Роль диетотерапии при болезни Крона у детей
Роль диетотерапии при болезни Крона у детей
Сара Паулино, Хорхе Амил Диас. Роль диетотерапии при болезни Крона у детей. Педиатрия (Прил. к журн. Consilium Medicum). 2018; 2: 10–16.
DOI: 10.26442/2413-8460_2018.2.10-16
DOI: 10.26442/2413-8460_2018.2.10-16
DOI: 10.26442/2413-8460_2018.2.10-16
________________________________________________
DOI: 10.26442/2413-8460_2018.2.10-16
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Аннотация
Болезнь Крона (БК) является хроническим воспалительным заболеванием, частота которого у детей растет во всем мире. Диетотерапия рассматривается в настоящее время как возможный способ индукции ремиссии заболевания, при этом более безопасный, чем фармакологические методы.
Цель настоящего обзора – изучение роли энтерального питания в процессе индукции/поддержании ремиссии БК у детей и сравнение диетотерапии с использованием кортикостероидов. В рамках публикации обсуждается значение диет, обогащенных омега-3 жирными кислотами, глутамином и трансформирующим фактором роста-b (ТФР-b). Поиск публикаций был осуществлен с использованием баз PubMed, Scopus и Web of Science. После оценки названий, тезисов и в ряде случаев полных текстов 45 статей были включены в анализ. Ряд исследований показали, что полное энтеральное питание (ПЭП) аналогично по эффективности в индукции клинической и биохимической ремиссии БК. Кроме того, ПЭП способствует восстановлению слизистой оболочки кишечника, улучшению параметров роста, массы тела и индекса массы тела. Дотация омега-3 жирных кислот не продемонстрировала эффективности в терапии БК. В ряде исследований изучалась роль дотации глутамина, однако убедительных доказательств превосходства данного подхода над стандартной диетотерапией получено не было. Помимо достижения клинической и биохимической ремиссии БК, ТФР-b продемонстрировал эффективность в процессе восстановления слизистой кишечника и снижения уровня провоспалительных цитокинов. Частичное энтеральное питание (ЧЭП) не показало эффективности в процессе индукции ремиссии, однако может быть эффективным способом поддержания ремиссии.
Основные выводы. ПЭП является наиболее оптимальным способом индукции ремиссии в большинстве случаев БК у детей. Целесообразность обогащения рациона омега-3 жирными кислотами и глутамином требует дальнейшего изучения, в то время как ТФР-β продемонстрировал свою эффективность, способствуя снижению активности заболевания. Несмотря на то что ЧЭП не является эффективным методом в индукции ремиссии БК, метод может стать эффективным дополнением к стандартной терапии с целью поддержания ремиссии.
Ключевые слова: болезнь Крона, лечение, питание, энтеральное питание, полимерная диета, педиатрия, дети.
The aim of this review is to examine the role of enteral nutrition in the induction and/or maintenance of remission in pediatric CD and compare it to corticosteroid therapy. Novel diets enriched with omega-3 fatty acids, glutamine and transforming growth factor-β (TGF-β) will also be addressed. A search was performed based on PubMed, Scopus and Web of Science. After screening titles, abstracts and some full texts, 45 articles were included. Several studies proved that exclusive enteral nutrition (EEN) is as effective in inducing clinical and biochemical remission of CD as corticosteroids. However, EEN is also capable of healing mucosa, improving height, weight and body mass index (BMI). Omega-3 supplemention has not been proven to be beneficial in the treatment of CD. Some trials investigated glutamine supplementation, but it was not demonstrated its superiority over standard diet. Besides achieving clinical and biochemical remission, TGF-β showed efficacy in mucosal healing and decreasing pro-inflammatory cytokine levels. Partial enteral nutrition (PEN) was not proved to be effective in inducing remission, but seems that it can be beneficial in the maintenance of remission.
Conclusions. EEN has shown to be the best option to induce remission in most cases of pediatric CD. The role of enrichment with omega-3 fatty acids and glutamine is not conclusive, while TGF-β appears to be effective, leading to improvement of disease activity. Although PEN is not effective in inducing remission, it seems to be beneficial as a supportive therapy for maintenance of disease remission.
Key words: Crohn’s disease, treatment, nutrition, enteral nutrition, polymeric diet, pediatric, children.
Цель настоящего обзора – изучение роли энтерального питания в процессе индукции/поддержании ремиссии БК у детей и сравнение диетотерапии с использованием кортикостероидов. В рамках публикации обсуждается значение диет, обогащенных омега-3 жирными кислотами, глутамином и трансформирующим фактором роста-b (ТФР-b). Поиск публикаций был осуществлен с использованием баз PubMed, Scopus и Web of Science. После оценки названий, тезисов и в ряде случаев полных текстов 45 статей были включены в анализ. Ряд исследований показали, что полное энтеральное питание (ПЭП) аналогично по эффективности в индукции клинической и биохимической ремиссии БК. Кроме того, ПЭП способствует восстановлению слизистой оболочки кишечника, улучшению параметров роста, массы тела и индекса массы тела. Дотация омега-3 жирных кислот не продемонстрировала эффективности в терапии БК. В ряде исследований изучалась роль дотации глутамина, однако убедительных доказательств превосходства данного подхода над стандартной диетотерапией получено не было. Помимо достижения клинической и биохимической ремиссии БК, ТФР-b продемонстрировал эффективность в процессе восстановления слизистой кишечника и снижения уровня провоспалительных цитокинов. Частичное энтеральное питание (ЧЭП) не показало эффективности в процессе индукции ремиссии, однако может быть эффективным способом поддержания ремиссии.
Основные выводы. ПЭП является наиболее оптимальным способом индукции ремиссии в большинстве случаев БК у детей. Целесообразность обогащения рациона омега-3 жирными кислотами и глутамином требует дальнейшего изучения, в то время как ТФР-β продемонстрировал свою эффективность, способствуя снижению активности заболевания. Несмотря на то что ЧЭП не является эффективным методом в индукции ремиссии БК, метод может стать эффективным дополнением к стандартной терапии с целью поддержания ремиссии.
Ключевые слова: болезнь Крона, лечение, питание, энтеральное питание, полимерная диета, педиатрия, дети.
________________________________________________
The aim of this review is to examine the role of enteral nutrition in the induction and/or maintenance of remission in pediatric CD and compare it to corticosteroid therapy. Novel diets enriched with omega-3 fatty acids, glutamine and transforming growth factor-β (TGF-β) will also be addressed. A search was performed based on PubMed, Scopus and Web of Science. After screening titles, abstracts and some full texts, 45 articles were included. Several studies proved that exclusive enteral nutrition (EEN) is as effective in inducing clinical and biochemical remission of CD as corticosteroids. However, EEN is also capable of healing mucosa, improving height, weight and body mass index (BMI). Omega-3 supplemention has not been proven to be beneficial in the treatment of CD. Some trials investigated glutamine supplementation, but it was not demonstrated its superiority over standard diet. Besides achieving clinical and biochemical remission, TGF-β showed efficacy in mucosal healing and decreasing pro-inflammatory cytokine levels. Partial enteral nutrition (PEN) was not proved to be effective in inducing remission, but seems that it can be beneficial in the maintenance of remission.
Conclusions. EEN has shown to be the best option to induce remission in most cases of pediatric CD. The role of enrichment with omega-3 fatty acids and glutamine is not conclusive, while TGF-β appears to be effective, leading to improvement of disease activity. Although PEN is not effective in inducing remission, it seems to be beneficial as a supportive therapy for maintenance of disease remission.
Key words: Crohn’s disease, treatment, nutrition, enteral nutrition, polymeric diet, pediatric, children.
Список литературы
1. Day AS, Lopez RN. Exclusive enteral nutrition in children with Crohn's disease. World J Gastroenterol 2015; 21 (22): 6809–16.
2. Sigall-Boneh R, Pfeffer-Gik T, Segal I et al. 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. Inflamm Bowel Dis 2014; 20 (8): 1353–60.
3. Cuiv PO, Begun J, Keely S et al. Towards an integrated understanding of the therapeutic utility of exclusive enteral nutrition in the treatment of Crohn's disease. Food Function 2016; 7 (4): 1741–51.
4. Ahmed I, Roy BC, Khan SA et al. Microbiome, Metabolome and Inflammatory Bowel Disease. Microorganisms 2016; 4 (2).
5. Chassaing B, Van de Wiele T, Gewirtz A. O-013 Dietary Emulsifiers Directly Impact the Human Gut Microbiota Increasing Its Pro-inflammatory Potential and Ability to Induce Intestinal Inflammation. Inflamm Bowel Dis 2017; 23 (Suppl. 1): S5.
6. Kang Y, Kim S, Kim SY, Koh H. Effect of short-term partial enteral nutrition on the treatment of younger patients with severe Crohn's disease. Gut Liver 2015; 9 (1): 87–93.
7. Ruemmele FM, Veres G, Kolho KL et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease. J Crohn Colitis 2014; 8 (10): 1179–207.
8. Sanderson IR, Udeen S, Davies PS et al. Remission induced by an elemental diet in small bowel Crohn's disease. Arch Dis Child 1987; 62 (2): 123–7.
9. Forbes A, Escher J, Hebuterne X et al. ESPEN guideline: Clinical nutrition in inflammatory bowel disease. Clinical nutrition. Edinburgh, 2016.
10. Day AS, Burgess L. Exclusive enteral nutrition and induction of remission of active Crohn's disease in children. Expert Rev Clin Immunol 2013; 9 (4): 375–83.
11. Penagini F, Dilillo D, Borsani B et al. Nutrition in Pediatric Inflammatory Bowel Disease: From Etiology to Treatment. Sys Rev Nutrients 2016; 8 (6).
12. Lee D, Baldassano RN, Otley AR et al. Comparative Effectiveness of Nutritional and Biological Therapy in North American Children with Active Crohn's Disease. Inflamm Bowel Dis 2015; 21 (8): 1786–93.
13. Dziechciarz P, Horvath A, Shamir R, Szajewska H. Meta-analysis: enteral nutrition in active Crohn's disease in children. Aliment Pharmacol Ther 2007; 26 (6): 795–806.
14. Rajendran N, Kumar D. Role of diet in the management of inflammatory bowel disease. World J Gastroenterol 2010; 16 (12): 1442–8.
15. Gavin J, Anderson CE, Bremner AR, Beattie RM. Energy intakes of children with Crohn's disease treated with enteral nutrition as primary therapy. J Hum Nutr Dietetic 2005; 18 (5): 337–42.
16. Frivolt K, Schwerd T, Werkstetter KJ et al. Repeated exclusive enteral nutrition in the treatment of paediatric Crohn's 17 disease: predictors of efficacy and outcome. Aliment Pharmacol Ther 2014; 39 (12): 1398–407.
17. Rodrigues AF, Johnson T, Davies P, Murphy MS. Does polymeric formula improve adherence to liquid diet therapy in children with active Crohn's disease? Arch Dis Child 2007; 92 (9): 767–70.
18. Grogan JL, Casson DH, Terry A et al. Enteral feeding therapy for newly diagnosed pediatric Crohn's disease: a doubleblind randomized controlled trial with two years follow-up. Inflamm Bowel Dis 2012; 18 (2): 246–53.
19. Ludvigsson JF, Krantz M, Bodin L et al. Elemental versus polymeric enteral nutrition in paediatric Crohn's disease: a multicentre randomized controlled trial. Acta Paediatrica 2004; 93 (3): 327–35.
20. Borrelli O, Cordischi L, Cirulli M et al. Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohn's disease: a randomized controlled open-label trial. Clin Gastroenterol Hepatol 2006; 4 (6): 744–53.
21. Berni Canani R, Terrin G, Borrelli O et al. Short- and long-term therapeutic efficacy of nutritional therapy and corticosteroids in paediatric Crohn's disease. Dig Liver Dis 2006; 38 (6): 381–7.
22. Grover Z, Muir R, Lewindon P. Exclusive enteral nutrition induces early clinical, mucosal and transmural remission in paediatric Crohn's disease. J Gastroenterol 2014; 49 (4): 638–45.
23. Jong NS, Leach ST, Day AS. Polymeric formula has direct antiinflammatory effects on enterocytes in an in vitro model of intestinal inflammation. Dig Dis Sci 2007; 52 (9): 2029–36.
24. Sylvester FA. Effects of exclusive enteral nutrition on bone mass, linear growth and body composition in children with Crohn's disease. Nestle Nutrition Inst Workshop Ser 2014; 79: 125–30.
25. Lambert B, Lemberg DA, Leach ST, Day AS. Longer-term outcomes of nutritional management of Crohn's disease in children. Dig Dis Sci 2012; 57 (8): 2171–7.
26. Leach ST, Mitchell HM, Eng WR et al. Sustained modulation of intestinal bacteria by exclusive enteral nutrition used to treat children with Crohn's disease. Aliment pharmacol Ther 2008; 28 (6): 724–33.
27. Dunn KA, Moore-Connors J, MacIntyre B et al. Early Changes in Microbial Community Structure Are Associated with Sustained Remission After Nutritional Treatment of Pediatric Crohn's Disease. Inflamm Bowel Dis 2016; 22 (12): 2853–62.
28. Gerasimidis K, Bertz M, Hanske L et al. Decline in presumptively protective gut bacterial species and metabolites are paradoxically associated with disease improvement in pediatric Crohn's disease during enteral nutrition. Inflamm Bowel Dis 2014; 20 (5): 861–71.
29. Lee D, Baldassano RN, Otley AR et al. Comparative Effectiveness of Nutritional and Biological Therapy in North American Children with Active Crohn’s Disease. Inflam Bowel Dis 2015; 21 (8): 1786–93.
30. Johnson T, Macdonald S, Hill SM et al. Treatment of active Crohn's disease in children using partial enteral nutrition with liquid formula: a randomised controlled trial. Gut 2006; 55 (3): 356–61.
31. Burgis JC, Nguyen K, Park KT, Cox K. Response to strict and liberalized specific carbohydrate diet in pediatric Crohn's disease. World J Gastroenterol 2016; 22 (6): 2111–7.
32. Suskind DL, Wahbeh G, Gregory N et al. Nutritional therapy in pediatric Crohn disease: the specific carbohydrate diet. J Pediatr Gastroenterol Nutr 2014; 58 (1): 87–91.
33. Cohen SA, Gold BD, Oliva S et al. Clinical and mucosal improvement with specific carbohydrate diet in pediatric Crohn disease. J Pediatr Gastroenterol Nutr 2014; 59 (4): 516–21.
34. Obih C, Wahbeh G, Lee D et al. Specific carbohydrate diet for pediatric inflammatory bowel disease in clinical practice within an academic IBD center. Nutrition 2016; 32 (4): 418–25.
35. Lewis JD, Abreu MT. Diet as a Trigger or Therapy for Inflammatory Bowel Diseases. Gastroenterology 2017; 152 (2): 398–414.e6.
36. Scholz D. The role of nutrition in the etiology of inflammatory bowel disease. Cur probl pediatr 2011; 41 (9): 248–53.
37. Costea I, Mack DR, Lemaitre RN et al. Interactions between the dietary polyunsaturated fatty acid ratio and genetic factors determine susceptibility to pediatric Crohn's disease. Gastroenterology 2014; 146 (4): 929–31.
38. Lev-Tzion R, Griffiths AM, Leder O, Turner D. Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev 2014 (2): Cd006320.
39. Gassull MA, Fernandez-Banares F, Cabre E et al. Fat composition may be a clue to explain the primary therapeutic effect of enteral nutrition in Crohn's disease: results of a double blind randomised multicentre European trial. Gut 2002; 51 (2): 164–8.
40. Akobeng AK, Elawad M, Gordon M. Glutamine for induction of remission in Crohn's disease. Cochrane Database Syst Rev 2016; 2: Cd007348.
41. Akobeng AK, Miller V, Stanton J et al. Double-blind randomized controlled trial of glutamine-enriched polymeric diet in the treatment of active Crohn's disease. J Pediatr Gastroenterol Nutr 2000; 30 (1): 78–84.
42. Rubio A, Pigneur B, Garnier-Lengline H et al. The efficacy of exclusive nutritional therapy in paediatric Crohn's disease, comparing fractionated oral vs. continuous enteral feeding. Aliment Pharmacol Ther 2011; 33 (12): 1332–9.
43. Fell JM, Paintin M, Arnaud-Battandier F et al. Mucosal healing and a fall in mucosal pro-inflammatory cytokine mRNA induced by a specific oral polymeric diet in paediatric Crohn's disease. Aliment Pharmacol Ther 2000; 14 (3): 281–9.
44. Fell JME. Control of systemic and local inflammation with transforming growth factor beta containing formulas. J Parenter Enteral Nutrition 2005; 29 (4): S126–S33.
45. Hartman C, Berkowitz D, Weiss B et al. Nutritional supplementation with polymeric diet enriched with transforming growth factor-beta 2 for children with Crohn's disease. IMAJ 2008; 10 (7): 503–7.
2. Sigall-Boneh R, Pfeffer-Gik T, Segal I et al. 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. Inflamm Bowel Dis 2014; 20 (8): 1353–60.
3. Cuiv PO, Begun J, Keely S et al. Towards an integrated understanding of the therapeutic utility of exclusive enteral nutrition in the treatment of Crohn's disease. Food Function 2016; 7 (4): 1741–51.
4. Ahmed I, Roy BC, Khan SA et al. Microbiome, Metabolome and Inflammatory Bowel Disease. Microorganisms 2016; 4 (2).
5. Chassaing B, Van de Wiele T, Gewirtz A. O-013 Dietary Emulsifiers Directly Impact the Human Gut Microbiota Increasing Its Pro-inflammatory Potential and Ability to Induce Intestinal Inflammation. Inflamm Bowel Dis 2017; 23 (Suppl. 1): S5.
6. Kang Y, Kim S, Kim SY, Koh H. Effect of short-term partial enteral nutrition on the treatment of younger patients with severe Crohn's disease. Gut Liver 2015; 9 (1): 87–93.
7. Ruemmele FM, Veres G, Kolho KL et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease. J Crohn Colitis 2014; 8 (10): 1179–207.
8. Sanderson IR, Udeen S, Davies PS et al. Remission induced by an elemental diet in small bowel Crohn's disease. Arch Dis Child 1987; 62 (2): 123–7.
9. Forbes A, Escher J, Hebuterne X et al. ESPEN guideline: Clinical nutrition in inflammatory bowel disease. Clinical nutrition. Edinburgh, 2016.
10. Day AS, Burgess L. Exclusive enteral nutrition and induction of remission of active Crohn's disease in children. Expert Rev Clin Immunol 2013; 9 (4): 375–83.
11. Penagini F, Dilillo D, Borsani B et al. Nutrition in Pediatric Inflammatory Bowel Disease: From Etiology to Treatment. Sys Rev Nutrients 2016; 8 (6).
12. Lee D, Baldassano RN, Otley AR et al. Comparative Effectiveness of Nutritional and Biological Therapy in North American Children with Active Crohn's Disease. Inflamm Bowel Dis 2015; 21 (8): 1786–93.
13. Dziechciarz P, Horvath A, Shamir R, Szajewska H. Meta-analysis: enteral nutrition in active Crohn's disease in children. Aliment Pharmacol Ther 2007; 26 (6): 795–806.
14. Rajendran N, Kumar D. Role of diet in the management of inflammatory bowel disease. World J Gastroenterol 2010; 16 (12): 1442–8.
15. Gavin J, Anderson CE, Bremner AR, Beattie RM. Energy intakes of children with Crohn's disease treated with enteral nutrition as primary therapy. J Hum Nutr Dietetic 2005; 18 (5): 337–42.
16. Frivolt K, Schwerd T, Werkstetter KJ et al. Repeated exclusive enteral nutrition in the treatment of paediatric Crohn's 17 disease: predictors of efficacy and outcome. Aliment Pharmacol Ther 2014; 39 (12): 1398–407.
17. Rodrigues AF, Johnson T, Davies P, Murphy MS. Does polymeric formula improve adherence to liquid diet therapy in children with active Crohn's disease? Arch Dis Child 2007; 92 (9): 767–70.
18. Grogan JL, Casson DH, Terry A et al. Enteral feeding therapy for newly diagnosed pediatric Crohn's disease: a doubleblind randomized controlled trial with two years follow-up. Inflamm Bowel Dis 2012; 18 (2): 246–53.
19. Ludvigsson JF, Krantz M, Bodin L et al. Elemental versus polymeric enteral nutrition in paediatric Crohn's disease: a multicentre randomized controlled trial. Acta Paediatrica 2004; 93 (3): 327–35.
20. Borrelli O, Cordischi L, Cirulli M et al. Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohn's disease: a randomized controlled open-label trial. Clin Gastroenterol Hepatol 2006; 4 (6): 744–53.
21. Berni Canani R, Terrin G, Borrelli O et al. Short- and long-term therapeutic efficacy of nutritional therapy and corticosteroids in paediatric Crohn's disease. Dig Liver Dis 2006; 38 (6): 381–7.
22. Grover Z, Muir R, Lewindon P. Exclusive enteral nutrition induces early clinical, mucosal and transmural remission in paediatric Crohn's disease. J Gastroenterol 2014; 49 (4): 638–45.
23. Jong NS, Leach ST, Day AS. Polymeric formula has direct antiinflammatory effects on enterocytes in an in vitro model of intestinal inflammation. Dig Dis Sci 2007; 52 (9): 2029–36.
24. Sylvester FA. Effects of exclusive enteral nutrition on bone mass, linear growth and body composition in children with Crohn's disease. Nestle Nutrition Inst Workshop Ser 2014; 79: 125–30.
25. Lambert B, Lemberg DA, Leach ST, Day AS. Longer-term outcomes of nutritional management of Crohn's disease in children. Dig Dis Sci 2012; 57 (8): 2171–7.
26. Leach ST, Mitchell HM, Eng WR et al. Sustained modulation of intestinal bacteria by exclusive enteral nutrition used to treat children with Crohn's disease. Aliment pharmacol Ther 2008; 28 (6): 724–33.
27. Dunn KA, Moore-Connors J, MacIntyre B et al. Early Changes in Microbial Community Structure Are Associated with Sustained Remission After Nutritional Treatment of Pediatric Crohn's Disease. Inflamm Bowel Dis 2016; 22 (12): 2853–62.
28. Gerasimidis K, Bertz M, Hanske L et al. Decline in presumptively protective gut bacterial species and metabolites are paradoxically associated with disease improvement in pediatric Crohn's disease during enteral nutrition. Inflamm Bowel Dis 2014; 20 (5): 861–71.
29. Lee D, Baldassano RN, Otley AR et al. Comparative Effectiveness of Nutritional and Biological Therapy in North American Children with Active Crohn’s Disease. Inflam Bowel Dis 2015; 21 (8): 1786–93.
30. Johnson T, Macdonald S, Hill SM et al. Treatment of active Crohn's disease in children using partial enteral nutrition with liquid formula: a randomised controlled trial. Gut 2006; 55 (3): 356–61.
31. Burgis JC, Nguyen K, Park KT, Cox K. Response to strict and liberalized specific carbohydrate diet in pediatric Crohn's disease. World J Gastroenterol 2016; 22 (6): 2111–7.
32. Suskind DL, Wahbeh G, Gregory N et al. Nutritional therapy in pediatric Crohn disease: the specific carbohydrate diet. J Pediatr Gastroenterol Nutr 2014; 58 (1): 87–91.
33. Cohen SA, Gold BD, Oliva S et al. Clinical and mucosal improvement with specific carbohydrate diet in pediatric Crohn disease. J Pediatr Gastroenterol Nutr 2014; 59 (4): 516–21.
34. Obih C, Wahbeh G, Lee D et al. Specific carbohydrate diet for pediatric inflammatory bowel disease in clinical practice within an academic IBD center. Nutrition 2016; 32 (4): 418–25.
35. Lewis JD, Abreu MT. Diet as a Trigger or Therapy for Inflammatory Bowel Diseases. Gastroenterology 2017; 152 (2): 398–414.e6.
36. Scholz D. The role of nutrition in the etiology of inflammatory bowel disease. Cur probl pediatr 2011; 41 (9): 248–53.
37. Costea I, Mack DR, Lemaitre RN et al. Interactions between the dietary polyunsaturated fatty acid ratio and genetic factors determine susceptibility to pediatric Crohn's disease. Gastroenterology 2014; 146 (4): 929–31.
38. Lev-Tzion R, Griffiths AM, Leder O, Turner D. Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev 2014 (2): Cd006320.
39. Gassull MA, Fernandez-Banares F, Cabre E et al. Fat composition may be a clue to explain the primary therapeutic effect of enteral nutrition in Crohn's disease: results of a double blind randomised multicentre European trial. Gut 2002; 51 (2): 164–8.
40. Akobeng AK, Elawad M, Gordon M. Glutamine for induction of remission in Crohn's disease. Cochrane Database Syst Rev 2016; 2: Cd007348.
41. Akobeng AK, Miller V, Stanton J et al. Double-blind randomized controlled trial of glutamine-enriched polymeric diet in the treatment of active Crohn's disease. J Pediatr Gastroenterol Nutr 2000; 30 (1): 78–84.
42. Rubio A, Pigneur B, Garnier-Lengline H et al. The efficacy of exclusive nutritional therapy in paediatric Crohn's disease, comparing fractionated oral vs. continuous enteral feeding. Aliment Pharmacol Ther 2011; 33 (12): 1332–9.
43. Fell JM, Paintin M, Arnaud-Battandier F et al. Mucosal healing and a fall in mucosal pro-inflammatory cytokine mRNA induced by a specific oral polymeric diet in paediatric Crohn's disease. Aliment Pharmacol Ther 2000; 14 (3): 281–9.
44. Fell JME. Control of systemic and local inflammation with transforming growth factor beta containing formulas. J Parenter Enteral Nutrition 2005; 29 (4): S126–S33.
45. Hartman C, Berkowitz D, Weiss B et al. Nutritional supplementation with polymeric diet enriched with transforming growth factor-beta 2 for children with Crohn's disease. IMAJ 2008; 10 (7): 503–7.
2. Sigall-Boneh R, Pfeffer-Gik T, Segal I et al. 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. Inflamm Bowel Dis 2014; 20 (8): 1353–60.
3. Cuiv PO, Begun J, Keely S et al. Towards an integrated understanding of the therapeutic utility of exclusive enteral nutrition in the treatment of Crohn's disease. Food Function 2016; 7 (4): 1741–51.
4. Ahmed I, Roy BC, Khan SA et al. Microbiome, Metabolome and Inflammatory Bowel Disease. Microorganisms 2016; 4 (2).
5. Chassaing B, Van de Wiele T, Gewirtz A. O-013 Dietary Emulsifiers Directly Impact the Human Gut Microbiota Increasing Its Pro-inflammatory Potential and Ability to Induce Intestinal Inflammation. Inflamm Bowel Dis 2017; 23 (Suppl. 1): S5.
6. Kang Y, Kim S, Kim SY, Koh H. Effect of short-term partial enteral nutrition on the treatment of younger patients with severe Crohn's disease. Gut Liver 2015; 9 (1): 87–93.
7. Ruemmele FM, Veres G, Kolho KL et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease. J Crohn Colitis 2014; 8 (10): 1179–207.
8. Sanderson IR, Udeen S, Davies PS et al. Remission induced by an elemental diet in small bowel Crohn's disease. Arch Dis Child 1987; 62 (2): 123–7.
9. Forbes A, Escher J, Hebuterne X et al. ESPEN guideline: Clinical nutrition in inflammatory bowel disease. Clinical nutrition. Edinburgh, 2016.
10. Day AS, Burgess L. Exclusive enteral nutrition and induction of remission of active Crohn's disease in children. Expert Rev Clin Immunol 2013; 9 (4): 375–83.
11. Penagini F, Dilillo D, Borsani B et al. Nutrition in Pediatric Inflammatory Bowel Disease: From Etiology to Treatment. Sys Rev Nutrients 2016; 8 (6).
12. Lee D, Baldassano RN, Otley AR et al. Comparative Effectiveness of Nutritional and Biological Therapy in North American Children with Active Crohn's Disease. Inflamm Bowel Dis 2015; 21 (8): 1786–93.
13. Dziechciarz P, Horvath A, Shamir R, Szajewska H. Meta-analysis: enteral nutrition in active Crohn's disease in children. Aliment Pharmacol Ther 2007; 26 (6): 795–806.
14. Rajendran N, Kumar D. Role of diet in the management of inflammatory bowel disease. World J Gastroenterol 2010; 16 (12): 1442–8.
15. Gavin J, Anderson CE, Bremner AR, Beattie RM. Energy intakes of children with Crohn's disease treated with enteral nutrition as primary therapy. J Hum Nutr Dietetic 2005; 18 (5): 337–42.
16. Frivolt K, Schwerd T, Werkstetter KJ et al. Repeated exclusive enteral nutrition in the treatment of paediatric Crohn's 17 disease: predictors of efficacy and outcome. Aliment Pharmacol Ther 2014; 39 (12): 1398–407.
17. Rodrigues AF, Johnson T, Davies P, Murphy MS. Does polymeric formula improve adherence to liquid diet therapy in children with active Crohn's disease? Arch Dis Child 2007; 92 (9): 767–70.
18. Grogan JL, Casson DH, Terry A et al. Enteral feeding therapy for newly diagnosed pediatric Crohn's disease: a doubleblind randomized controlled trial with two years follow-up. Inflamm Bowel Dis 2012; 18 (2): 246–53.
19. Ludvigsson JF, Krantz M, Bodin L et al. Elemental versus polymeric enteral nutrition in paediatric Crohn's disease: a multicentre randomized controlled trial. Acta Paediatrica 2004; 93 (3): 327–35.
20. Borrelli O, Cordischi L, Cirulli M et al. Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohn's disease: a randomized controlled open-label trial. Clin Gastroenterol Hepatol 2006; 4 (6): 744–53.
21. Berni Canani R, Terrin G, Borrelli O et al. Short- and long-term therapeutic efficacy of nutritional therapy and corticosteroids in paediatric Crohn's disease. Dig Liver Dis 2006; 38 (6): 381–7.
22. Grover Z, Muir R, Lewindon P. Exclusive enteral nutrition induces early clinical, mucosal and transmural remission in paediatric Crohn's disease. J Gastroenterol 2014; 49 (4): 638–45.
23. Jong NS, Leach ST, Day AS. Polymeric formula has direct antiinflammatory effects on enterocytes in an in vitro model of intestinal inflammation. Dig Dis Sci 2007; 52 (9): 2029–36.
24. Sylvester FA. Effects of exclusive enteral nutrition on bone mass, linear growth and body composition in children with Crohn's disease. Nestle Nutrition Inst Workshop Ser 2014; 79: 125–30.
25. Lambert B, Lemberg DA, Leach ST, Day AS. Longer-term outcomes of nutritional management of Crohn's disease in children. Dig Dis Sci 2012; 57 (8): 2171–7.
26. Leach ST, Mitchell HM, Eng WR et al. Sustained modulation of intestinal bacteria by exclusive enteral nutrition used to treat children with Crohn's disease. Aliment pharmacol Ther 2008; 28 (6): 724–33.
27. Dunn KA, Moore-Connors J, MacIntyre B et al. Early Changes in Microbial Community Structure Are Associated with Sustained Remission After Nutritional Treatment of Pediatric Crohn's Disease. Inflamm Bowel Dis 2016; 22 (12): 2853–62.
28. Gerasimidis K, Bertz M, Hanske L et al. Decline in presumptively protective gut bacterial species and metabolites are paradoxically associated with disease improvement in pediatric Crohn's disease during enteral nutrition. Inflamm Bowel Dis 2014; 20 (5): 861–71.
29. Lee D, Baldassano RN, Otley AR et al. Comparative Effectiveness of Nutritional and Biological Therapy in North American Children with Active Crohn’s Disease. Inflam Bowel Dis 2015; 21 (8): 1786–93.
30. Johnson T, Macdonald S, Hill SM et al. Treatment of active Crohn's disease in children using partial enteral nutrition with liquid formula: a randomised controlled trial. Gut 2006; 55 (3): 356–61.
31. Burgis JC, Nguyen K, Park KT, Cox K. Response to strict and liberalized specific carbohydrate diet in pediatric Crohn's disease. World J Gastroenterol 2016; 22 (6): 2111–7.
32. Suskind DL, Wahbeh G, Gregory N et al. Nutritional therapy in pediatric Crohn disease: the specific carbohydrate diet. J Pediatr Gastroenterol Nutr 2014; 58 (1): 87–91.
33. Cohen SA, Gold BD, Oliva S et al. Clinical and mucosal improvement with specific carbohydrate diet in pediatric Crohn disease. J Pediatr Gastroenterol Nutr 2014; 59 (4): 516–21.
34. Obih C, Wahbeh G, Lee D et al. Specific carbohydrate diet for pediatric inflammatory bowel disease in clinical practice within an academic IBD center. Nutrition 2016; 32 (4): 418–25.
35. Lewis JD, Abreu MT. Diet as a Trigger or Therapy for Inflammatory Bowel Diseases. Gastroenterology 2017; 152 (2): 398–414.e6.
36. Scholz D. The role of nutrition in the etiology of inflammatory bowel disease. Cur probl pediatr 2011; 41 (9): 248–53.
37. Costea I, Mack DR, Lemaitre RN et al. Interactions between the dietary polyunsaturated fatty acid ratio and genetic factors determine susceptibility to pediatric Crohn's disease. Gastroenterology 2014; 146 (4): 929–31.
38. Lev-Tzion R, Griffiths AM, Leder O, Turner D. Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev 2014 (2): Cd006320.
39. Gassull MA, Fernandez-Banares F, Cabre E et al. Fat composition may be a clue to explain the primary therapeutic effect of enteral nutrition in Crohn's disease: results of a double blind randomised multicentre European trial. Gut 2002; 51 (2): 164–8.
40. Akobeng AK, Elawad M, Gordon M. Glutamine for induction of remission in Crohn's disease. Cochrane Database Syst Rev 2016; 2: Cd007348.
41. Akobeng AK, Miller V, Stanton J et al. Double-blind randomized controlled trial of glutamine-enriched polymeric diet in the treatment of active Crohn's disease. J Pediatr Gastroenterol Nutr 2000; 30 (1): 78–84.
42. Rubio A, Pigneur B, Garnier-Lengline H et al. The efficacy of exclusive nutritional therapy in paediatric Crohn's disease, comparing fractionated oral vs. continuous enteral feeding. Aliment Pharmacol Ther 2011; 33 (12): 1332–9.
43. Fell JM, Paintin M, Arnaud-Battandier F et al. Mucosal healing and a fall in mucosal pro-inflammatory cytokine mRNA induced by a specific oral polymeric diet in paediatric Crohn's disease. Aliment Pharmacol Ther 2000; 14 (3): 281–9.
44. Fell JME. Control of systemic and local inflammation with transforming growth factor beta containing formulas. J Parenter Enteral Nutrition 2005; 29 (4): S126–S33.
45. Hartman C, Berkowitz D, Weiss B et al. Nutritional supplementation with polymeric diet enriched with transforming growth factor-beta 2 for children with Crohn's disease. IMAJ 2008; 10 (7): 503–7.
________________________________________________
2. Sigall-Boneh R, Pfeffer-Gik T, Segal I et al. 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. Inflamm Bowel Dis 2014; 20 (8): 1353–60.
3. Cuiv PO, Begun J, Keely S et al. Towards an integrated understanding of the therapeutic utility of exclusive enteral nutrition in the treatment of Crohn's disease. Food Function 2016; 7 (4): 1741–51.
4. Ahmed I, Roy BC, Khan SA et al. Microbiome, Metabolome and Inflammatory Bowel Disease. Microorganisms 2016; 4 (2).
5. Chassaing B, Van de Wiele T, Gewirtz A. O-013 Dietary Emulsifiers Directly Impact the Human Gut Microbiota Increasing Its Pro-inflammatory Potential and Ability to Induce Intestinal Inflammation. Inflamm Bowel Dis 2017; 23 (Suppl. 1): S5.
6. Kang Y, Kim S, Kim SY, Koh H. Effect of short-term partial enteral nutrition on the treatment of younger patients with severe Crohn's disease. Gut Liver 2015; 9 (1): 87–93.
7. Ruemmele FM, Veres G, Kolho KL et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease. J Crohn Colitis 2014; 8 (10): 1179–207.
8. Sanderson IR, Udeen S, Davies PS et al. Remission induced by an elemental diet in small bowel Crohn's disease. Arch Dis Child 1987; 62 (2): 123–7.
9. Forbes A, Escher J, Hebuterne X et al. ESPEN guideline: Clinical nutrition in inflammatory bowel disease. Clinical nutrition. Edinburgh, 2016.
10. Day AS, Burgess L. Exclusive enteral nutrition and induction of remission of active Crohn's disease in children. Expert Rev Clin Immunol 2013; 9 (4): 375–83.
11. Penagini F, Dilillo D, Borsani B et al. Nutrition in Pediatric Inflammatory Bowel Disease: From Etiology to Treatment. Sys Rev Nutrients 2016; 8 (6).
12. Lee D, Baldassano RN, Otley AR et al. Comparative Effectiveness of Nutritional and Biological Therapy in North American Children with Active Crohn's Disease. Inflamm Bowel Dis 2015; 21 (8): 1786–93.
13. Dziechciarz P, Horvath A, Shamir R, Szajewska H. Meta-analysis: enteral nutrition in active Crohn's disease in children. Aliment Pharmacol Ther 2007; 26 (6): 795–806.
14. Rajendran N, Kumar D. Role of diet in the management of inflammatory bowel disease. World J Gastroenterol 2010; 16 (12): 1442–8.
15. Gavin J, Anderson CE, Bremner AR, Beattie RM. Energy intakes of children with Crohn's disease treated with enteral nutrition as primary therapy. J Hum Nutr Dietetic 2005; 18 (5): 337–42.
16. Frivolt K, Schwerd T, Werkstetter KJ et al. Repeated exclusive enteral nutrition in the treatment of paediatric Crohn's 17 disease: predictors of efficacy and outcome. Aliment Pharmacol Ther 2014; 39 (12): 1398–407.
17. Rodrigues AF, Johnson T, Davies P, Murphy MS. Does polymeric formula improve adherence to liquid diet therapy in children with active Crohn's disease? Arch Dis Child 2007; 92 (9): 767–70.
18. Grogan JL, Casson DH, Terry A et al. Enteral feeding therapy for newly diagnosed pediatric Crohn's disease: a doubleblind randomized controlled trial with two years follow-up. Inflamm Bowel Dis 2012; 18 (2): 246–53.
19. Ludvigsson JF, Krantz M, Bodin L et al. Elemental versus polymeric enteral nutrition in paediatric Crohn's disease: a multicentre randomized controlled trial. Acta Paediatrica 2004; 93 (3): 327–35.
20. Borrelli O, Cordischi L, Cirulli M et al. Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohn's disease: a randomized controlled open-label trial. Clin Gastroenterol Hepatol 2006; 4 (6): 744–53.
21. Berni Canani R, Terrin G, Borrelli O et al. Short- and long-term therapeutic efficacy of nutritional therapy and corticosteroids in paediatric Crohn's disease. Dig Liver Dis 2006; 38 (6): 381–7.
22. Grover Z, Muir R, Lewindon P. Exclusive enteral nutrition induces early clinical, mucosal and transmural remission in paediatric Crohn's disease. J Gastroenterol 2014; 49 (4): 638–45.
23. Jong NS, Leach ST, Day AS. Polymeric formula has direct antiinflammatory effects on enterocytes in an in vitro model of intestinal inflammation. Dig Dis Sci 2007; 52 (9): 2029–36.
24. Sylvester FA. Effects of exclusive enteral nutrition on bone mass, linear growth and body composition in children with Crohn's disease. Nestle Nutrition Inst Workshop Ser 2014; 79: 125–30.
25. Lambert B, Lemberg DA, Leach ST, Day AS. Longer-term outcomes of nutritional management of Crohn's disease in children. Dig Dis Sci 2012; 57 (8): 2171–7.
26. Leach ST, Mitchell HM, Eng WR et al. Sustained modulation of intestinal bacteria by exclusive enteral nutrition used to treat children with Crohn's disease. Aliment pharmacol Ther 2008; 28 (6): 724–33.
27. Dunn KA, Moore-Connors J, MacIntyre B et al. Early Changes in Microbial Community Structure Are Associated with Sustained Remission After Nutritional Treatment of Pediatric Crohn's Disease. Inflamm Bowel Dis 2016; 22 (12): 2853–62.
28. Gerasimidis K, Bertz M, Hanske L et al. Decline in presumptively protective gut bacterial species and metabolites are paradoxically associated with disease improvement in pediatric Crohn's disease during enteral nutrition. Inflamm Bowel Dis 2014; 20 (5): 861–71.
29. Lee D, Baldassano RN, Otley AR et al. Comparative Effectiveness of Nutritional and Biological Therapy in North American Children with Active Crohn’s Disease. Inflam Bowel Dis 2015; 21 (8): 1786–93.
30. Johnson T, Macdonald S, Hill SM et al. Treatment of active Crohn's disease in children using partial enteral nutrition with liquid formula: a randomised controlled trial. Gut 2006; 55 (3): 356–61.
31. Burgis JC, Nguyen K, Park KT, Cox K. Response to strict and liberalized specific carbohydrate diet in pediatric Crohn's disease. World J Gastroenterol 2016; 22 (6): 2111–7.
32. Suskind DL, Wahbeh G, Gregory N et al. Nutritional therapy in pediatric Crohn disease: the specific carbohydrate diet. J Pediatr Gastroenterol Nutr 2014; 58 (1): 87–91.
33. Cohen SA, Gold BD, Oliva S et al. Clinical and mucosal improvement with specific carbohydrate diet in pediatric Crohn disease. J Pediatr Gastroenterol Nutr 2014; 59 (4): 516–21.
34. Obih C, Wahbeh G, Lee D et al. Specific carbohydrate diet for pediatric inflammatory bowel disease in clinical practice within an academic IBD center. Nutrition 2016; 32 (4): 418–25.
35. Lewis JD, Abreu MT. Diet as a Trigger or Therapy for Inflammatory Bowel Diseases. Gastroenterology 2017; 152 (2): 398–414.e6.
36. Scholz D. The role of nutrition in the etiology of inflammatory bowel disease. Cur probl pediatr 2011; 41 (9): 248–53.
37. Costea I, Mack DR, Lemaitre RN et al. Interactions between the dietary polyunsaturated fatty acid ratio and genetic factors determine susceptibility to pediatric Crohn's disease. Gastroenterology 2014; 146 (4): 929–31.
38. Lev-Tzion R, Griffiths AM, Leder O, Turner D. Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev 2014 (2): Cd006320.
39. Gassull MA, Fernandez-Banares F, Cabre E et al. Fat composition may be a clue to explain the primary therapeutic effect of enteral nutrition in Crohn's disease: results of a double blind randomised multicentre European trial. Gut 2002; 51 (2): 164–8.
40. Akobeng AK, Elawad M, Gordon M. Glutamine for induction of remission in Crohn's disease. Cochrane Database Syst Rev 2016; 2: Cd007348.
41. Akobeng AK, Miller V, Stanton J et al. Double-blind randomized controlled trial of glutamine-enriched polymeric diet in the treatment of active Crohn's disease. J Pediatr Gastroenterol Nutr 2000; 30 (1): 78–84.
42. Rubio A, Pigneur B, Garnier-Lengline H et al. The efficacy of exclusive nutritional therapy in paediatric Crohn's disease, comparing fractionated oral vs. continuous enteral feeding. Aliment Pharmacol Ther 2011; 33 (12): 1332–9.
43. Fell JM, Paintin M, Arnaud-Battandier F et al. Mucosal healing and a fall in mucosal pro-inflammatory cytokine mRNA induced by a specific oral polymeric diet in paediatric Crohn's disease. Aliment Pharmacol Ther 2000; 14 (3): 281–9.
44. Fell JME. Control of systemic and local inflammation with transforming growth factor beta containing formulas. J Parenter Enteral Nutrition 2005; 29 (4): S126–S33.
45. Hartman C, Berkowitz D, Weiss B et al. Nutritional supplementation with polymeric diet enriched with transforming growth factor-beta 2 for children with Crohn's disease. IMAJ 2008; 10 (7): 503–7.
Авторы
Сара Паулино*1, Хорхе Амил Диас1,2
1 Медицинский факультет, Университет Порто. Португалия, Порто, Монтейро, 4200-319;
2 Отделение детской гастроэнтерологии и педиатрии Госпиталя S.João, г. Порто, Португалия
*sara.geraldes.paulino@gmail.com
1 Faculdade de Medicina da Universidade do Porto. Portugal, Porto, Hernâni Monteiro, 4200-319;
2 Serviço de Pediatria, Centro Hospitalar São João, Porto, Portugal
*sara.geraldes.paulino@gmail.com
1 Медицинский факультет, Университет Порто. Португалия, Порто, Монтейро, 4200-319;
2 Отделение детской гастроэнтерологии и педиатрии Госпиталя S.João, г. Порто, Португалия
*sara.geraldes.paulino@gmail.com
________________________________________________
1 Faculdade de Medicina da Universidade do Porto. Portugal, Porto, Hernâni Monteiro, 4200-319;
2 Serviço de Pediatria, Centro Hospitalar São João, Porto, Portugal
*sara.geraldes.paulino@gmail.com
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