Department of Gastroenterology, Monash University and Alfred Hospital, Melbourne, Victoria, Australia.
J Gastroenterol Hepatol. 2013 Dec;28 Suppl 4:37-40. doi: 10.1111/jgh.12253.
The use of diet has traditionally been used to improve the nutrition of patients. However, diet also can be utilized to modify disease processes and manage symptoms independently of its nutritional role. There are few chronic gastrointestinal conditions where dietary modification is utilized therapeutically and backed by a high degree of evidence. This is not due to a lack of ideas but is more likely to lie in the difficulties associated with translating those ideas into evidence-based practice. Long lead-in times and low incidence hinders interventional studies of prevention for many conditions. The design and execution of dietary clinical trials is challenging and funding them even more so. The knowledge base of doctors in nutrition and food composition is often poor, and attitudes toward the success of and adherence to dietary therapies create additional problems. However, ideas can be successfully translated into evidence-based practice, as exemplified but the low fermentable, oligo-, di-, and mono-saccharides and polyols (FODMAP) (poorly-absorbed short-chain carbohydrates) diet for patients with functional bowel symptoms. Showing efficacy is, however, insufficient for non-nutritional dietary manipulations. Adverse effects, such as nutritional adequacy of the diet and effect on pathogenesis of other diseases, must also be carefully addressed. The physiological principles upon which the diet is based should be matched to the physiology associated with the condition being targeted, as it can be hazardous to extrapolate findings in healthy persons. There is a need for greater attention to the evaluation of dietary therapies for many chronic gastrointestinal disorders.
饮食传统上被用于改善患者的营养状况。然而，饮食也可以用于改变疾病过程，并独立于其营养作用来管理症状。在少数慢性胃肠道疾病中，饮食的改变被用于治疗，并得到了高度的证据支持。这并不是因为缺乏想法，而是更有可能是因为将这些想法转化为基于证据的实践存在困难。许多疾病的预防干预研究由于潜伏期长和发病率低而受到阻碍。饮食临床试验的设计和执行具有挑战性，而且为其提供资金更加困难。医生对营养和食物成分的知识基础往往很差，对饮食治疗的成功和坚持的态度也会造成额外的问题。然而，正如功能性肠病患者的低可发酵、寡糖、双糖和单糖及多元醇（FODMAP）（不易吸收的短链碳水化合物）饮食所证明的那样，这些想法可以成功地转化为基于证据的实践。然而，对于非营养性饮食干预，证明疗效是不够的。还必须仔细考虑饮食的不良反应，如饮食的营养充足性以及对其他疾病发病机制的影响。饮食所依据的生理原理应该与所针对的疾病的生理相匹配，因为将健康人的发现推断到其他疾病中可能是危险的。需要更多地关注许多慢性胃肠道疾病的饮食治疗的评估。
