Department of Clinical Nutrition, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
J Dig Dis. 2019 Jan;20(1):11-17. doi: 10.1111/1751-2980.12686. Epub 2018 Dec 4.
The current review aimed to elucidate the role of diet in every stage of inflammatory bowel diseases, from aspects of prevention, treatment and rehabilitation. Western diet, characterized by overconsumption of refined sugar and saturated fat and low consumption of dietary fiber, may partly be blamed for its pathogenesis. Some immune-modulated nutrients (fibers, monounsaturated fatty acids, n-3 polyunsaturated fatty acids and vitamin D) exert their potential beneficial effects on gut microbiota and immune function, resulting in clinical remission and/or preventing relapse. However, data is limited to conclude optimal micronutrient levels and therapeutic implications. Further, diet itself is complex; therefore, it is reasonable to evaluate diet as a whole rather than a single type of food. Some specific dietary patterns are generated for the management of inflammatory bowel diseases with controversial results. Only exclusive enteral nutrition has been widely recommended for pediatric patients with non-stricturing active Crohn's disease. Self-monitoring, avoidance of certain types of foods, limited intake of alcohol and smoking, supplementation of minerals and vitamins if deficiency is confirmed, and adherence to the diet enriched in vegetables and fruits and low in animal food and un-digested fiber during flares are the most common dietary recommendation. Further clinical trials with a high evidence rank are warranted.
本综述旨在从预防、治疗和康复等方面阐明饮食在炎症性肠病各个阶段的作用。西方饮食的特点是精制糖和饱和脂肪摄入过多，膳食纤维摄入不足，其发病机制部分归咎于此。一些具有免疫调节作用的营养素（纤维、单不饱和脂肪酸、n-3 多不饱和脂肪酸和维生素 D）对肠道菌群和免疫功能发挥潜在的有益作用，从而实现临床缓解和/或预防复发。然而，目前的数据还不足以确定最佳的微量营养素水平和治疗意义。此外，饮食本身很复杂；因此，评估整个饮食而不是单一类型的食物是合理的。一些特定的饮食模式被用于炎症性肠病的管理，但结果存在争议。只有完全肠内营养被广泛推荐用于非狭窄性活动性克罗恩病的儿科患者。自我监测、避免某些类型的食物、限制饮酒和吸烟、在确认缺乏时补充矿物质和维生素、以及在疾病发作期间遵循富含蔬菜和水果、低动物食品和未消化纤维的饮食，是最常见的饮食建议。需要进一步进行具有高证据等级的临床试验。
