Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, Hamilton, Ontario, Canada.
Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom.
Gastroenterology. 2017 Aug;153(2):395-409.e3. doi: 10.1053/j.gastro.2017.04.009. Epub 2017 Apr 18.
BACKGROUND & AIMS: Patients with celiac disease should maintain a gluten-free diet (GFD), excluding wheat, rye, and barley. Oats might increase the nutritional value of a GFD, but their inclusion is controversial. We performed a systematic review and meta-analysis to evaluate the safety of oats as part of a GFD in patients with celiac disease.
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases for clinical trials and observational studies of the effects of including oats in GFD of patients with celiac disease. The studies reported patients' symptoms, results from serology tests, and findings from histologic analyses. We used the GRADE approach to assess the quality of evidence.
We identified 433 studies; 28 were eligible for analysis. Of these, 6 were randomized and 2 were not randomized controlled trials comprising a total of 661 patients-the remaining studies were observational. All randomized controlled trials used pure/uncontaminated oats. Oat consumption for 12 months did not affect symptoms (standardized mean difference: reduction in symptom scores in patients who did and did not consume oats, -0.22; 95% CI, -0.56 to 0.13; P = .22), histologic scores (relative risk for histologic findings in patients who consumed oats, 0.24; 95% CI, 0.01-4.8; P = .35), intraepithelial lymphocyte counts (standardized mean difference, 0.21; 95% CI, reduction of 1.44 to increase in 1.86), or results from serologic tests. Subgroup analyses of adults vs children did not reveal differences. The overall quality of evidence was low.
In a systematic review and meta-analysis, we found no evidence that addition of oats to a GFD affects symptoms, histology, immunity, or serologic features of patients with celiac disease. However, there were few studies for many endpoints, as well as limited geographic distribution and low quality of evidence. Rigorous double-blind, placebo-controlled, randomized controlled trials, using commonly available oats sourced from different regions, are needed.
乳糜泻患者应坚持无麸质饮食（GFD），不包括小麦、黑麦和大麦。燕麦可能会增加 GFD 的营养价值，但关于其纳入是否安全仍存在争议。我们进行了一项系统评价和荟萃分析，以评估燕麦作为乳糜泻患者 GFD 的一部分的安全性。
我们检索了 Cochrane 对照试验中心注册库、MEDLINE 和 EMBASE 数据库，以评估包含燕麦的 GFD 对乳糜泻患者的影响。这些研究报告了患者的症状、血清学检测结果和组织学分析结果。我们使用 GRADE 方法评估证据质量。
我们共检索到 433 项研究，其中 28 项符合纳入标准。这些研究中，有 6 项为随机对照试验，2 项为非随机对照试验，共纳入 661 例患者，其余研究为观察性研究。所有随机对照试验均使用纯/未污染的燕麦。食用燕麦 12 个月不会影响症状（食用和未食用燕麦的患者症状评分的标准化均数差，-0.22；95%CI，-0.56 至 0.13；P=0.22）、组织学评分（食用燕麦的患者组织学发现的相对风险，0.24；95%CI，0.01 至 4.8；P=0.35）、上皮内淋巴细胞计数（标准化均数差，0.21；95%CI，减少 1.44 至增加 1.86）或血清学检测结果。成人和儿童亚组分析未发现差异。总体证据质量较低。
在这项系统评价和荟萃分析中，我们没有发现添加燕麦到 GFD 会影响乳糜泻患者的症状、组织学、免疫或血清学特征的证据。然而，许多终点的研究较少，且研究的地理分布有限，证据质量较低。需要进行严格的双盲、安慰剂对照、随机对照试验，使用常见的、来自不同地区的燕麦源。
