Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands.
Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centers, University of Amsterdam, 1105 BK Amsterdam, The Netherlands.
Nutrients. 2021 Jan 13;13(1):212. doi: 10.3390/nu13010212.
The increase in incidences of pediatric Crohn's Disease (CD) worldwide has been strongly linked with dietary shifts towards a Westernized diet, ultimately leading to altered gut microbiota and disturbance in intestinal immunity and the metabolome. Multiple clinical studies in children with CD have demonstrated the high efficacy of nutritional therapy with exclusive enteral nutrition (EEN) to induce remission with an excellent safety profile. However, EEN is poorly tolerated, limiting its compliance and clinical application. This has spiked an interest in the development of alternative and better-tolerated nutritional therapy strategies. Several nutritional therapies have now been designed not only to treat the nutritional deficiencies seen in children with active CD but also to correct dysbiosis and reduce intestinal inflammation. In this review, we report the most recent insights regarding nutritional strategies in children with active CD: EEN, partial enteral nutrition (PEN), Crohn's disease exclusive diet (CDED), and CD treatment-with-eating diet (CD-TREAT). We describe their setup, efficacy, safety, and (dis)advantages as well as some of their potential mechanisms of action and perspectives. A better understanding of different nutritional therapeutic options and their mechanisms will yield better and safer management strategies for children with CD and may address the barriers and limitations of current strategies in children.
小儿克罗恩病（CD）发病率在全球范围内的上升与饮食向西方化饮食的转变密切相关，这最终导致肠道微生物群的改变以及肠道免疫和代谢组的紊乱。多项针对 CD 患儿的临床研究表明，营养治疗（即完全肠内营养，EEN）具有很高的疗效，可诱导缓解且安全性良好。然而，EEN 的耐受性较差，限制了其依从性和临床应用。这激发了人们对开发替代且耐受性更好的营养治疗策略的兴趣。目前已经设计了多种营养疗法，不仅可以治疗活动期 CD 患儿的营养缺乏，还可以纠正肠道菌群失调和减轻肠道炎症。在这篇综述中，我们报告了关于活动期 CD 患儿的营养策略的最新见解：EEN、部分肠内营养（PEN）、CD 特殊饮食（CDED）和 CD 饮食治疗（CD-TREAT）。我们描述了它们的设置、疗效、安全性和优缺点，以及它们的一些潜在作用机制和前景。更好地了解不同的营养治疗选择及其机制将为 CD 患儿提供更好和更安全的管理策略，并可能解决当前策略在儿童中存在的障碍和局限性。
