BACKGROUND A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) has gained increasing acceptance for the treatment of irritable bowel syndrome but safety concerns have been raised regarding nutritional adequacy. Changes in nutrient intake during the elimination phase of the low-FODMAP diet remain predominantly unknown. OBJECTIVE To determine changes in the mean reported daily nutrient content before and after 4 weeks of a low-FODMAP diet vs modified National Institute for Health and Clinical Excellence (mNICE) dietary intervention and to identify nutritional inadequacies based on comparison to the Dietary Reference Intakes in patients with irritable bowel syndrome-diarrhea subtype. DESIGN Post hoc analysis of a randomized controlled trial entailing a 4-week trial period comparing the low-FODMAP and mNICE diets. PARTICIPANTS AND SETTING A total of 78 patients (41 low FODMAP and 37 mNICE) meeting the Rome III criteria for irritable bowel syndrome-diarrhea subtype were consecutively recruited from gastroenterology and primary care clinics at the University of Michigan Medical Center between October 2012 and November 2015. METHODS Participants randomized to the low-FODMAP arm were instructed to decrease their dietary intake of FODMAPs, whereas participants randomized to the mNICE intervention arm were instructed to eat small frequent meals, avoid trigger foods, and avoid excess alcohol and caffeine. MAIN OUTCOME MEASURES Post hoc evaluation for presence of micronutrient deficiencies per Dietary Reference Intakes when implementing low-FODMAP vs mNICE dietary interventions. Dietary intake was analyzed via 3-day food diaries at baseline and during the final week of the assigned diet. STATISTICAL ANALYSES PERFORMED A post hoc analysis utilizing either a t test or χ2 analysis was conducted between before and after data. RESULTS Both diets resulted in fewer daily kilocalories consumed, fewer number of daily meals consumed, and less daily carbohydrate intake. Among the patients following the low-FODMAP diet, there was a statistically significant decrease from baseline in several micronutrients, which was not observed in the mNICE cohort. However, these differences in the low-FODMAP group remained significant only for riboflavin after correcting for calorie-adjusted nutrient intake. Comparing Dietary Reference Intakes of participants pre- and postintervention, fewer patients met the Dietary Reference Intakes for thiamin and iron in the low FODMAP group, and for calcium and copper in the mNICE group. CONCLUSIONS During a 4-week dietary intervention, the mean daily intake of most micronutrients remained stable and within the Recommended Dietary Allowances for both diets. Although decrease in several micronutrients was observed with implementation of the low-FODMAP diet relative to the mNICE diet, most of these disappeared after adjusting for energy intake.

中文翻译：

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4 周低 FODMAP 和 mNICE 饮食对患有腹泻的肠易激综合征的美国成人样本营养摄入量的影响

背景 可发酵寡糖、二糖、单糖和多元醇 (FODMAP) 含量低的饮食已越来越被接受用于治疗肠易激综合征，但关于营养充足性的安全问题已引起关注。在低 FODMAP 饮食的消除阶段，营养摄入的变化仍然主要是未知的。目的 确定低 FODMAP 饮食与改良的国家健康与临床卓越研究所 (mNICE) 饮食干预前后 4 周平均报告的每日营养素含量的变化，并根据与膳食参考摄入量的比较确定营养不足肠易激综合征-腹泻亚型患者。设计 一项随机对照试验的事后分析，该试验需要 4 周的试验期，比较低 FODMAP 和 mNICE 饮食。参与者和地点 2012 年 10 月至 2015 年 11 月期间，从密歇根大学医学中心的胃肠病学和初级保健诊所连续招募了 78 名符合罗马 III 肠易激综合征 - 腹泻亚型标准的患者（41 名低 FODMAP 和 37 名 mNICE） . 方法 随机分配到低 FODMAP 组的参与者被要求减少 FODMAP 的饮食摄入量，而随机分配到 mNICE 干预组的参与者被指示少食多餐，避免触发食物，避免过量饮酒和咖啡因。主要结果测量 在实施低 FODMAP 与 mNICE 饮食干预时，对每个膳食参考摄入量是否存在微量营养素缺乏进行事后评估。在基线和指定饮食的最后一周，通过 3 天的食物日记分析饮食摄入量。执行的统计分析在数据前后进行了利用at test 或χ2 分析的事后分析。结果 两种饮食均导致每日消耗的卡路里减少、每日膳食消耗的次数减少以及每日碳水化合物的摄入量减少。在遵循低 FODMAP 饮食的患者中，几种微量营养素从基线水平显着降低，这在 mNICE 队列中未观察到。然而，低 FODMAP 组的这些差异在校正卡路里调整后的营养摄入后仅对核黄素而言仍然显着。比较干预前后参与者的膳食参考摄入量，低 FODMAP 组中符合硫胺素和铁的膳食参考摄入量以及 mNICE 组中达到钙和铜膳食参考摄入量的患者较少。结论 在为期 4 周的饮食干预期间，大多数微量营养素的平均每日摄入量保持稳定，并且在两种饮食的推荐膳食允许量范围内。尽管相对于 mNICE 饮食而言，在实施低 FODMAP 饮食时观察到几种微量营养素的减少，但在调整能量摄入后，其中大部分消失了。在低 FODMAP 组中满足硫胺和铁的膳食参考摄入量以及在 mNICE 组中满足钙和铜的膳食参考摄入量的患者较少。结论 在为期 4 周的饮食干预期间，大多数微量营养素的平均每日摄入量保持稳定，并且在两种饮食的推荐膳食允许量范围内。尽管相对于 mNICE 饮食而言，在实施低 FODMAP 饮食时观察到几种微量营养素的减少，但在调整能量摄入后，其中大部分消失了。在低 FODMAP 组中满足硫胺素和铁的膳食参考摄入量以及在 mNICE 组中满足钙和铜的膳食参考摄入量的患者较少。结论 在为期 4 周的饮食干预期间，大多数微量营养素的平均每日摄入量保持稳定，并且在两种饮食的推荐膳食允许量范围内。尽管相对于 mNICE 饮食而言，在实施低 FODMAP 饮食时观察到几种微量营养素的减少，但在调整能量摄入后，这些微量营养素中的大部分都消失了。