A Multicenter Randomized Controlled Trial of Microbiome-Based Artificial Intelligence-Assisted Personalized Diet vs Low-Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols Diet: A Novel Approach for the Management of Irritable Bowel Syndrome

INTRODUCTION: Personalized management strategies are pivotal in addressing irritable bowel syndrome (IBS). This multicenter randomized controlled trial focuses on comparing the efficacy of a microbiome-based artificial intelligence-assisted personalized diet (PD) with a low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet (FODMAP) for IBS management. METHODS: One hundred twenty-one patients participated, with 70 assigned to the PD group and 51 to the FODMAP diet group. IBS subtypes, demographics, symptom severity (IBS-SSS), anxiety, depression, and quality of life (IBS-QOL) were evaluated. Both interventions spanned 6 weeks. The trial's primary outcome was the within-individual difference in IBS-SSS compared between intervention groups. RESULTS: For the primary outcome, there was a change in IBS-SSS of −112.7 for those in the PD group vs −99.9 for those in the FODMAP diet group (P=0.29). Significant improvement occurred in IBS-SSS scores (P<0.001), frequency (P<0.001), abdominal distension (P<0.001), and life interference (P<0.001) in both groups. Anxiety levels and IBS-QOL scores improved in both groups (P<0.001). PD reduced IBS-SSS across all subtypes (IBS-C P<0.001; IBS-D P=0.01; IBS-M P<0.001), whereas the FODMAP diet showed comparable improvements in IBS-C (P=0.004) and IBS-M (P<0.001). PD improved IBS-QOL in all subtypes (IBS-C P<0.001; IBS-D P<0.001; IBS-M P=0.008), while FODMAP improved IBS-QOL in IBS-C (P=0.004) and IBS-D (P=0.022). PD led to significant microbiome diversity shifts (P<0.05) and taxa alterations compared with FODMAP. DISCUSSION: The AI-assisted PD emerges as a promising approach for comprehensive IBS management, demonstrating symptom relief, enhanced QOL, and notable diversity shifts in the gut microbiome.

Varol Tunali, Naciye Çiğdem Arslan, Beyza Hilal Ermiş, Gözde Derviş Hakim, Aycan Gündoğdu, Mehmet Hora, Özkan Ufuk Nalbantoğlu