Department of Paediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
Immunology. 2018 Sep;155(1):36-52. doi: 10.1111/imm.12939. Epub 2018 May 16.
Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract, thought to at least in part reflect an aberrant immune response to gut bacteria. IBD is increasing in incidence, particularly in populations that have recently immigrated to western countries. This suggests that environmental factors are involved in its pathogenesis. We hypothesize that the increase in IBD rates might reflect the consumption of an unhealthy Western diet, containing excess calories and lacking in key nutritional factors, such as fibre and vitamin D. Several recent studies have determined that dietary factors can dramatically influence the activation of immune cells and the mediators they release through a process called immunonutrition. Moreover, dietary changes can profoundly affect the balance of beneficial versus pathogenic bacteria in the gut. This microbial imbalance can alter levels of microbiota-derived metabolites that in turn can influence innate and adaptive intestinal immune responses. If the diet-gut microbiome disease axis does indeed underpin much of the 'western' influence on the onset and progression of IBD, then tremendous opportunity exists for therapeutic changes in lifestyle, to modulate the gut microbiome and to correct immune imbalances in individuals with IBD. This review highlights four such therapeutic strategies - probiotics, prebiotics, vitamin D and caloric restriction - that have the potential to improve and add to current IBD treatment regimens.
炎症性肠病（IBD）是一种胃肠道的慢性炎症性疾病，至少部分反映了对肠道细菌的异常免疫反应。IBD 的发病率正在上升，特别是在最近移民到西方国家的人群中。这表明环境因素参与了其发病机制。我们假设 IBD 发病率的增加可能反映了不健康的西方饮食的摄入，这种饮食含有过多的卡路里，缺乏关键的营养因素，如纤维和维生素 D。最近的几项研究已经确定，饮食因素可以通过一种称为免疫营养的过程，显著影响免疫细胞的激活及其释放的介质。此外，饮食的改变可以深刻地影响肠道中有益菌和致病菌的平衡。这种微生物失衡可以改变微生物衍生代谢物的水平，进而影响肠道先天和适应性免疫反应。如果饮食-肠道微生物组-疾病轴确实是“西方”对 IBD 的发病和进展产生影响的基础，那么在生活方式、调节肠道微生物组和纠正 IBD 患者免疫失衡方面，就有巨大的治疗机会。这篇综述强调了四种有潜力改善和补充当前 IBD 治疗方案的治疗策略，即益生菌、益生元、维生素 D 和热量限制。
