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British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update).

Abstract

BACKGROUND

The first British Dietetic Association (BDA) guidelines for the dietary management of irritable bowel syndrome (IBS) in adults were published in 2012. Subsequently, there has been a wealth of new research. The aim of this work was to systematically review the evidence for the role of diet in the management of IBS and to update the guidelines.

METHODS

Twelve questions relating to diet and IBS were defined based on review of the previous guideline questions, current evidence and clinical practice. Chosen topics were on healthy eating and lifestyle (alcohol, caffeine, spicy food, elimination diets, fat and fluid intakes and dietary habits), milk and dairy, dietary fibre, fermentable carbohydrates, gluten, probiotics and elimination diets/food hypersensitivity. Data sources were CINAHL, Cochrane Register of Controlled Trials, Embase, Medline, Scopus and Web of Science up to October 2015. Studies were assessed independently in duplicate using risk of bias tools specific to each included study based on inclusion and exclusion criteria for each question. National Health and Medical Research Council grading evidence levels were used to develop evidence statements and recommendations, in accordance with Practice-based Evidence in Nutrition Global protocol used by the BDA.

RESULTS

Eighty-six studies were critically appraised to generate 46 evidence statements, 15 clinical recommendations and four research recommendations. The IBS dietary algorithm was simplified to first-line (healthy eating, provided by any healthcare professional) and second-line [low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) to be provided by dietitian] dietary advice.

CONCLUSIONS

These guidelines provide updated comprehensive evidence-based details to achieve the successful dietary management of IBS in adults.

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  • Authors+Show Affiliations

    ,

    Nuffield Health The Manor Hospital, Oxford, UK. yvonne@digestiblenutrition.co.uk.

    ,

    Department of Nutrition and Dietetics, Great Western Hospitals NHS Foundation Trust, Swindon, UK.

    ,

    Department of Nutrition and Dietetics, Southampton NHS Foundation Trust, Southampton, UK.

    ,

    Dr Ashok Ayurveda Clinic, Birmingham, UK.

    ,

    Department of Nutrition and Dietetics, North Middlesex University Hospital NHS Trust, London, UK.

    ,

    Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, UK.

    ,

    Faculty of Medicine, Imperial College London, London, UK.

    ,

    Allergy Services, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

    ,

    Specialist Gastroenterology Community Dietetic Service, Somerset Partnership NHS Foundation Trust, Bridgwater, UK.

    ,

    Specialist Gastroenterology Community Dietetic Service, Somerset Partnership NHS Foundation Trust, Bridgwater, UK.

    ,

    Calm Gut Clinic, Todmorden, UK.

    ,

    Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, UK. Department of Nutrition and Dietetics, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.

    Source

    MeSH

    Adult
    Dietary Carbohydrates
    Dietary Supplements
    Dietetics
    Dysbiosis
    Evidence-Based Medicine
    Fermentation
    Gastrointestinal Microbiome
    Healthy Diet
    Healthy Lifestyle
    Humans
    Irritable Bowel Syndrome
    Meta-Analysis as Topic
    Randomized Controlled Trials as Topic
    Societies, Scientific
    United Kingdom

    Pub Type(s)

    Journal Article
    Practice Guideline
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    27272325

    Citation

    McKenzie, Y A., et al. "British Dietetic Association Systematic Review and Evidence-based Practice Guidelines for the Dietary Management of Irritable Bowel Syndrome in Adults (2016 Update)." Journal of Human Nutrition and Dietetics : the Official Journal of the British Dietetic Association, vol. 29, no. 5, 2016, pp. 549-75.
    McKenzie YA, Bowyer RK, Leach H, et al. British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet. 2016;29(5):549-75.
    McKenzie, Y. A., Bowyer, R. K., Leach, H., Gulia, P., Horobin, J., O'Sullivan, N. A., ... Lomer, M. C. (2016). British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). Journal of Human Nutrition and Dietetics : the Official Journal of the British Dietetic Association, 29(5), pp. 549-75. doi:10.1111/jhn.12385.
    McKenzie YA, et al. British Dietetic Association Systematic Review and Evidence-based Practice Guidelines for the Dietary Management of Irritable Bowel Syndrome in Adults (2016 Update). J Hum Nutr Diet. 2016;29(5):549-75. PubMed PMID: 27272325.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). AU - McKenzie,Y A, AU - Bowyer,R K, AU - Leach,H, AU - Gulia,P, AU - Horobin,J, AU - O'Sullivan,N A, AU - Pettitt,C, AU - Reeves,L B, AU - Seamark,L, AU - Williams,M, AU - Thompson,J, AU - Lomer,M C E, AU - ,, Y1 - 2016/06/08/ PY - 2016/6/9/entrez PY - 2016/6/9/pubmed PY - 2018/1/25/medline KW - alcohol, caffeine KW - diet KW - dietary fibre KW - dietary habits KW - elimination diets and food hypersensitivity KW - fat KW - fermentable carbohydrates KW - fluid KW - gluten KW - guidelines KW - healthy eating KW - low FODMAP diet KW - milk and dairy KW - probiotics KW - spicy food KW - systematic review SP - 549 EP - 75 JF - Journal of human nutrition and dietetics : the official journal of the British Dietetic Association JO - J Hum Nutr Diet VL - 29 IS - 5 N2 - BACKGROUND: The first British Dietetic Association (BDA) guidelines for the dietary management of irritable bowel syndrome (IBS) in adults were published in 2012. Subsequently, there has been a wealth of new research. The aim of this work was to systematically review the evidence for the role of diet in the management of IBS and to update the guidelines. METHODS: Twelve questions relating to diet and IBS were defined based on review of the previous guideline questions, current evidence and clinical practice. Chosen topics were on healthy eating and lifestyle (alcohol, caffeine, spicy food, elimination diets, fat and fluid intakes and dietary habits), milk and dairy, dietary fibre, fermentable carbohydrates, gluten, probiotics and elimination diets/food hypersensitivity. Data sources were CINAHL, Cochrane Register of Controlled Trials, Embase, Medline, Scopus and Web of Science up to October 2015. Studies were assessed independently in duplicate using risk of bias tools specific to each included study based on inclusion and exclusion criteria for each question. National Health and Medical Research Council grading evidence levels were used to develop evidence statements and recommendations, in accordance with Practice-based Evidence in Nutrition Global protocol used by the BDA. RESULTS: Eighty-six studies were critically appraised to generate 46 evidence statements, 15 clinical recommendations and four research recommendations. The IBS dietary algorithm was simplified to first-line (healthy eating, provided by any healthcare professional) and second-line [low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) to be provided by dietitian] dietary advice. CONCLUSIONS: These guidelines provide updated comprehensive evidence-based details to achieve the successful dietary management of IBS in adults. SN - 1365-277X UR - https://www.unboundmedicine.com/medline/citation/27272325/full_citation L2 - https://doi.org/10.1111/jhn.12385 DB - PRIME DP - Unbound Medicine ER -