Randomized controlled pilot study assessing fructose tolerance during fructose reintroduction in non-constipated irritable bowel syndrome patients successfully treated with a low FODMAP diet.
Randomized controlled pilot study assessing fructose tolerance during fructose reintroduction in non-constipated irritable bowel syndrome patients successfully treated with a low FODMAP diet.
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随机对照试点研究评估了成功接受低 FODMAP 饮食治疗的非便秘型肠易激综合征患者在重新引入果糖期间的果糖耐受性。
DOI：
10.1111/nmo.14575
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发表时间：
2023
影响因子：
3.5
通讯作者：
Chang,Lin
中科院分区：
文献类型：
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作者：
Cuff,Callie;Lin,LisaD;Mahurkar-Joshi,Swapna;Jacobs,JonathanP;Lagishetty,Venu;Jaffe,Nancee;Smith,Janelle;Dong,Tien;Sohn,Jessica;Chang,Lin
背景有限的数据可以指导FODMAP（可发酵的寡糖、二糖、单糖和多元醇）的重新引入，以评估低FODMAP饮食（LFD）后的耐受性。果糖的再引入通常是逐步的，直至7.5g果糖（例如，三茶匙蜂蜜）。我们的目的是确定果糖耐受阈值在非便秘，LFD响应患者肠易激综合征（IBS）和评估粪便微生物组是否预测LFD响应或果糖tolerance. MethodsThirty-nine非便秘IBS患者（51%的女性，平均年龄33.7岁）完成了为期4周的LFD。LFD应答者定义为LFD后IBS症状充分缓解的患者。应答者被随机分配到三个溶液组（100%果糖，56%果糖/44%葡萄糖或100%葡萄糖）中的一个，并接受四个剂量（2.5，5，10，15 g），每个剂量3天。如果患者的平均每日IBS症状严重程度（视觉模拟量表[VAS]，0-100 mm）比LFD后VAS高>20 mm，则患者达到其耐受剂量。使用鸟枪宏基因组学分析LFD前后的粪便样本。Results70%的患者是LFD应答者。大多数应答者耐受15 g糖剂量。溶液组之间的平均耐受剂量无显著差异（p= 0.56）。与基线相比，微生物组组成（β多样性）显着转移和六个细菌基因的果糖和甘露糖代谢途径减少LFD后，无论LFD响应或解决group. ConclusionsNon-constipated，LFD响应IBS患者应重新引入果糖在高于15 g的剂量来评估耐受性。LFD与FODMAP代谢中涉及的微生物组成和细菌基因的显著变化相关。
BackgroundLimited data exist to guide FODMAP (fermentable oligo‐, di‐, monosaccharides, and polyols) reintroduction to assess tolerance following a low FODMAP diet (LFD). Fructose reintroduction is often stepwise up to 7.5 g fructose (e.g., three tsp of honey). We aimed to determine the fructose tolerance threshold in non‐constipated, LFD‐responsive patients with irritable bowel syndrome (IBS) and assess whether stool microbiome predicted LFD response or fructose tolerance.MethodsThirty‐nine non‐constipated IBS patients (51% women, mean age 33.7 years) completed a 4‐week LFD. LFD responders were defined as those who reported adequate relief of IBS symptoms following the LFD. Responders were randomized to one of the three solution groups (100% fructose, 56% fructose/44% glucose, or 100% glucose) and received four doses (2.5, 5, 10, 15 g) for 3 days each. Patients reached their tolerance dose if their mean daily IBS symptom severity (visual analog scale [VAS], 0–100 mm) was >20 mm higher than post‐LFD VAS. Stool samples before and after LFD were analyzed using shotgun metagenomics.ResultsSeventy‐nine percent of patients were LFD responders. Most responders tolerated the 15 g sugar dose. There was no significant difference in mean dose tolerated between solution groups (p= 0.56). Compared to baseline, microbiome composition (beta diversity) significantly shifted and six bacterial genes in fructose and mannose metabolism pathways decreased after LFD, irrespective of LFD response or the solution group.ConclusionsNon‐constipated, LFD‐responsive IBS patients should be reintroduced to fructose in higher doses than 15 g to assess tolerance. LFD is associated with significant changes in microbial composition and bacterial genes involved in FODMAP metabolism.