systematic umbrella review with meta-analysis.
Results Summary
The study found that an LFD significantly improved total IBS symptoms, stool consistency, and frequency, as well as quality of life, but did not affect anxiety and depression. However, it may increase fecal pH, dysbiosis, and reduce SCFA and Bifidobacterium abundance.
Population
Patients with irritable bowel syndrome (IBS)
Effective Dosage
Not specified
Duration
Varied, with some outcomes requiring more than 4 weeks of LFD implementation
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
A low FODMAP diet (LFD) | increase | total symptoms according to the IBS-SSS questionnaire | all the subtypes of IBS | RR: 1.42; 95% CI: 1.02, 1.97; P = 0.04 | significantly affected the clinical improvement | #1 |
A low FODMAP diet (LFD) | decrease | stool consistency | patients with irritable bowel syndrome (IBS) | WMD: -0.48; 95% CI: -0.902, -0.07 | had favorable effects on | #2 |
A low FODMAP diet (LFD) | decrease | stool frequency | patients with irritable bowel syndrome (IBS) | WMD: -0.36; 95% CI: -0.61, -0.10 | had favorable effects on | #3 |
A low FODMAP diet (LFD) | decrease | some other GI symptoms | patients with irritable bowel syndrome (IBS) | - | had favorable effects on | #4 |
A low FODMAP diet (LFD) | increase | quality of life (QoL) | IBS patients | - | A significant improvement was observed | #5 |
A low FODMAP diet (LFD) | no change | anxiety and depression state | IBS patients | - | not in the anxiety and depression state | #6 |
A low FODMAP diet (LFD) | increase | fecal pH | IBS patients | - | may increase | #7 |
A low FODMAP diet (LFD) | increase | dysbiosis | IBS patients | - | may increase | #8 |
A low FODMAP diet (LFD) | decrease | SCFA | IBS patients | - | reduce | #9 |
A low FODMAP diet (LFD) | decrease | the abundance of Bifidobacterium | IBS patients | - | reduce | #10 |
A low FODMAP diet (LFD) | decrease | symptoms | IBS patients | - | can alleviate | #11 |
A low FODMAP diet (LFD) | increase | QoL | IBS patients | - | can alleviate | #12 |
A low FODMAP diet (LFD) | increase | dysbiosis | IBS patients | - | may occur | #13 |
A low FODMAP diet (LFD) is a common restrictive diet to manage the symptoms of irritable bowel syndrome (IBS). However, there is no consensus on the alleviating effects of this diet. Herein, a systematic umbrella review with meta-analysis was conducted to investigate the effect of an LFD on IBS symptoms and its secondary outcomes in patients, which were not reported in previous meta-analyses. We performed a systematic literature search in PubMed, Scopus, and ISI Web of Science up to December 2023. The methodological quality of systematic reviews and their included trials was evaluated using AMSTAR 2 and the Cochrane risk of bias, respectively. The certainty of the evidence tool was evaluated using the GRADE approach. The data related to IBS symptoms, quality of life (QoL), microbiome diversity, and stool short-chain fatty acids were extracted. A random-effect (if RCTs ≥ 6) or fixed-effect model (if RCTs < 5) was used to recalculate effect sizes and 95% CIs and report them in both qualitative and quantitative terms (pooled risk ratio, Hedges' g, and weighted mean difference). A total of 658 articles were initially identified, with 11 meta-analyses and 24 RCTs reporting 28 outcomes with 1646 participants included. An LFD significantly affected the clinical improvement of total symptoms according to the IBS-SSS questionnaire (RR: 1.42; 95% CI: 1.02, 1.97; P = 0.04) in all the subtypes of IBS and also had favorable effects on stool consistency (WMD: -0.48; 95% CI: -0.902, -0.07) and frequency (WMD: -0.36; 95% CI: -0.61, -0.10) and some other GI symptoms in both less and more than 4 weeks of diet intervention except for stool consistency, which needed more than 4 weeks of LFD implementation. A significant QoL improvement was observed but not in the anxiety and depression state. Furthermore, some studies showed that an LFD may increase fecal pH and dysbiosis and reduce SCFA and the abundance of Bifidobacterium. In conclusion, an LFD can alleviate symptoms and QoL in IBS patients, although dysbiosis may occur. Considering the low certainty of evidence, strong RCTs with more appropriate designs are needed.