Dietary Patterns and the Course of Inflammatory Bowel Disease

描述(由申请者提供)：这项以患者为中心的研究的职业生涯中期研究人员奖将为申请者提供受保护的时间，以指导以患者为中心的研究的受训人员，并就克隆氏病患者有限限制饮食的有效性进行新的研究。申请者詹姆斯·D·刘易斯，医学博士，MSCE有着良好的指导记录，在过去的4年里曾担任过6名初级教员、11名研究员(3名现为教员导师)、3名住院医生和4名医学生的导师。他的学员从这种指导中受益，他们的职业生涯取得了重大进步，如新的教员职位、R01、VA Merit、K08/K23、F32和基金会补助金，以及许多同行评议的出版物。IBD，包括克罗恩病(CD)和溃疡性结肠炎(UC)，是一种慢性和复发性疾病，被认为是由遗传和环境因素引起的，如肠道微生物群的组成和饮食。这些因素，特别是饮食，也会影响Cd的进程。在欧洲，完全肠内营养配合元素、半元素或限定配方饮食是活动性CD的一线治疗方法，对维持病情缓解也是有效的。极端排斥饮食也在几项小规模研究中证明了有效性。然而，这些饮食策略对于长期使用是不现实的。因此，确定哪些特定的饮食因素影响病程是至关重要的，这样饮食建议才能既实用又有效。动物模型和人类数据导致了一种假设，即食用红色和加工过的肉类可能与CD复发有关。因此，我们将在一项前瞻性随机试验中检验排除红肉和加工肉可降低CD复发风险的假设。相关的具体目标是：目标1.确定低水平的红肉和加工肉类消费是否与降低镉的复发率有关。探索性目标。找出与CD194患者较低复发风险相关的其他饮食模式 缓解期的CD患者将随机接受两种研究饮食之一。控制饮食减少了含糖饮料的摄入量。这项研究的饮食减少了含糖饮料和红肉和加工肉类的消费。患者将被跟踪48周或直到他们经历复发。探索性分析将使用有效的食物频率问卷来确定与Cd复发有关的其他饮食模式。这项研究结果将帮助医生回答患者最常见的问题：“我应该吃什么？”

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?"