Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, California; Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Medicine, University of Miami, Miami, Florida.
Clin Gastroenterol Hepatol. 2023 Sep;21(10):2508-2525.e10. doi: 10.1016/j.cgh.2022.11.026. Epub 2022 Dec 5.
BACKGROUND & AIMS: This study aimed (1) to systematically review controlled trials of solid food diets for the treatment of inflammatory bowel disease (IBD); and (2) to grade the overall quality of evidence.
Systematic review of prospective controlled trials of solid food diets for the induction or maintenance of remission in IBD. Two authors independently performed study selection, data extraction, and assessment of certainty of evidence. Meta-analyses were performed on studies with quantitative data on response, remission, and relapse.
There were 27 studies for meta-analysis. For induction of remission in Crohn's disease (CD), low refined carbohydrate diet and symptoms-guided diet outperformed controls, but studies had serious imprecision and very low certainty of evidence. The Mediterranean diet was similar to the Specific Carbohydrate Diet (low certainty of evidence), and partial enteral nutrition (PEN) was similar to exclusive enteral nutrition (very low certainty of evidence). PEN reduced risk of relapse (very low certainty of evidence), whereas reduction of red meat or refined carbohydrates did not (low certainty of evidence). For ulcerative colitis, diets were similar to controls (very low and low certainty of evidence).
Among the most robust dietary trials in IBD currently available, certainty of evidence remains very low or low. Nonetheless, emerging data suggest potential benefit with PEN for induction and maintenance of remission in CD. Reduction of red meat and refined carbohydrates might not reduce risk of CD relapse. As more dietary studies become available, the certainty of evidence could improve, thus allowing for more meaningful recommendations for patients.
本研究旨在：（1）系统评价治疗炎症性肠病（IBD）的固体食物饮食的对照试验；（2）对整体证据质量进行分级。
对用于诱导或维持 IBD 缓解的固体食物饮食的前瞻性对照试验进行系统评价。两名作者独立进行了研究选择、数据提取和证据确定性评估。对有定量数据的反应、缓解和复发的研究进行了荟萃分析。
共有 27 项研究进行了荟萃分析。对于克罗恩病（CD）的缓解诱导，低精制碳水化合物饮食和症状导向饮食优于对照组，但研究存在严重的不精确性和极低的证据确定性。地中海饮食与特定碳水化合物饮食（低确定性证据）相似，而部分肠内营养（PEN）与完全肠内营养（极低确定性证据）相似。PEN 降低了复发的风险（极低确定性证据），而减少红肉或精制碳水化合物则没有（低确定性证据）。对于溃疡性结肠炎，饮食与对照组相似（极低和低确定性证据）。
在目前可获得的最具说服力的 IBD 饮食试验中，证据的确定性仍然非常低或低。尽管如此，新出现的数据表明 PEN 在诱导和维持 CD 缓解方面可能具有潜在的益处。减少红肉和精制碳水化合物可能不会降低 CD 复发的风险。随着更多的饮食研究可用，证据的确定性可能会提高，从而为患者提供更有意义的建议。
