Dietary Patterns and the Course of Inflammatory Bowel Disease

描述（由申请人提供）：这项以患者为导向的研究的中期职业研究者奖将为申请人提供受保护的时间，以指导以患者为导向的研究的学员，并对克罗恩病患者进行有限限制饮食的疗效进行新的研究。申请人James D.刘易斯，医学博士，MSCE有一个很好的指导记录，曾担任导师6初级教师，11名研究员（3谁现在是教师学员），3名居民，和4名医学生在过去4年。他的学员从这种指导中受益，他们的职业发展，如新的教师职位，R 01，VA Merit，K 08/K23，F32和基金会赠款，以及许多同行评审的出版物。 IBD，包括克罗恩病（CD）和溃疡性结肠炎（UC），是慢性和复发性疾病，被认为是由遗传和环境因素引起的，如肠道微生物组和饮食的组成。这些因素，尤其是饮食，也会影响CD的病程。在欧洲，使用元素、半元素或规定配方饮食的纯肠内营养是活动性CD的一线治疗，也可有效维持缓解。极端排斥饮食也在几项小型研究中证明了其有效性。然而，这些饮食策略对于长期使用是不实用的。因此，确定哪些特定的饮食因素影响疾病进程，以便饮食建议既实用又有效，这是非常重要的。 动物模型和人类数据导致一种假设，即红肉和加工肉类消费可能与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类可降低CD复发风险的假设。相互关联的具体目标是：目标1。确定低水平红肉和加工肉类消费的饮食是否与CD复发率降低相关。探索性目标。确定与CD 194患者复发风险较低相关的其他饮食模式 CD缓解期的患者将随机接受两种研究饮食之一。对照饮食减少了含糖饮料的消耗。研究饮食减少了含糖饮料、红肉和加工肉类的摄入。患者将被随访48周或直到他们经历复发。探索性分析将使用经验证的食物频率问卷，以确定与CD复发相关的其他饮食模式。研究结果将有助于医生回答患者最常见的问题，“我应该吃什么？”" 公共卫生相关性：克罗恩病患者最常提出的问题是“医生，我应该吃什么？”“来自人类和动物模型的数据表明，肉类，特别是红肉和加工肉类，可能会恶化克罗恩病的病程。这项随机试验将测试限制摄入红肉和加工肉类对克罗恩病病程的影响。

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?" PUBLIC HEALTH RELEVANCE: The most frequently posed question from patients with Crohn's disease is "Doctor, what should I eat?" Data from humans and animal models suggest that meats, particularly red and processed meats, may worsen the course of Crohn's disease. This randomized trial will test the efficacy of restricting intake of red and processed meats on the course of Crohn's disease.