Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Crohn's and Colitis Center, Department of Medicine, Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida.
Gastroenterology. 2017 Feb;152(2):398-414.e6. doi: 10.1053/j.gastro.2016.10.019. Epub 2016 Oct 25.
The most common question asked by patients with inflammatory bowel disease (IBD) is, "Doctor, what should I eat?" Findings from epidemiology studies have indicated that diets high in animal fat and low in fruits and vegetables are the most common pattern associated with an increased risk of IBD. Low levels of vitamin D also appear to be a risk factor for IBD. In murine models, diets high in fat, especially saturated animal fats, also increase inflammation, whereas supplementation with omega 3 long-chain fatty acids protect against intestinal inflammation. Unfortunately, omega 3 supplements have not been shown to decrease the risk of relapse in patients with Crohn's disease. Dietary intervention studies have shown that enteral therapy, with defined formula diets, helps children with Crohn's disease and reduces inflammation and dysbiosis. Although fiber supplements have not been shown definitively to benefit patients with IBD, soluble fiber is the best way to generate short-chain fatty acids such as butyrate, which has anti-inflammatory effects. Addition of vitamin D and curcumin has been shown to increase the efficacy of IBD therapy. There is compelling evidence from animal models that emulsifiers in processed foods increase risk for IBD. We discuss current knowledge about popular diets, including the specific carbohydrate diet and diet low in fermentable oligo-, di-, and monosaccharides and polyols. We present findings from clinical and basic science studies to help gastroenterologists navigate diet as it relates to the management of IBD.
炎症性肠病（IBD）患者最常问的问题是：“医生，我应该吃什么？”流行病学研究的结果表明，高动物脂肪、低水果和蔬菜的饮食是与 IBD 风险增加最常见的相关模式。维生素 D 水平低似乎也是 IBD 的一个风险因素。在鼠类模型中，高脂肪饮食，尤其是饱和动物脂肪，也会增加炎症，而ω-3 长链脂肪酸的补充则可以预防肠道炎症。不幸的是，ω-3 补充剂并未显示出降低克罗恩病患者复发的风险。饮食干预研究表明，肠内营养疗法，即使用特定配方的饮食，可以帮助患有克罗恩病的儿童减轻炎症和肠道菌群失调。虽然膳食纤维补充剂并未被明确证明对 IBD 患者有益，但可溶性纤维是产生短链脂肪酸（如丁酸盐）的最佳方法，后者具有抗炎作用。添加维生素 D 和姜黄素已被证明可以提高 IBD 治疗的效果。动物模型提供了令人信服的证据，表明加工食品中的乳化剂会增加 IBD 的风险。我们讨论了关于流行饮食的现有知识，包括特定碳水化合物饮食和低可发酵寡糖、双糖和单糖及多元醇饮食。我们介绍了临床和基础科学研究的结果，以帮助胃肠病学家在管理 IBD 时了解饮食。
