Introduction
A diet with low content of fermentable oligo-, di-, and monosaccharides and polyols (FODMAP) are established treatment for irritable bowel syndrome (IBS), with well-documented efficiency. Recently, a starch- and sucrose-reduced diet (SSRD) has shown similar promising effects.
Aims & Methods
This randomized, non-inferiority study aimed to test SSRD against low FODMAP and compare the responder rates to a 4-week dietary intervention of either diet.
The 155 IBS patients were randomized to SSRD (n=77) or low FODMAP (n=78) for 4 weeks, with a follow-up 20 weeks later. The SSRD advice means removal of sucrose and reduction of starch-containing food such as cereals, some vegetables (e.g., potatoes), rice, and pasta, with maintained gluten and lactose. Low FODMAP means reduction of fermentable saccharides and polyols. 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, 4, and 24 weeks. Weight, height, waist circumference, and blood pressures were measured at week 2, 4, and 24. Comparisons were made within the groups and the differences between the changes in the two groups were compared.
Results
The patients were categorized according to the Rome IV criteria as constipation-predominated IBS (IBS-C) (n=26, 16.8%), diarrhea-predominated IBS (IBS-D) (n=44, 28.4%), mixed IBS (IBS-M) (n=54, 34.8%), unspecified IBS (IBS-U) (n=7, 4.5%), and unspecific functional bowel disorder (FBD) (n=24, 15.5%) with weekly abdominal pain but weak association between the pain and bowel habits. There were no differences between the groups at baseline. In the SSRD group, 72 (93.5%) completed the study at week 4 and 53 (68.8%) at week 24, with corresponding figures 72 (92.3%) and 49 (62.8%) in low FODMAP. The responding rate (RR=∆Total IBS-SSS ≥ −50) was non-inferior in SSRD compared with low FODMAP at week 2 (84.7% vs. 81.4%); p=0.658), week 4 (84.7% vs. 84.7%; p=1.00), and week 24 (52.8% vs. 68.0%; p=0.159). All gastrointestinal and extraintestinal symptoms were equally improved (p<0.001 in most variables) after the 4-week intervention. This remained at week 24 for all specific abdominal symptoms, total IBS-SSS, total extraintestinal IBS-SSS, and most specific extraintestinal symptoms. The decrease in total IBS-SSS correlated at all time points with the decrease of total extraintestinal symptoms (p<0.001) and improved psychological well-being (p<0.001). At week 4, 26.4% in both groups were considered healthy with <75 in total IBS-SSS. At week 24, around 40-50% had abominal pain 2-3 times a month, or less, or did have <75 in total IBS-SSS. SSRD rendered more pronounced reductions in weight (p=0.006), body mass index (BMI) (p=0.005), and sugar craving (p=0.05) compared with low FODMAP, whereas waist circumference and blood pressure were equally decreased in both groups. Weight and BMI were regained at follow-up. The decrease in total IBS-SSS at week 24 correlated with the decrease of weight (p=.010) and BMI (p=0.013), and the responders at week 24 in the SSRD group 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).
Conclusion
The SSRD effect on gastrointestinal and extraintestinal IBS symptoms were not inferior to the low FODMAP effect. Reductions of weight, BMI, and sugar craving were most pronounced following SSRD. Thus, dietary intervention in IBS do not only affect symptoms but also anthropometric parameters.
Disclosure
Nothing
