Vasudevan Jaya, DiVincenzo Clara, Feagins Linda A
Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin, Texas.
Division of Gastroenterology and Hepatology, Dell Medical School at The University of Texas at Austin, Austin, Texas.
Gastroenterol Hepatol (N Y). 2022 Feb;18(2):95-103.
Inflammatory bowel disease (IBD) consists of chronic, relapsing-remitting autoimmune diseases of the gastrointestinal (GI) tract with an increasing global disease burden. Pathogenetic mechanisms are not well understood, but current hypotheses involve the role of environmental factors, including dietary antigens, in immune dysregulation and proinflammatory shifts in microbial composition (gut dysbiosis) in genetically susceptible individuals. Increased metabolic demand and malabsorption secondary to systemic inflammation, coupled with significant GI symptoms that lead to reduced oral food intake, may leave patients with IBD vulnerable to developing malnutrition. The use of diet as therapy for potential induction or maintenance of remission in IBD has risen to prominence in the past several decades, especially as patients explore diet as a means to improve their symptoms and overall quality of life. However, these nutritional therapies remain underutilized by many gastroenterologists, and randomized controlled trials (RCTs) for most popular diets are lacking. Moreover, formal and consistent assessments of the nutritional status of patients with IBD in the inpatient and outpatient settings are often overlooked. To address these gaps, this article aims to discuss the progress of diet therapy and considerations for optimizing nutrition in patients with IBD, as well as summarize current RCTs evaluating efficacy for the most popular diets in IBD therapy.
炎症性肠病（IBD）是胃肠道的慢性、复发-缓解型自身免疫性疾病，全球疾病负担日益加重。其发病机制尚不完全清楚，但目前的假说认为，在遗传易感个体中，环境因素（包括饮食抗原）在免疫失调和微生物组成的促炎转变（肠道生态失调）中起作用。全身炎症继发的代谢需求增加和吸收不良，再加上导致口服食物摄入量减少的严重胃肠道症状，可能使IBD患者易发生营养不良。在过去几十年中，饮食作为IBD潜在诱导缓解或维持缓解的疗法已日益受到关注，尤其是当患者将饮食作为改善症状和整体生活质量的一种手段时。然而，许多胃肠病学家对这些营养疗法的利用仍然不足，而且缺乏针对最流行饮食的随机对照试验（RCT）。此外，在住院和门诊环境中，对IBD患者营养状况的正式和持续评估常常被忽视。为了填补这些空白，本文旨在讨论饮食疗法的进展以及优化IBD患者营养的注意事项，并总结目前评估最流行饮食在IBD治疗中疗效的RCT。
