Diet as Adjunctive Treatment for Inflammatory Bowel Disease: Review and Update of the Latest Literature.
Diet as Adjunctive Treatment for Inflammatory Bowel Disease: Review and Update of the Latest Literature.
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DOI：
10.1007/s11938-019-00231-8
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发表时间：
2019-06-01
期刊：
影响因子：
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通讯作者：
Abreu, Maria T
中科院分区：
文献类型：
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作者：
Damas, Oriana M;Garces, Luis;Abreu, Maria T
审查目的：饮食在炎症性肠病（IBD）的发展中起着不可或缺的作用，并且一旦疾病发生，饮食将继续充当肠道炎症的介质。大多数临床医生很少为IBD患者提供饮食指导，部分原因是缺乏营养知识和缺乏可用的营养资源。本综述的目的是为临床医生提供IBD患者流行饮食背后的最新证据的简要总结，突出已知疗效的饮食，并提供可能有助于忙碌从业者的指导。最新的研究表明，单纯肠内营养（EEN）仍然是诱导克罗恩病（CD）缓解的最有效饮食，无论是以元素的形式，半元素或聚合物配方。最近的研究还表明，EEN可用于复杂的CD，包括肠外瘘闭合和优化术前营养。虽然新的研究表明，部分肠内营养补充消除饮食可能是有益的溃疡性结肠炎（UC）和CD，需要更大的对照研究，以支持他们的使用。自身免疫饮食也显示出希望，但缺乏更大的研究。最近评估特定碳水化合物饮食（SCD）的非对照临床研究表明，这种饮食可以改善炎症的生化标志物并诱导粘膜愈合，尽管需要更大规模的研究来支持其使用，特别是因为SCD非常严格。在急性发作和/或狭窄性疾病的情况下，短期使用低FODMAP饮食是合适的，但考虑到微生物组的长期变化，不建议长期限制FODMAP。最近的研究表明，避免加工食品，包装与防腐剂和乳化剂，可能是重要的，在减少肠道炎症;许多最近流行的饮食有一个共同的概念，避免加工食品。在这篇最新的文献综述中，我们强调饮食研究仍处于初级阶段。大型前瞻性随机对照研究正在进行中，以评估这些饮食的功效。我们提供了一般的指导原则，可以帮助胃肠病学家在此期间。
PURPOSE OF REVIEW: Diet plays an integral role in development of inflammatory bowel disease (IBD) and continues to act as a mediator of intestinal inflammation once disease sets in. Most clinicians provide little dietary guidance to IBD patients, in part due to lack of knowledge in nutrition and lack of available nutritional resources. The purpose of this review is to provide clinicians with a brief summary of the latest evidence behind diets popular among IBD patients, to highlight diets with known efficacy, and to provide guidance that may help busy practitioners.RECENT FINDINGS: The latest studies show that exclusive enteral nutrition (EEN) remains the most effective diet for induction of remission in Crohn's disease (CD), either in the form of elemental, semi-elemental, or polymeric formulas. Recent studies also show that EEN can be useful in complicated CD including in enterocutaneous fistulas closure and to optimize nutrition in the pre-operative setting. Although new studies suggest that partial enteral nutrition supplemented with elimination diets may be beneficial in ulcerative colitis (UC) and CD, larger controlled studies are needed to support their use. The autoimmune diet also shows promise but lacks larger studies. Recent uncontrolled clinical studies evaluating the specific carbohydrate diet (SCD) suggest that this diet may improve biochemical markers of inflammation and induce mucosal healing, although larger studies are needed to support its use, especially because the SCD is very restrictive. Short-term use of the low FODMAP diet is appropriate when in the setting of an acute flare up and/or in stricturing disease, but long-term restriction of FODMAPs is not recommended given long-term changes observed in the microbiome. Recent studies suggest that avoidance of processed foods, packaged with preservatives and emulsifiers, may be important in decreasing intestinal inflammation; many of the recent popular diets share a common concept, avoidance of processed foods. In this review of the latest literature, we highlight that dietary studies are still in a rudimentary stage. Large prospective randomized control studies are underway evaluating head to head comparisons on the efficacy of some of these diets. We offer general guiding principles that may help gastroenterologists in the meantime.