{"title":"肠易激综合征成人患者的营养干预：随机临床试验的系统综述和元分析》（Umbrella Review of Systematic Reviews and Meta-analyses of Randomized Clinical Trials）。","authors":"Sheida Zeraattalab-Motlagh, Mahsa Ranjbar, Hamed Mohammadi, Peyman Adibi","doi":"10.1093/nutrit/nuae107","DOIUrl":null,"url":null,"abstract":"<p><strong>Context: </strong>There is still debate regarding the effect of nutritional interventions in improving irritable bowel syndrome (IBS) symptoms.</p><p><strong>Objectives: </strong>The aim was to examine the evidence certainty and validity of all existing meta-analyses of intervention trials on nutritional interventions in patients with IBS.</p><p><strong>Data sources: </strong>Scopus, PubMed, and Web of Science were reviewed until June 2023.</p><p><strong>Data extraction: </strong>Meta-analyses assessing the impacts of nutritional interventions in adults with IBS were entered. Effect sizes of nutritional interventions were recalculated by applying a random-effects model. GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) was implemented to determine evidence certainty.</p><p><strong>Results: </strong>A total of 175 trials in 58 meta-analyses were entered describing the effects of 11 nutritional interventions on IBS-related outcomes. Nutritional interventions had beneficial effects on some IBS-related outcomes. For instance, soluble fiber, peppermint oil, and aloe vera improved IBS symptoms, and vitamin D3 and curcumin improved IBS symptom severity. Tongxieyaofang improved abdominal pain severity and stool frequency. Nevertheless, these outcomes have mainly shown small effects and low to very low evidence certainty. With regard to abdominal pain after probiotic supplementation (relative risk [RR]: 4.04; 95% confidence interval [CI]: 2.36, 6.92; GRADE = moderate) and IBS symptoms after a low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet (RR: 1.48; 95% CI: 1.14, 1.93; GRADE = moderate), there was evidence that probiotics and a low-FODMAP diet can confer clinical and favorable effects.</p><p><strong>Conclusion: </strong>The current review does not support nutritional interventions for improving IBS symptoms. With regard to probiotics and a low-FODMAP diet, considering limitations like short-term study duration, there was an influential clinical impact.</p><p><strong>Systematic review registration: </strong>PROSPERO registration no. CRD42023429991.</p>","PeriodicalId":19469,"journal":{"name":"Nutrition reviews","volume":" ","pages":""},"PeriodicalIF":5.9000,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Nutritional Interventions in Adult Patients With Irritable Bowel Syndrome: An Umbrella Review of Systematic Reviews and Meta-analyses of Randomized Clinical Trials.\",\"authors\":\"Sheida Zeraattalab-Motlagh, Mahsa Ranjbar, Hamed Mohammadi, Peyman Adibi\",\"doi\":\"10.1093/nutrit/nuae107\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Context: </strong>There is still debate regarding the effect of nutritional interventions in improving irritable bowel syndrome (IBS) symptoms.</p><p><strong>Objectives: </strong>The aim was to examine the evidence certainty and validity of all existing meta-analyses of intervention trials on nutritional interventions in patients with IBS.</p><p><strong>Data sources: </strong>Scopus, PubMed, and Web of Science were reviewed until June 2023.</p><p><strong>Data extraction: </strong>Meta-analyses assessing the impacts of nutritional interventions in adults with IBS were entered. Effect sizes of nutritional interventions were recalculated by applying a random-effects model. GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) was implemented to determine evidence certainty.</p><p><strong>Results: </strong>A total of 175 trials in 58 meta-analyses were entered describing the effects of 11 nutritional interventions on IBS-related outcomes. Nutritional interventions had beneficial effects on some IBS-related outcomes. For instance, soluble fiber, peppermint oil, and aloe vera improved IBS symptoms, and vitamin D3 and curcumin improved IBS symptom severity. Tongxieyaofang improved abdominal pain severity and stool frequency. Nevertheless, these outcomes have mainly shown small effects and low to very low evidence certainty. 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引用次数: 0
摘要
背景：营养干预对改善肠易激综合征（IBS）症状的效果仍存在争议：目的：检查所有现有的肠易激综合征患者营养干预试验荟萃分析的证据确定性和有效性：对Scopus、PubMed和Web of Science进行了审查，直至2023年6月：数据提取：输入评估营养干预对成人肠易激综合征患者影响的 Meta 分析。采用随机效应模型重新计算营养干预措施的效应大小。采用 GRADE（建议、评估、发展和评价分级）确定证据的确定性：结果：在 58 项元分析中，共有 175 项试验描述了 11 种营养干预措施对肠易激综合征相关结果的影响。营养干预对某些肠易激综合征相关结果产生了有益影响。例如，可溶性纤维、薄荷油和芦荟可改善肠易激综合征症状，维生素 D3 和姜黄素可改善肠易激综合征症状的严重程度。通协草方可改善腹痛严重程度和大便次数。尽管如此，这些结果主要显示出较小的效果和较低至极低的证据确定性。关于补充益生菌后的腹痛（相对风险 [RR]：4.04；95% 置信区间[CI]：2.36, 6.92；GRADE=中等）和低发酵性低聚糖、双糖、单糖和多元醇（FODMAP）饮食后的肠易激综合征症状（RR：1.48；95% CI：1.14, 1.93；GRADE=中等），有证据表明益生菌和低FODMAP饮食可产生临床和有利影响：目前的综述并不支持通过营养干预来改善肠易激综合征症状。关于益生菌和低FODMAP饮食，考虑到短期研究持续时间等限制因素，其临床影响是有影响力的：系统综述注册：PROSPERO 注册号CRD42023429991。
Nutritional Interventions in Adult Patients With Irritable Bowel Syndrome: An Umbrella Review of Systematic Reviews and Meta-analyses of Randomized Clinical Trials.
Context: There is still debate regarding the effect of nutritional interventions in improving irritable bowel syndrome (IBS) symptoms.
Objectives: The aim was to examine the evidence certainty and validity of all existing meta-analyses of intervention trials on nutritional interventions in patients with IBS.
Data sources: Scopus, PubMed, and Web of Science were reviewed until June 2023.
Data extraction: Meta-analyses assessing the impacts of nutritional interventions in adults with IBS were entered. Effect sizes of nutritional interventions were recalculated by applying a random-effects model. GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) was implemented to determine evidence certainty.
Results: A total of 175 trials in 58 meta-analyses were entered describing the effects of 11 nutritional interventions on IBS-related outcomes. Nutritional interventions had beneficial effects on some IBS-related outcomes. For instance, soluble fiber, peppermint oil, and aloe vera improved IBS symptoms, and vitamin D3 and curcumin improved IBS symptom severity. Tongxieyaofang improved abdominal pain severity and stool frequency. Nevertheless, these outcomes have mainly shown small effects and low to very low evidence certainty. With regard to abdominal pain after probiotic supplementation (relative risk [RR]: 4.04; 95% confidence interval [CI]: 2.36, 6.92; GRADE = moderate) and IBS symptoms after a low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet (RR: 1.48; 95% CI: 1.14, 1.93; GRADE = moderate), there was evidence that probiotics and a low-FODMAP diet can confer clinical and favorable effects.
Conclusion: The current review does not support nutritional interventions for improving IBS symptoms. With regard to probiotics and a low-FODMAP diet, considering limitations like short-term study duration, there was an influential clinical impact.
期刊介绍：
Nutrition Reviews is a highly cited, monthly, international, peer-reviewed journal that specializes in the publication of authoritative and critical literature reviews on current and emerging topics in nutrition science, food science, clinical nutrition, and nutrition policy. Readers of Nutrition Reviews include nutrition scientists, biomedical researchers, clinical and dietetic practitioners, and advanced students of nutrition.
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