- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03997708
A Mediterranean Approach to Low FODMAP Diet (MED-LFD) for Managing IBS Symptoms
Mediterranean Diet Adjusted to Low FODMAP Diet (MED-LFD) vs NICE Guidelines for Improving IBS Symptoms: a New Approach for Managing IBS
Study Overview
Status
Conditions
Detailed Description
Irritable Bowel Syndrome (IBS) is a functional bowel disorder. Patients associate their symptoms with specific foods consumption, creating the need for developing a new therapeutic approach based on altering the dietary intake of these patients. Low FODMAP Diet is often used as a first-line treatment based on observations showing that short-chain carbohydrates are not adequately absorbed in the small intestine and exacerbate the symptoms of IBS. Additionally, the Mediterranean diet is a cultural heritage representative of all the countries surrounded by the Mediterranean Sea, described as a diet rich in herbal foods (cereals, fruits, vegetables, legumes, nuts, olives), with olive oil as the main consumption of fats, high to moderate consumption of fish and seafood, moderate consumption of eggs, poultry, dairy products and alcohol and low consumption of red meat. On the other hand, the nutritional recommendations of British National Institute for Health and Care Excellence (NICE) managing IBS were created on the grounds of systematic reviews and are based on dietary and lifestyle modifications about caffeine, alcohol, fizzy drinks, fiber, resistant starch, fruits, sorbitol, oat and linseed consumption, meal patterns, probiotics and physical activity.
The direct aim of the study is to compare the efficacy of two dietary patterns, the MED-LFD and the nutritional recommendations of NICE managing IBS. Efficacy will be assessed based on the severity of symptoms. Additionally, possible improvements in quality of life and relief of symptoms between the two groups will be evaluated. Finally, the collected fecal samples will be used to assess the effect of each intervention on gut microbiota.
The sample was calculated to 108 participants with prespecified statistical power 80%, level of significance α=0.05 and 10% adjustment for non-compliance in each group to detect an increase in the primary outcome measure (standard deviation of outcome=60). The above hypothesis of the means was based in the meta-analysis of Peter Varju, et al. 2017. Patients will be recruited by the Department of Clinical Nutrition, Attikon University General Hospital, where the nutritional intervention will be carried out.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Arezina N. Kasti
- Phone Number: 6942917860 6942917860
- Email: kastiare@yahoo.gr
Study Locations
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Athens, Greece, 12462
- Attikon University General Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Fulfillment of the Rome IV criteria for IBS (IBS-D, IBS-M, IBS-U)
- Provision of written informed consent.
- Commitment of availability throughout the study period.
- IBS-SSS > 175
Exclusion Criteria:
- Any concomitant disease requiring specialized nutrition (e.g. renal failure, diabetes, celiac disease, cerebrovascular disease of the central nervous system, major surgical cavity).
- Pregnancy.
- Breastfeeding.
- IBS-C (Bristol Scale type 1 - 2)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Active Comparator: Group A
MED-LFD Diet (diet A) for 2 - 6 weeks.
After this period there will be a reintroduction phase protocol that will last 6 - 8 weeks.
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All participants of this group at phase 1 (elimination phase), will initially follow the Med- LFD (2-6 weeks).
At phase 2 (reintroduction phase), patients will gradually reintroduce foods rich in FODMAPs (6-8 weeks) and test their tolerance.
At phase 3 (maintenance phase), following the reintroduction of foods rich in FODMAPs, patients will follow an individualized diet based on their personal tolerance (a combination of high and low FODMAPs).
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Active Comparator: Group B
Diet according to guidelines from the National Institute for Health and Care Excellent (NICE) Managing IBS (diet B) for 4 weeks.
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All participants of this group will be informed to follow a diet based on the nutritional guidelines of the British National Institute for Health and Care Excellence (NICE) for Managing IBS for 4 weeks.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change of symptoms severity pre and post intervention using a specialized questionnaire.
Time Frame: Baseline, 4 - 8 weeks and 6 months post intervention
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IBS- SSS contains 5 specific questions with instructions on how to score them.
Each of the five questions (pain severity, pain frequency, abdominal distension severity, bowel movement satisfaction, quality of life) ranges from 0 to a maximum score of 100 using a visual analog scale (VAS) with total scores ranging from 0 to 500, with higher scores indicating more severe symptoms.
Subjects can be categorized as having mild (75-175), moderate (175-300), or severe (>300) IBS.
A decrease of 50 points is associated with a clinically meaningful improvement.
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Baseline, 4 - 8 weeks and 6 months post intervention
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Assessment of IBS related quality of life with a specialized questionnaire pre and post intervention between groups.
Time Frame: Baseline, 4 - 8 weeks and 6 months post intervention
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IBS-QOL - a measure that assesses the degree to which IBS interfered with quality of life over the past 30 days.
It is a self-report quality of life measure, which includes domains such as dysphoria, interference with activity, body image, health worry, food avoidance, social relation, sexual and relationship issues.
Each of them is rated based on the Likert scale from 1 to 5, the higher the score the lower the quality of life is.
The overall score ranges between 34 - 170.
A decrease of 10 points or more is a significant improvement.
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Baseline, 4 - 8 weeks and 6 months post intervention
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Assessment of general quality of life pre and post intervention between groups
Time Frame: Baseline, 4 - 8 weeks and 6 months post intervention
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12-Item Short Form Survey (SF-12) is a 12-item questionnaire used to assess generic health outcomes from the patient's perspective, covering the eight domains of health outcomes: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional & mental health.
The items are weighted and summed to provide physical and mental health scores (PCS and MCS).
The two composite scores are computed using the scores on the questions that range from 0 to 100, with higher score indicating better health.
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Baseline, 4 - 8 weeks and 6 months post intervention
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Adequate relief of symptoms after the intervention.
Time Frame: Once per week
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Adequate relief (IBS-AR) is a single item questionnaire of pain and discomfort.
It poses the question "Over the past week have you had adequate relief of your IBS symptoms?",
with a positive or negative answer.
Adequate relief is defined as 50% positive answers within the study period, for the purposes of the trial.
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Once per week
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Assessment of symptoms burden in general pre and post intervention.
Time Frame: Baseline, 4 - 8 weeks and 6 months post intervention
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The GSRS questionnaire was originally developed for dyspeptic patients but was later validated in patients with IBS.
The GSRS is a 15-item questionnaire designed to assess common gastrointestinal symptoms.
The questionnaire has five subscales, reflux, diarrhea, constipation, indigestion, and abdominal pain, with subscale scores ranging from 1 (no discomfort) to 7 (severe discomfort).
Higher scores represent higher symptom burden.
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Baseline, 4 - 8 weeks and 6 months post intervention
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Assessment of anxiety and depression disorders pre and post intervention.
Time Frame: Baseline, 4 - 8 weeks and 6 months post intervention
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The Hospital Anxiety and Depression Scale (HADS) questionnaire is used for the assessment of anxiety and depression symptoms.
It's a 14-item scale with seven items for each subscale, anxiety (HADS-A) and depression (HADS-D).
Each item is scored on a response scale with four alternatives, ranging between 0 and 3.
The total score is the sum of the 14 items, and for each subscale the score is the sum of the respective seven items (ranging from 0-21).
A final score of 0-7 on each scale indicates that the patient has no symptoms, a score of 8-10 indicates mild symptoms while a score ≥11 indicates severe symptoms of anxiety and depressive disorders.
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Baseline, 4 - 8 weeks and 6 months post intervention
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Evaluation of the effect of interventions on gut microbiota composition between groups.
Time Frame: Baseline, 2 weeks and 6 months post intervention
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Fecal samples will be collected from each participant and stored at -80°C.
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Baseline, 2 weeks and 6 months post intervention
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Collaborators and Investigators
Sponsor
Investigators
- Study Director: Konstantinos Triantafyllou, Attikon Hospital
Publications and helpful links
General Publications
- Varju P, Farkas N, Hegyi P, Garami A, Szabo I, Illes A, Solymar M, Vincze A, Balasko M, Par G, Bajor J, Szucs A, Huszar O, Pecsi D, Czimmer J. Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet improves symptoms in adults suffering from irritable bowel syndrome (IBS) compared to standard IBS diet: A meta-analysis of clinical studies. PLoS One. 2017 Aug 14;12(8):e0182942. doi: 10.1371/journal.pone.0182942. eCollection 2017.
- Dalrymple J, Bullock I. Diagnosis and management of irritable bowel syndrome in adults in primary care: summary of NICE guidance. BMJ. 2008 Mar 8;336(7643):556-8. doi: 10.1136/bmj.39484.712616.AD. No abstract available. Erratum In: BMJ. 2015;350:h1216.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- ΕΒΔ435/19-06-2018
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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