Dietary Patterns and the Course of Inflammatory Bowel Disease

描述（由申请人提供）：这项面向患者研究的中期研究者奖将为申请人提供受保护的时间，以指导面向患者的研究的学员，并对克罗恩病患者的有限限制饮食的功效进行新的研究。申请人James D. Lewis，医学博士，MSCE有着良好的指导记录，在过去的4年里，他曾担任6名初级教员、11名研究员（其中3名现在是教员学员）、3名住院医生和4名医科学生的导师。他的学员受益于他的指导，他们显著的职业发展证明了这一点，如新的教师职位，R01, VA Merit, K08/K23， F32和基金会资助，以及许多同行评审的出版物。包括克罗恩病（CD）和溃疡性结肠炎（UC）在内的IBD是一种慢性和复发性疾病，被认为是由遗传和环境因素（如肠道微生物组的组成和饮食）引起的。这些因素，尤其是饮食，也会影响乳糜泻的病程。在欧洲，单质、半单质或配方饮食的独家肠内营养是活动性乳糜泻的一线治疗方法，对维持缓解也是有效的。在几项小型研究中，极端排斥饮食也证明了其有效性。然而，这些饮食策略不适合长期使用。因此，确定哪些特定的饮食因素会影响疾病进程，从而使饮食建议既实用又有效，这一点至关重要。动物模型和人类数据得出一个假设，即食用红肉和加工肉类可能与乳糜泻复发有关。因此，我们将在一项前瞻性随机试验中验证不食用红肉和加工肉类可降低乳糜泻复发风险的假设。相关的具体目标是：目标1。确定低水平食用红肉和加工肉的饮食是否与降低乳糜泻复发率有关。探索性目的。确定与cd194患者复发风险较低相关的其他饮食模式

DESCRIPTION (provided by applicant): This Midcareer Investigator Award in Patient-Oriented Research will provide protected time for the applicant to mentor trainees in patient-oriented research and to conduct novel research on the efficacy of a limited restriction diet for patients with Crohn's disease. The applicant, James D. Lewis, MD, MSCE has a strong track record of mentoring, having served as a mentor for 6 junior faculty members, 11 fellows (3 who are now faculty mentees), 3 residents, and 4 medical students during the last 4 years. His trainees have benefitted from this mentoring, as evidenced by their significant career advancements such as new faculty positions, R01, VA Merit, K08/K23, F32 and foundation grants, and numerous peer reviewed publications. IBD, including Crohn's disease (CD) and ulcerative colitis (UC), are chronic and relapsing diseases believed to be caused by both genetic and environmental factors such as the composition of the gut microbiome and diet. These factors, particularly diet, can also impact the course of CD. Exclusive enteral nutrition with elemental, semi-elemental, or defined formula diets is first line therapy for active CD in Europe and is also efficacious to maintain remission. Extreme exclusion diets also have demonstrated efficacy in several small studies. However, these dietary strategies are not practical for long term use. Therefore, it is fundamentally important to determine what specific dietary factors influence disease course so that dietary recommendations can be both practical and effective. Animal models and human data lead to a hypothesis that red and processed meat consumption may be associated with relapse of CD. As such, we will test the hypothesis that exclusion of red and processed meats reduces the risk of relapse of CD in a prospective randomized trial. The interrelated specific aims are: Aim 1. To determine whether a diet with low levels of red and processed meat consumption is associated with a reduced rate of relapse of CD. Exploratory aim. To identify other dietary patterns associated with a lower risk of relapse of CD 194 patients with CD in remission will be randomized to one of two study diets. The control diet reduces consumption of sweetened beverages. The study diet reduces consumption of sweetened beverages and red and processed meats. Patients will be followed for 48 weeks or until they experience a relapse. Exploratory analyses will use a validated food frequency questionnaire to identify other dietary patterns associated with relapse of CD. The results will help physicians to answer patients' most common question, "What should I eat?"