Norwich Medical School, University of East Anglia, Norwich Research Park, UK; Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Saudi Arabia.
Norwich Medical School, University of East Anglia, Norwich Research Park, UK.
Clin Nutr. 2019 Feb;38(1):90-99. doi: 10.1016/j.clnu.2017.12.018. Epub 2017 Dec 28.
BACKGROUND & AIMS: The role of enteral nutrition (EN) fat composition in regulating inflammation in Crohn's disease (CD) is not clear. There is, moreover, insufficient evidence to guide the choice of EN in CD with any confidence. We have reanalysed the findings of previous studies in a systematic review focussing on the relationship between EN fat content and remission rates (RR).
A systematic search with no language restriction was undertaken in Medline and Embase databases supplemented by a manual search in the reference lists of identified studies. The selection criteria were: clinical trial, exclusive EN, adults and CD. Data on the type of EN, its fat composition, achieved RR, and study design were extracted. An established assessment tool was used to assess the quality of the studies.
A total of 29 clinical trials are included in this review. The quality of the studies was highly variable. No fewer than 27 formulations of enteral feed were identified including 4 elemental and 23 non-elemental preparations. There was a positive correlation between the total n-6 fatty acid content and response rates, which was significant when expressed as the ratio between n-6 and n-3 fatty acids (r = 0.378, p = 0.018). A non-significant positive trend was founded (r = 0.072; p = 0.643) between medium chain triglycerides (MCT) delivery as a percentage of the total energy provision and RR. While a non-significant negative trend was reported for the delivery of monounsaturated fatty acids (MUFA) (r = -0.23, p = 0.13). A qualitative advantage to regimens based on safflower oil suggest that optimised therapeutic approaches are within reach.
肠内营养（EN）脂肪成分在调节克罗恩病（CD）中的炎症作用尚不清楚。此外，没有足够的证据有信心地指导 CD 中 EN 的选择。我们在一项系统评价中重新分析了之前研究的结果，该系统评价重点关注 EN 脂肪含量与缓解率（RR）之间的关系。
我们在 Medline 和 Embase 数据库中进行了无语言限制的系统搜索，并通过手动搜索已确定研究的参考文献进行了补充。选择标准为：临床试验、EN 专用、成人和 CD。提取关于 EN 类型、脂肪组成、RR 及研究设计的数据。使用既定的评估工具评估研究质量。
共有 29 项临床试验纳入本综述。研究质量差异很大。确定了至少 27 种肠内喂养配方，包括 4 种要素制剂和 23 种非要素制剂。n-6 脂肪酸总含量与反应率呈正相关，当以 n-6 与 n-3 脂肪酸的比值表示时，这种相关性具有统计学意义（r = 0.378，p = 0.018）。发现 MCT 作为总能量供给的百分比与 RR 之间存在非显著正趋势（r = 0.072；p = 0.643）。而 MUFA 的供应与 RR 呈负相关（r = -0.23，p = 0.13）。葵花籽油为基础的方案具有定性优势，表明优化的治疗方法是可行的。
