Characteristics and clinical applicability of four dietary interventions for irritable bowel syndrome: A systematic review and meta-analysis
Abstract
BACKGROUND: Dietary interventions are first-line management for irritable bowel syndrome (IBS), but their relative efficacy, acceptability, and safety remain incompletely understood. This systematic review and meta-analysis aimed to comprehensively evaluate four dietary interventions for adult patients with IBS: the low FODMAP diet (LFD), Mediterranean-based dietary interventions (including the Mediterranean diet [MD] and Mediterranean low-FODMAP diet [MED-LFD]), traditional dietary advice (TDA), and emerging dietary interventions (including the starch- and sucrose-reduced diet [SSRD] and gluten-free diet [GFD]).
METHODS: We searched PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) for randomized controlled trials (RCTs) published or registered between 2019 and 2025. Meta-analyses were performed using a random-effects model, and risk of bias was assessed using the Cochrane risk of bias tool.
RESULTS: Ten RCTs involving 939 participants were included. LFD showed relatively consistent short-term efficacy (responder rate 34%-78%) with no significant difference versus other dietary interventions in pooled analysis (RR = 1.04, 95% CI: 0.91-1.19, P = 0.55, I2 = 0%). Mediterranean-based interventions, particularly MED-LFD, showed promising longer-term benefit in individual trials, with response rates of 81.5% and 70.4% at…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 939 participants or records.
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