Yawen Zhang1, Lijun Feng2, Xin Wang3, Mark Fox4,5, Liang Luo1, Lijun Du1, Binrui Chen1, Xiaoli Chen1, Huiqin He1, Shuwen Zhu1,6, Zhefang Hu2, Shujie Chen1, Yanqin Long1, Yubin Zhu1, Li Xu2, Yanyong Deng1, Benjamin Misselwitz7, Brian M Lang8, Bahtiyar Yilmaz9, John J Kim10, Chung Owyang11, Ning Dai1,12. 1. Department of Gastroenterology, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China. 2. Department of Nutrition, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China. 3. State Microbial Technology of Zhejiang Province, Institute of Plant Protection and Microbiology, Zhejiang Academy of Agricultural Sciences, Hangzhou, Zhejiang, China. 4. Digestive Function: Basel, Laboratory and Clinic for Disorders of Gastrointestinal Motility and Function, Center for Integrative Gastroenterology, Klinik Arlesheim, Arlesheim, Switzerland. 5. Department of Gastroenterology and Hepatology, Zurich University Hospital, University of Zurich, Zürich, Switzerland. 6. Department of Gastroenterology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China. 7. Department of Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland. 8. Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland. 9. Maurice Müller Laboratories, Department for Biomedical Research, University of Bern, Bern, Switzerland. 10. Division of Gastroenterology, Loma Linda University Health, Loma Linda, CA, USA. 11. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA. 12. School of Medicine, Zhejiang University City College, Hangzhou, Zhejiang, China.
Abstract
BACKGROUND: The efficacy and factors associated with patient outcomes for a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (LFD) compared with traditional dietary advice (TDA) based on modified National Institute for Clinical Excellence guidelines for irritable bowel syndrome with diarrhea (IBS-D) in regions consuming a non-Western diet are unclear. OBJECTIVES: We aimed to determine the efficacy of an LFD compared with TDA for the treatment of IBS-D in Chinese patients and to investigate the factors associated with favorable outcomes. METHODS:One hundred and eight Chinese IBS-D patients (Rome III criteria) were randomly assigned to an LFD or TDA. The primary endpoint was a ≥50-point reduction in the IBS Severity Scoring System at 3 wk. Fecal samples collected before and after the dietary intervention were assessed for changes in SCFAs and microbiota profiles. A logistic regression model was used to identify predictors of outcomes. RESULTS: Among the 100 patients who completed the study, the primary endpoint was met in a similar number of LFD (30 of 51, 59%) and TDA (26 of 49, 53%) patients (∆6%; 95% CI: -13%, 24%). Patients in the LFD group achieved earlier symptomatic improvement in stool frequency and excessive wind than those following TDA. LFD reduced carbohydrate-fermenting bacteria such as Bifidobacterium and Bacteroides, and decreased saccharolytic fermentation activity. This was associated with symptomatic improvement in the responders. High saccharolytic fermentation activity at baseline was associated with a higher symptom burden (P = 0.01) and a favorable therapeutic response to the LFD (log OR: 4.9; 95% CI: -0.1, 9.9; P = 0.05). CONCLUSIONS: An LFD and TDA each reduced symptoms in Chinese IBS-D patients; however, the LFD achieved earlier symptomatic improvements in stool frequency and excessive wind. The therapeutic effect of the LFD was associated with changes in the fecal microbiota and the fecal fermentation index. At baseline, the presence of severe symptoms and microbial metabolic dysbiosis characterized by high saccharolytic capability predicted favorable outcomes to LFD intervention.This trial was registered at clinicaltrials.gov as NCT03304041.
RCT Entities:
BACKGROUND: The efficacy and factors associated with patient outcomes for a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (LFD) compared with traditional dietary advice (TDA) based on modified National Institute for Clinical Excellence guidelines for irritable bowel syndrome with diarrhea (IBS-D) in regions consuming a non-Western diet are unclear. OBJECTIVES: We aimed to determine the efficacy of an LFD compared with TDA for the treatment of IBS-D in Chinese patients and to investigate the factors associated with favorable outcomes. METHODS: One hundred and eight Chinese IBS-D patients (Rome III criteria) were randomly assigned to an LFD or TDA. The primary endpoint was a ≥50-point reduction in the IBS Severity Scoring System at 3 wk. Fecal samples collected before and after the dietary intervention were assessed for changes in SCFAs and microbiota profiles. A logistic regression model was used to identify predictors of outcomes. RESULTS: Among the 100 patients who completed the study, the primary endpoint was met in a similar number of LFD (30 of 51, 59%) and TDA (26 of 49, 53%) patients (∆6%; 95% CI: -13%, 24%). Patients in the LFD group achieved earlier symptomatic improvement in stool frequency and excessive wind than those following TDA. LFD reduced carbohydrate-fermenting bacteria such as Bifidobacterium and Bacteroides, and decreased saccharolytic fermentation activity. This was associated with symptomatic improvement in the responders. High saccharolytic fermentation activity at baseline was associated with a higher symptom burden (P = 0.01) and a favorable therapeutic response to the LFD (log OR: 4.9; 95% CI: -0.1, 9.9; P = 0.05). CONCLUSIONS: An LFD and TDA each reduced symptoms in Chinese IBS-D patients; however, the LFD achieved earlier symptomatic improvements in stool frequency and excessive wind. The therapeutic effect of the LFD was associated with changes in the fecal microbiota and the fecal fermentation index. At baseline, the presence of severe symptoms and microbial metabolic dysbiosis characterized by high saccharolytic capability predicted favorable outcomes to LFD intervention.This trial was registered at clinicaltrials.gov as NCT03304041.
Authors: Nessmah Sultan; Jane E Varney; Emma P Halmos; Jessica R Biesiekierski; Chu K Yao; Jane G Muir; Peter R Gibson; Caroline J Tuck Journal: J Neurogastroenterol Motil Date: 2022-07-30 Impact factor: 4.725
Authors: Esther Colomier; Lukas Van Oudenhove; Jan Tack; Lena Böhn; Sean Bennet; Sanna Nybacka; Stine Störsrud; Lena Öhman; Hans Törnblom; Magnus Simrén Journal: Nutrients Date: 2022-01-17 Impact factor: 5.717