Damas Oriana M, Garces Luis, Abreu Maria T
Division of Gastroenterology, University of Miami Miller School of Medicine, Clinical Research Building (CRB) Rm 971, 1120 NW 14th Street, Miami, FL, 33136, USA.
Curr Treat Options Gastroenterol. 2019 Jun;17(2):313-325. doi: 10.1007/s11938-019-00231-8.
Diet plays an integral role in development of inflammatory bowel disease (IBD) and continues to act as a mediator of intestinal inflammation once disease sets in. Most clinicians provide little dietary guidance to IBD patients, in part due to lack of knowledge in nutrition and lack of available nutritional resources. The purpose of this review is to provide clinicians with a brief summary of the latest evidence behind diets popular among IBD patients, to highlight diets with known efficacy, and to provide guidance that may help busy practitioners.
The latest studies show that exclusive enteral nutrition (EEN) remains the most effective diet for induction of remission in Crohn's disease (CD), either in the form of elemental, semi-elemental, or polymeric formulas. Recent studies also show that EEN can be useful in complicated CD including in enterocutaneous fistulas closure and to optimize nutrition in the pre-operative setting. Although new studies suggest that partial enteral nutrition supplemented with elimination diets may be beneficial in ulcerative colitis (UC) and CD, larger controlled studies are needed to support their use. The autoimmune diet also shows promise but lacks larger studies. Recent uncontrolled clinical studies evaluating the specific carbohydrate diet (SCD) suggest that this diet may improve biochemical markers of inflammation and induce mucosal healing, although larger studies are needed to support its use, especially because the SCD is very restrictive. Short-term use of the low FODMAP diet is appropriate when in the setting of an acute flare up and/or in stricturing disease, but long-term restriction of FODMAPs is not recommended given long-term changes observed in the microbiome. Recent studies suggest that avoidance of processed foods, packaged with preservatives and emulsifiers, may be important in decreasing intestinal inflammation; many of the recent popular diets share a common concept, avoidance of processed foods. In this review of the latest literature, we highlight that dietary studies are still in a rudimentary stage. Large prospective randomized control studies are underway evaluating head to head comparisons on the efficacy of some of these diets. We offer general guiding principles that may help gastroenterologists in the meantime.
饮食在炎症性肠病（IBD）的发生发展中起着不可或缺的作用，并且在疾病发生后继续作为肠道炎症的调节因素。大多数临床医生很少为IBD患者提供饮食指导，部分原因是缺乏营养知识以及缺乏可用的营养资源。本综述的目的是向临床医生简要总结IBD患者中流行的饮食背后的最新证据，突出具有已知疗效的饮食，并提供可能有助于忙碌从业者的指导。
最新研究表明，全肠内营养（EEN）仍然是诱导克罗恩病（CD）缓解最有效的饮食，无论是以要素型、半要素型还是聚合型配方的形式。最近的研究还表明，EEN可用于复杂的CD，包括肠皮肤瘘的闭合以及在术前优化营养。尽管新的研究表明补充排除饮食的部分肠内营养可能对溃疡性结肠炎（UC）和CD有益，但需要更大规模的对照研究来支持其使用。自身免疫饮食也显示出前景，但缺乏大规模研究。最近评估特定碳水化合物饮食（SCD）的非对照临床研究表明，这种饮食可能改善炎症的生化指标并诱导黏膜愈合，尽管需要更大规模的研究来支持其使用，特别是因为SCD非常严格。在急性发作和/或狭窄性疾病的情况下，短期使用低FODMAP饮食是合适的，但鉴于在微生物群中观察到的长期变化，不建议长期限制FODMAPs。最近的研究表明，避免食用含有防腐剂和乳化剂的加工食品可能对减少肠道炎症很重要；最近许多流行的饮食都有一个共同的概念，即避免食用加工食品。在对最新文献的综述中，我们强调饮食研究仍处于初级阶段。正在进行大型前瞻性随机对照研究，对其中一些饮食的疗效进行直接比较。同时，我们提供了一些可能有助于胃肠病学家的一般指导原则。
