克罗恩病排除饮食在儿童克罗恩病中的应用
The Application of Crohn’s Disease Exclusion Diet in Children with Crohn’s Disease
DOI: 10.12677/acm.2024.1441206, PDF,   
作者: 秦 欢, 王玉婷*:重庆医科大学附属儿童医院消化科,儿童发育疾病研究教育部重点实验室,国家儿童健康与疾病临床医学研究中心,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,重庆
关键词: 克罗恩病儿童克罗恩病排除饮食部分肠内营养Crohn’s Disease Child Crohn’s Disease Exclusion Diet Partial Enteral Nutrition
摘要: 儿童克罗恩病(CD)的发病率不断升高,饮食在克罗恩病的发生发展中起着重要作用,且克罗恩病患儿易出现营养不良问题,营养治疗显得尤为重要。指南推荐将全肠内营养(EEN)作为一线诱导缓解方案,但EEN具有不耐受等问题,克罗恩病排除饮食(CDED)联合部分肠内营养(PEN)具有比EEN耐受性好等优势,是目前的研究热点。本文旨在对CDED联合PEN在儿童克罗恩病中的应用进行阐述,为营养治疗在儿童克罗恩病中的应用提供新的思路。
Abstract: The incidence of Crohn’s disease (CD) in children is increasing, diet plays an important role in the occurrence and development of Crohn’s disease, and children with Crohn’s disease are prone to malnutrition, and nutrition therapy is particularly important. Guidelines recommend exclusive enteral nutrition (EEN) as a first-line regimen to induce remission, but there is a problem with EEN that is not tolerated. Crohn’s disease exclusion diet (CDED) with partial enteral nutrition (PEN) has the advantage of better tolerance than EEN, and is a research hotspot. This article aims to elaborate the application of CDED with PEN in children with Crohn’s disease, and to provide new ideas for the application of nutrition therapy in children with Crohn’s disease.
文章引用:秦欢, 王玉婷. 克罗恩病排除饮食在儿童克罗恩病中的应用[J]. 临床医学进展, 2024, 14(4): 1660-1665. https://doi.org/10.12677/acm.2024.1441206

参考文献

[1] Kuenzig, M.E., Fung, S.G., Marderfeld, L., Mak, J.W.Y., Kaplan, G.G., Ng, S.C., Wilson, D.C., Cameron, F., Henderson, P., Kotze, P.G., et al. (2022) Twenty-First Century Trends in the Global Epidemiology of Pediatric-Onset Inflammatory Bowel Disease: Systematic Review. Gastroenterology, 162, 1147-1159.E4. [Google Scholar] [CrossRef] [PubMed]
[2] Sanmarco, L.M., Chao, C.C., Wang, Y.C., Kenison, J.E., Li, Z., Rone, J.M., Rejano-Gordillo, C.M., Polonio, C.M., Gutierrez-Vazquez, C., Piester, G., et al. (2022) Identification of Environmental Factors That Promote Intestinal Inflammation. Nature, 611, 801-809. [Google Scholar] [CrossRef] [PubMed]
[3] Noble, A.J., Nowak, J.K., Adams, A.T., Uhlig, H.H. and Satsangi, J. (2023) Defining Interactions between the Genome, Epigenome, and the Environment in Inflammatory Bowel Disease: Progress and Prospects. Gastroenterology, 165, 44-60.E2. [Google Scholar] [CrossRef] [PubMed]
[4] Sasson, A.N., Ananthakrishnan, A.N. and Raman, M. (2021) Diet in Treatment of Inflammatory Bowel Diseases. Clinical Gastroenterology and Hepatology, 19, 425-435.E3. [Google Scholar] [CrossRef] [PubMed]
[5] Piovani, D., Danese, S., Peyrin-Biroulet, L., Nikolopoulos, G.K., Lytras, T. and Bonovas, S. (2019) Environmental Risk Factors for Inflammatory Bowel Diseases: An Umbrella Review of Meta-Analyses. Gastroenterology, 157, 647-659.E4. [Google Scholar] [CrossRef] [PubMed]
[6] Vasseur, F., Gower-Rousseau, C., Vernier-Massouille, G., Dupas, J.L., Merle, V., Merlin, B., Lerebours, E., Savoye, G., Salomez, J.L., Cortot, A., et al. (2010) Nutritional Status and Growth in Pediatric Crohn’s Disease: A Population-Based Study. American Journal of Gastroenterology, 105, 1893-1900. [Google Scholar] [CrossRef] [PubMed]
[7] 中华医学会肠内肠外营养学分会, 中国医药教育协会炎症性肠病专业委员会. 中国炎症性肠病营养诊疗共识[J]. 中华消化病与影像杂志(电子版), 2021, 11(1): 8-15.
[8] Van Rheenen, P.F., Aloi, M., Assa, A., Bronsky, J., Escher, J.C., Fagerberg, U.L., Gasparetto, M., Gerasimidis, K., Griffiths, A., Henderson, P., et al. (2020) the Medical Management of Paediatric Crohn’s Disease: An ECCO-ESPGHAN Guideline Update. Journal of Crohns and Colitis, 15, 171-194. [Google Scholar] [CrossRef] [PubMed]
[9] Herrador-Lopez, M., Martin-Masot, R. and Navas-Lopez, V.M. (2020) EEN Yesterday and Today ... CDED Today and Tomorrow. Nutrients, 12, Article 3793. [Google Scholar] [CrossRef] [PubMed]
[10] Levine, A., Wine, E., Assa, A., Sigall, Boneh, R., Shaoul, R., Kori, M., Cohen, S., Peleg, S., Shamaly, H., On, A., et al. (2019) Crohn’s Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial. Gastroenterology, 157, 440-450.E8. [Google Scholar] [CrossRef] [PubMed]
[11] 薛宁, 魏绪霞. 定制饮食与炎症性肠病研究进展[J]. 肠外与肠内营养, 2022, 29(6): 375-379.
[12] Ghiboub, M., Penny, S., Verburgt, C.M., Boneh, R.S., Wine, E., Cohen, A., Dunn, K.A., Pinto, D.M., Benninga, M.A., De Jonge, W.J., et al. (2022) Metabolome Changes with Diet-Induced Remission in Pediatric Crohn’s Disease. Gastroenterology, 163, 922-936.E15. [Google Scholar] [CrossRef] [PubMed]
[13] Bischoff, S.C., Bager, P., Escher, J., Forbes, A., Hebuterne, X., Hvas, C.L., Joly, F., Klek, S., Krznaric, Z., Ockenga, J., et al. (2023) ESPEN Guideline on Clinical Nutrition in Inflammatory Bowel Disease. Clinical Nutrition, 42, 352-379. [Google Scholar] [CrossRef] [PubMed]
[14] Sigall-Boneh, R., Pfeffer-Gik, T., Segal, I., Zangen, T., Boaz, M. and Levine, A. (2014) Partial Enteral Nutrition with a Crohn’s Disease Exclusion Diet Is Effective for Induction of Remission in Children and Young Adults with Crohn’s Disease. Inflammatory Bowel Diseases, 20, 1353-1360. [Google Scholar] [CrossRef
[15] Sigall-Boneh, R., Levine, A., Lomer, M., Wierdsma, N., Allan, P., Fiorino, G., Gatti, S., Jonkers, D., Kierkus, J., Katsanos, K.H., et al. (2017) Research Gaps in Diet and Nutrition in Inflammatory Bowel Disease. A Topical Review by D-ECCO Working Group [Dietitians of ECCO]. Journal of Crohns and Colitis, 11, 1407-1419. [Google Scholar] [CrossRef] [PubMed]
[16] Levine, A., El-Matary, W. and Van Limbergen, J. (2020) A Case-Based Approach to New Directions in Dietary Therapy of Crohn’s Disease: Food for Thought. Nutrients, 12, Article 880. [Google Scholar] [CrossRef] [PubMed]
[17] Yanai, H., Levine, A., Hirsch, A., Boneh, R.S., Kopylov, U., Eran, H.B., Cohen, N.A., Ron, Y., Goren, I., Leibovitzh, H., et al. (2022) The Crohn’s Disease Exclusion Diet for Induction and Maintenance of Remission in Adults with Mild-to-Moderate Crohn’s Disease (CDED-AD): An Open-Label, Pilot, Randomised Trial. The Lancet Gastroenterology and Hepatology, 7, 49-59. [Google Scholar] [CrossRef
[18] Adolph, T.E., Meyer, M., Schwarzler, J., Mayr, L., Grabherr, F. and Tilg, H. (2022) The Metabolic Nature of Inflammatory Bowel Diseases. Nature Reviews Gastroenterology & Hepatology, 19, 753-767. [Google Scholar] [CrossRef] [PubMed]
[19] Lo, C.H., Lochhead, P., Khalili, H., Song, M., Tabung, F.K., Burke, K.E., Richter, J.M., Giovannucci, E.L., Chan, A.T. and Ananthakrishnan, A.N. (2020) Dietary Inflammatory Potential and Risk of Crohn’s Disease and Ulcerative Colitis. Gastroenterology, 159, 873-883.E1. [Google Scholar] [CrossRef] [PubMed]
[20] Verburgt, C.M., Dunn, K.A., Ghiboub, M., Lewis, J.D., Wine, E., Sigall Boneh, R., Gerasimidis, K., Shamir, R., Penny, S., Pinto, D.M., et al. (2022) Successful Dietary Therapy in Paediatric Crohn’s Disease Is Associated with Shifts in Bacterial Dysbiosis and Inflammatory Metabotype Towards Healthy Controls. Journal of Crohns and Colitis, 17, 61-72. [Google Scholar] [CrossRef] [PubMed]
[21] Lavelle, A. and Sokol, H. (2020) Gut Microbiota-Derived Metabolites as Key Actors in Inflammatory Bowel Disease. Nature Reviews Gastroenterology & Hepatology, 17, 223-237. [Google Scholar] [CrossRef] [PubMed]
[22] Ghosh, S., Whitley, C.S., Haribabu, B. and Jala, V.R. (2021) Regulation of Intestinal Barrier Function by Microbial Metabolites. Cellular and Molecular Gastroenterology and Hepatology, 11, 1463-1482. [Google Scholar] [CrossRef] [PubMed]
[23] Proietti, E., Rossini, S., Grohmann, U. and Mondanelli, G. (2020) Polyamines and Kynurenines at the Intersection of Immune Modulation. Trends in Immunology, 41, 1037-1050. [Google Scholar] [CrossRef] [PubMed]
[24] Yu, Y., Chen, K.C. and Chen, J. (2019) Exclusive Enteral Nutrition versus Corticosteroids for Treatment of Pediatric Crohn’s Disease: A Meta-Analysis. World Journal of Pediatrics, 15, 26-36. [Google Scholar] [CrossRef] [PubMed]
[25] Sigall Boneh, R., Sarbagili Shabat, C., Yanai, H., Chermesh, I., Ben,Avraham, S., Boaz, M. and Levine, A. (2017) Dietary Therapy with the Crohn’s Disease Exclusion Diet Is a Successful Strategy for Induction of Remission in Children and Adults Failing Biological Therapy. Journal of Crohns and Colitis, 11, 1205-1212. [Google Scholar] [CrossRef] [PubMed]
[26] Sigall Boneh, R., Van Limbergen, J., Wine, E., Assa, A., Shaoul, R., Milman, P., Cohen, S., Kori, M., Peleg, S., On, A., et al. (2021) Dietary Therapies Induce Rapid Response and Remission in Pediatric Patients with Active Crohn’s Disease. Clinical Gastroenterology and Hepatology, 19, 752-759. [Google Scholar] [CrossRef] [PubMed]
[27] Yelencich, E., Truong, E., Widaman, A.M., Pignotti, G., Yang, L., Jeon, Y., Weber, A.T., Shah, R., Smith, J., Sauk, J.S. and Limketkai, B.N. (2022) Avoidant Restrictive Food Intake Disorder Prevalent among Patients with Inflammatory Bowel Disease. Clinical Gastroenterology and Hepatology, 20, 1282-1289.E1. [Google Scholar] [CrossRef] [PubMed]