ESPEN guideline: Clinical nutrition in inflammatory bowel disease
ESPEN guideline: Clinical nutrition in inflammatory bowel disease
复制标题
DOI：
10.1016/j.clnu.2016.12.027
复制
发表时间：
2017-04-01
影响因子：
6.3
通讯作者：
Bischoff, Stephan C.
中科院分区：
文献类型：
--
作者：
Forbes, Alastair;Escher, Johanna;Bischoff, Stephan C.
简介：ESPEN指南提出了一个多学科的重点临床营养炎症性肠病（IBD）。方法：该指南是基于广泛的系统性文献综述，但依赖于专家意见时，缺乏客观数据或不确定。的结论和64项建议已受到充分的同行评议和德尔菲过程中，统一的积极响应（同意或强烈同意）是required.Results：IBD是越来越常见的，其病因学和潜在的饮食因素进行了简要审查。营养不良在IBD中非常普遍-特别是在克罗恩病中。在一些患者中观察到能量和蛋白质需求增加。IBD中营养不良的管理被认为是在营养不良患者支持的一般背景下。强烈建议治疗铁缺乏症（必要时胃肠外）。然而，不支持在IBD中常规提供特殊饮食。肠外营养仅在肠内营养失败或不可能时才适用。接受手术的IBD患者的推荐围手术期管理符合腹部手术患者的一般ESPEN指南。益生菌可能对UC有帮助，但对克罗恩病没有帮助。在溃疡性结肠炎中不支持使用营养来治疗IBD的主要疗法，但在克罗恩病中得到了中等程度的支持，特别是在类固醇治疗的不良后果比例更大的儿童中。然而，一般不推荐排除性饮食，并且在构建营养方案时，几乎没有证据支持任何特定的配方饲料。现有的指导IBD营养支持和主要营养治疗的客观数据显示为64项建议，其中9项是非常强烈的建议（A级），22个是强烈建议（B级），12个仅基于稀疏证据（0级）; 21个建议是良好实践点（GPP）。(C)2017年欧洲临床营养与代谢学会。由爱思唯尔有限公司出版。保留所有权利。
Introduction: The ESPEN guideline presents a multidisciplinary focus on clinical nutrition in inflammatory bowel disease (IBD).Methodology: The guideline is based on extensive systematic review of the literature, but relies on expert opinion when objective data were lacking or inconclusive. The conclusions and 64 recommendations have been subject to full peer review and a Delphi process in which uniformly positive responses (agree or strongly agree) were required.Results: IBD is increasingly common and potential dietary factors in its aetiology are briefly reviewed. Malnutrition is highly prevalent in IBD - especially in Crohn's disease. Increased energy and protein requirements are observed in some patients. The management of malnutrition in IBD is considered within the general context of support for malnourished patients. Treatment of iron deficiency (parenterally if necessary) is strongly recommended. Routine provision of a special diet in IBD is not however supported. Parenteral nutrition is indicated only when enteral nutrition has failed or is impossible. The recommended perioperative management of patients with IBD undergoing surgery accords with general ESPEN guidance for patients having abdominal surgery. Probiotics may be helpful in UC but not Crohn's disease. Primary therapy using nutrition to treat IBD is not supported in ulcerative colitis, but is moderately well supported in Crohn's disease, especially in children where the adverse consequences of steroid therapy are proportionally greater. However, exclusion diets are generally not recommended and there is little evidence to support any particular formula feed when nutritional regimens are constructed.Conclusions: Available objective data to guide nutritional support and primary nutritional therapy in IBD are presented as 64 recommendations, of which 9 are very strong recommendations (grade A), 22 are strong recommendations (grade B) and 12 are based only on sparse evidence (grade 0); 21 recommendations are good practice points (GPP). (C) 2017 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.