Stephan C Bischoff1, Johanna Escher2, Xavier Hébuterne3, Stanisław Kłęk4, Zeljko Krznaric5, Stéphane Schneider3, Raanan Shamir6, Kalina Stardelova7, Nicolette Wierdsma8, Anthony E Wiskin9, Alastair Forbes10, Miguel Montoro11, Rosa Burgos Peláez12. 1. Departamento de Nutrición Clínica. Universität Hohenheim. 2. Erasmus Medical Center-Sophia Kinderziekenhuis. 3. Gastroenterología y Nutrición Clínica. Centre Hospitalier Universitaire de Nice. Université Côte d'Azur. 4. Unidad de Cirugía General y Oncológica. Szpital Wielospecjalistyczny im. Stanleya Dudricka. 5. Klinički Bolnički Centar Zagreb. Sveučilište u Zagrebu. 6. Schneider Children's Medical Center of Israel. Tel-Aviv University. 7. University Clinic for Gastroenterohepatology. Clinical Centre "Mother Therese". 8. Amsterdam Universitair Medische Centra. 9. Unidad Pediátrica de Gastroenterología y Nutrición. Bristol Royal Hospital for Children. 10. Norwich Medical School, University of East Anglia. 11. Unidad de Gastroenterología, Hepatología y Nutrición. Hospital Universitario San Jorge. 12. Unidad de Soporte Nutricional. Hospital Universitario Vall d'Hebron.
Abstract
Introduction: Introduction: the ESPEN guideline offers a multidisciplinary focus on clinical nutrition in inflammatory bowel disease (IBD). Methodology: the guideline is based on a extensive systematic review of the literature, but relies on expert opinion when objective data are lacking or inconclusive. The conclusions and 64 recommendations have been subject to full peer review and a Delphi process, in which uniformly positive responses (agree or strongly agree) were required. Results: IBD is increasingly common and potential dietary factors in its etiology are briefly reviewed. Malnutrition is highly prevalent in IBD - especially in Crohn's disease. Increased energy and protein requirements are observed in some patients. The management of malnutrition in IBD is considered within the general context of support for malnourished patients. Treatment of iron deficiency (parenterally, if necessary) is strongly recommended. Routine provision of a special diet in IBD is not, however, supported. Parenteral nutrition is indicated only when enteral nutrition has failed or is impossible. The recommended perioperative management of patients with IBD undergoing surgery accords with general ESPEN guidance for patients having abdominal surgery. Probiotics may be helpful in UC but not in Crohn's disease. Primary therapy using nutrition to treat IBD is not supported in ulcerative colitis but is moderately well supported in Crohn's disease, especially in children, where the adverse consequences of steroid therapy are proportionally greater. However, exclusion diets are generally not recommended and there is little evidence to support any particular formula feed when nutritional regimens are constructed. Conclusions: available objective data to guide nutritional support and primary nutritional therapy in IBD are presented as 64 recommendations, of which 9 are very strong recommendations (grade A), 22 are strong recommendations (grade B), and 12 are based only on sparse evidence (grade 0); 21 recommendations are good practice points (GPP).
Introduction: Introduction: the ESPEN guideline offers a multidisciplinary focus on clinical nutrition in inflammatory bowel disease (IBD). Methodology: the guideline is based on a extensive systematic review of the literature, but relies on expert opinion when objective data are lacking or inconclusive. The conclusions and 64 recommendations have been subject to full peer review and a Delphi process, in which uniformly positive responses (agree or strongly agree) were required. Results: IBD is increasingly common and potential dietary factors in its etiology are briefly reviewed. Malnutrition is highly prevalent in IBD - especially in Crohn's disease. Increased energy and protein requirements are observed in some patients. The management of malnutrition in IBD is considered within the general context of support for malnourished patients. Treatment of iron deficiency (parenterally, if necessary) is strongly recommended. Routine provision of a special diet in IBD is not, however, supported. Parenteral nutrition is indicated only when enteral nutrition has failed or is impossible. The recommended perioperative management of patients with IBD undergoing surgery accords with general ESPEN guidance for patients having abdominal surgery. Probiotics may be helpful in UC but not in Crohn's disease. Primary therapy using nutrition to treat IBD is not supported in ulcerative colitis but is moderately well supported in Crohn's disease, especially in children, where the adverse consequences of steroid therapy are proportionally greater. However, exclusion diets are generally not recommended and there is little evidence to support any particular formula feed when nutritional regimens are constructed. Conclusions: available objective data to guide nutritional support and primary nutritional therapy in IBD are presented as 64 recommendations, of which 9 are very strong recommendations (grade A), 22 are strong recommendations (grade B), and 12 are based only on sparse evidence (grade 0); 21 recommendations are good practice points (GPP).
Authors: Antonio Fernández-Gálvez; Sebastián Rivera; María Del Carmen Durán Ventura; Rubén Morilla Romero de la Osa Journal: Nutrients Date: 2022-08-20 Impact factor: 6.706