重视微量营养素缺乏在炎症性肠病中的作用
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摘要
蛋白质等营养物质缺乏是炎症性肠病(inflammation bowel disease,IBD)患者的常见症状.营养缺乏不仅是复杂疾病的表现,也是疾病发生的原因之一.微量营养素是人体健康必须的重要的物质,然而目前较少有文章就微量营养素缺乏对IBD的影响进行详尽阐述.最新的研究发现,半数以上的IBD患者存在微量营养素的缺乏,且相比于溃疡性结肠炎(ulcerative colitis,UC)患者和克罗恩病(Crohn's disease,CD)患者微量营养素缺乏则更常见.另外,在IBD活跃期较静止期更普遍.可见微量营养素缺乏与病程的持续时间和复杂程度有关.本综述分别从微量营养素的定义,IBD的微量营养素缺乏,IBD发生微量营养素缺乏的原因,微量营养素在IBD治疗中的作用这些方面对微量营养素缺乏在IBD中的作用进行了探讨和总结.
As is known to all, deficiencies of protein and other nutrients are common symptoms of inflammatory bowel disease(IBD). Nutrient deficiency is not only a manifestation of complicated diseases but also a cause of morbidity. Micronutrient is also the essential material for human health.However, there are few articles elaborating the influence of micronutrient deficiency. At present, choosing available food to keep healthy and to treat diseases is very popular, which is also suitable for IBD patients. Recent studies show that micronutrient deficiencies occur in more than half of patients with IBD, and deficiencies are more common in Crohn's disease than in ulcerative colitis, and in active disease than in disease in remission. Micronutrient deficiencies are associated with prolonged and complicated course of disease. The present review summarizes the effect of micronutrient deficiencies in IBD with regard to the definition of micronutrient, the deficiency status of micronutrient in IBD, the reasons for the lack of micronutrient and the role of micronutrient in the treatment of IBD.
As is known to all, deficiencies of protein and other nutrients are common symptoms of inflammatory bowel disease(IBD). Nutrient deficiency is not only a manifestation of complicated diseases but also a cause of morbidity. Micronutrient is also the essential material for human health.However, there are few articles elaborating the influence of micronutrient deficiency. At present, choosing available food to keep healthy and to treat diseases is very popular, which is also suitable for IBD patients. Recent studies show that micronutrient deficiencies occur in more than half of patients with IBD, and deficiencies are more common in Crohn's disease than in ulcerative colitis, and in active disease than in disease in remission. Micronutrient deficiencies are associated with prolonged and complicated course of disease. The present review summarizes the effect of micronutrient deficiencies in IBD with regard to the definition of micronutrient, the deficiency status of micronutrient in IBD, the reasons for the lack of micronutrient and the role of micronutrient in the treatment of IBD.
引文
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3 O'Sullivan M.Symposium on'The challenge of translating nutrition research into public health nutrition'.Session 3:Joint Nutrition Society and Irish Nutrition and Dietetic Institute Symposium on'Nutrition and autoimmune disease'.Nutrition in Crohn's disease.Proc Nutr Soc 2009;68:127-134[PMID:19208269 DOI:10.1017/s0029665109001025]
4 Nguyen GC,Munsell M,Harris ML.Nationwide prevalence and prognostic significance of clinically diagnosable protein-calorie malnutrition in hospitalized inflammatory bowel disease patients.Inflamm Bowel Dis 2008;14:1105-1111[PMID:18302272 DOI:10.1002/ibd.20429]
5 Weisshof R,Chermesh I.Micronutrient deficiencies in inflammatory bowel disease.Curr Opin Clin Nutr Metab Care 2015;18:576-581[PMID:26418823 DOI:10.1097/mco.0000000000000226]
6 Prideaux L,Kamm MA,De Cruz PP,Chan FK,Ng SC.Inflammatory bowel disease in Asia:a systematic review.J Gastroenterol Hepatol 2012;27:1266-1280[PMID:22497584 DOI:10.1111/j.1440-1746.2012.07150.x]
7 Alkhouri RH,Hashmi H,Baker RD,Gelfond D,Baker SS.Vitamin and mineral status in patients with inflammatory bowel disease.J Pediatr Gastroenterol Nutr 2013;56:89-92[PMID:22832510DOI:10.1097/MPG.0b013e31826a105d]
8 Valentini L,Schaper L,Buning C,Hengstermann S,Koernicke T,Tillinger W,Guglielmi FW,Norman K,Buhner S,Ockenga J,Pirlich M,Lochs H.Malnutrition and impaired muscle strength in patients with Crohn's disease and ulcerative colitis in remission.Nutrition 2008;24:694-702[PMID:18499398 DOI:10.1016/j.nut.2008.03.018]
9 Gasche C,Lomer MC,Cavill I,Weiss G.Iron,anaemia,and inflammatory bowel diseases.Gut 2004;53:1190-1197[PMID:15247190 DOI:10.1136/gut.2003.035758]
10 Lupu A,Diculescu M,Diaconescu R,Tantau M,Tantau A,Visovan I,Gheorghe C,Lupei C,Gheorghe L,Cerban R,Vadan R,Goldis A.Prevalence of anemia and iron deficiency in Romanian patients with inflammatory bowel disease:a prospective multicenter study.JGastrointestin Liver Dis 2015;24:15-20[PMID:25822429 DOI:10.15403/jgld.2014.1121.lpu]
11 Alves RA,Miszputen SJ,Figueiredo MS.Anemia in inflammatory bowel disease:prevalence,differential diagnosis and association with clinical and laboratory variables.Sao Paulo Med J 2014;132:140-146[PMID:24760213]
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13 Kim KO.[Management of anemia in patients with inflammatory bowel disease].Korean JGastroenterol 2015;65:145-150[PMID:25797377]
14 Arasaradnam RP,Commane DM,Bradburn D,Mathers JC.A review of dietary factors and its influence on DNA methylation in colorectal carcinogenesis.Epigenetics 2008;3:193-198[PMID:18682688]
15 Yakut M,Ustün Y,Kaba?am G,Soykan I.Serum vitamin B12 and folate status in patients with inflammatory bowel diseases.Eur J Intern Med2010;21:320-323[PMID:20603044 DOI:10.1016/j.ejim.2010.05.007]
16 Bermejo F,Algaba A,Guerra I,Chaparro M,De-La-Poza G,Valer P,Piqueras B,Bermejo A,García-Alonso J,Pérez MJ,Gisbert JP.Should we monitor vitamin B12 and folate levels in Crohn's disease patients?Scand J Gastroenterol 2013;48:1272-1277[PMID:24063425 DOI:10.3109/00365521.2013.836752]
17 Geerling BJ,Badart-Smook A,Stockbrügger RW,Brummer RJ.Comprehensive nutritional status in recently diagnosed patients with inflammatory bowel disease compared with population controls.Eur J Clin Nutr 2000;54:514-521[PMID:10878655]
18 Finley JW,Davis CD.Selenium(Se)from highselenium broccoli is utilized differently than selenite,selenate and selenomethionine,but is more effective in inhibiting colon carcinogenesis.Biofactors 2001;14:191-196[PMID:11568456]
19 Davis CD,Uthus EO,Finley JW.Dietary selenium and arsenic affect DNA methylation in vitro in Caco-2 cells and in vivo in rat liver and colon.JNutr 2000;130:2903-2909[PMID:11110844]
20 Tirosh O,Levy E,Reifen R.High selenium diet protects against TNBS-induced acute inflammation,mitochondrial dysfunction,and secondary necrosis in rat colon.Nutrition 2007;23:878-886[PMID:17936198 DOI:10.1016/j.nut.2007.08.019]
21 Barrett CW,Singh K,Motley AK,Lintel MK,Matafonova E,Bradley AM,Ning W,Poindexter SV,Parang B,Reddy VK,Chaturvedi R,Fingleton BM,Washington MK,Wilson KT,Davies SS,Hill KE,Burk RF,Williams CS.Dietary selenium deficiency exacerbates DSS-induced epithelial injury and AOM/DSS-induced tumorigenesis.PLo S One 2013;8:e67845[PMID:23861820 DOI:10.1371/journal.pone.0067845]
22 Krehl S,Loewinger M,Florian S,Kipp AP,Banning A,Wessjohann LA,Brauer MN,Iori R,Esworthy RS,Chu FF,Brigelius-FlohéR.Glutathione peroxidase-2 and selenium decreased inflammation and tumors in a mouse model of inflammation-associated carcinogenesis whereas sulforaphane effects differed with selenium supply.Carcinogenesis 2012;33:620-628[PMID:22180572 DOI:10.1093/carcin/bgr288]
23 Suibhne TN,Cox G,Healy M,O'Morain C,O'Sullivan M.Vitamin D deficiency in Crohn's disease:prevalence,risk factors and supplement use in an outpatient setting.J Crohns Colitis2012;6:182-188[PMID:22325172 DOI:10.1016/j.crohns.2011.08.002]
24 Froicu M,Weaver V,Wynn TA,Mc Dowell MA,Welsh JE,Cantorna MT.A crucial role for the vitamin D receptor in experimental inflammatory bowel diseases.Mol Endocrinol 2003;17:2386-2392[PMID:14500760 DOI:10.1210/me.2003-0281]
25 Torki M,Gholamrezaei A,Mirbagher L,Danesh M,Kheiri S,Emami MH.Vitamin D Deficiency Associated with Disease Activity in Patients with Inflammatory Bowel Diseases.Dig Dis Sci 2015;60:3085-3091[PMID:26031421 DOI:10.1007/s10620-015-3727-4]
26 Bartels LE,Bendix M,Hvas CL,J?rgensen SP,Agnholt J,Agger R,Dahlerup JF.Oral vitamin D3 supplementation reduces monocyte-derived dendritic cell maturation and cytokine production in Crohn's disease patients.Inflammopharmacology2014;22:95-103[PMID:24374976 DOI:10.1007/s10787-013-0197-1]
27 Dadaei T,Safapoor MH,Asadzadeh Aghdaei H,Balaii H,Pourhoseingholi MA,Naderi N,Zojaji H,Azimzadeh P,Mohammadi P,Zali MR.Effect of vitamin D3 supplementation on TNF-αserum level and disease activity index in Iranian IBDpatients.Gastroenterol Hepatol Bed Bench 2015;8:49-55[PMID:25584176]
28 Vagianos K,Bector S,Mc Connell J,Bernstein CN.Nutrition assessment of patients with inflammatory bowel disease.JPEN J Parenter Enteral Nutr 2007;31:311-319[PMID:17595441]
29 Singhal N,Alam S,Sherwani R,Musarrat J.Serum zinc levels in celiac disease.Indian Pediatr2008;45:319-321[PMID:18451454]
30 Wong CP,Rinaldi NA,Ho E.Zinc deficiency enhanced inflammatory response by increasing immune cell activation and inducing IL6promoter demethylation.Mol Nutr Food Res2015;59:991-999[PMID:25656040 DOI:10.1002/mnfr.201400761]
31 Cho DD,Austin PC,Atzema CL.Management of Discharged Emergency Department Patients with a Primary Diagnosis of Hypertension:AMulticentre Study.CJEM 2015;17:523-531[PMID:26062927 DOI:10.1017/cem.2015.36]
32 Costantini A,Pala MI.Thiamine and fatigue in inflammatory bowel diseases:an open-label pilot study.J Altern Complement Med 2013;19:704-708[PMID:23379830 DOI:10.1089/acm.2011.0840]
33 Urbano AP,Sassaki LY,Dorna MS,Carvalhaes MA,Martini LA,Ferreira AL.Nutritional intake according to injury extent in ulcerative colitis patients.J Hum Nutr Diet 2013;26:445-451[PMID:23560822 DOI:10.1111/jhn.12064]
34 Williams K,Sobol RW.Mutation research/fundamental and molecular mechanisms of mutagenesis:special issue:DNA repair and genetic instability.Mutat Res 2013;743-744,1-3[PMID:23688353 DOI:10.1016/j.mrfmmm.2013.04.009]
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2 Kalantari H,Barekat SM,Maracy MR,Azadbakht L,Shahshahan Z.Nutritional status in patients with ulcerative colitis in Isfahan,Iran.Adv Biomed Res 2014;3:58[PMID:24627866 DOI:10.4103/2277-9175.125812]
3 O'Sullivan M.Symposium on'The challenge of translating nutrition research into public health nutrition'.Session 3:Joint Nutrition Society and Irish Nutrition and Dietetic Institute Symposium on'Nutrition and autoimmune disease'.Nutrition in Crohn's disease.Proc Nutr Soc 2009;68:127-134[PMID:19208269 DOI:10.1017/s0029665109001025]
4 Nguyen GC,Munsell M,Harris ML.Nationwide prevalence and prognostic significance of clinically diagnosable protein-calorie malnutrition in hospitalized inflammatory bowel disease patients.Inflamm Bowel Dis 2008;14:1105-1111[PMID:18302272 DOI:10.1002/ibd.20429]
5 Weisshof R,Chermesh I.Micronutrient deficiencies in inflammatory bowel disease.Curr Opin Clin Nutr Metab Care 2015;18:576-581[PMID:26418823 DOI:10.1097/mco.0000000000000226]
6 Prideaux L,Kamm MA,De Cruz PP,Chan FK,Ng SC.Inflammatory bowel disease in Asia:a systematic review.J Gastroenterol Hepatol 2012;27:1266-1280[PMID:22497584 DOI:10.1111/j.1440-1746.2012.07150.x]
7 Alkhouri RH,Hashmi H,Baker RD,Gelfond D,Baker SS.Vitamin and mineral status in patients with inflammatory bowel disease.J Pediatr Gastroenterol Nutr 2013;56:89-92[PMID:22832510DOI:10.1097/MPG.0b013e31826a105d]
8 Valentini L,Schaper L,Buning C,Hengstermann S,Koernicke T,Tillinger W,Guglielmi FW,Norman K,Buhner S,Ockenga J,Pirlich M,Lochs H.Malnutrition and impaired muscle strength in patients with Crohn's disease and ulcerative colitis in remission.Nutrition 2008;24:694-702[PMID:18499398 DOI:10.1016/j.nut.2008.03.018]
9 Gasche C,Lomer MC,Cavill I,Weiss G.Iron,anaemia,and inflammatory bowel diseases.Gut 2004;53:1190-1197[PMID:15247190 DOI:10.1136/gut.2003.035758]
10 Lupu A,Diculescu M,Diaconescu R,Tantau M,Tantau A,Visovan I,Gheorghe C,Lupei C,Gheorghe L,Cerban R,Vadan R,Goldis A.Prevalence of anemia and iron deficiency in Romanian patients with inflammatory bowel disease:a prospective multicenter study.JGastrointestin Liver Dis 2015;24:15-20[PMID:25822429 DOI:10.15403/jgld.2014.1121.lpu]
11 Alves RA,Miszputen SJ,Figueiredo MS.Anemia in inflammatory bowel disease:prevalence,differential diagnosis and association with clinical and laboratory variables.Sao Paulo Med J 2014;132:140-146[PMID:24760213]
12 Rogler G,Vavricka S.Anemia in inflammatory bowel disease:an under-estimated problem?Front Med(Lausanne)2014;1:58[PMID:25646159DOI:10.3389/fmed.2014.00058]
13 Kim KO.[Management of anemia in patients with inflammatory bowel disease].Korean JGastroenterol 2015;65:145-150[PMID:25797377]
14 Arasaradnam RP,Commane DM,Bradburn D,Mathers JC.A review of dietary factors and its influence on DNA methylation in colorectal carcinogenesis.Epigenetics 2008;3:193-198[PMID:18682688]
15 Yakut M,Ustün Y,Kaba?am G,Soykan I.Serum vitamin B12 and folate status in patients with inflammatory bowel diseases.Eur J Intern Med2010;21:320-323[PMID:20603044 DOI:10.1016/j.ejim.2010.05.007]
16 Bermejo F,Algaba A,Guerra I,Chaparro M,De-La-Poza G,Valer P,Piqueras B,Bermejo A,García-Alonso J,Pérez MJ,Gisbert JP.Should we monitor vitamin B12 and folate levels in Crohn's disease patients?Scand J Gastroenterol 2013;48:1272-1277[PMID:24063425 DOI:10.3109/00365521.2013.836752]
17 Geerling BJ,Badart-Smook A,Stockbrügger RW,Brummer RJ.Comprehensive nutritional status in recently diagnosed patients with inflammatory bowel disease compared with population controls.Eur J Clin Nutr 2000;54:514-521[PMID:10878655]
18 Finley JW,Davis CD.Selenium(Se)from highselenium broccoli is utilized differently than selenite,selenate and selenomethionine,but is more effective in inhibiting colon carcinogenesis.Biofactors 2001;14:191-196[PMID:11568456]
19 Davis CD,Uthus EO,Finley JW.Dietary selenium and arsenic affect DNA methylation in vitro in Caco-2 cells and in vivo in rat liver and colon.JNutr 2000;130:2903-2909[PMID:11110844]
20 Tirosh O,Levy E,Reifen R.High selenium diet protects against TNBS-induced acute inflammation,mitochondrial dysfunction,and secondary necrosis in rat colon.Nutrition 2007;23:878-886[PMID:17936198 DOI:10.1016/j.nut.2007.08.019]
21 Barrett CW,Singh K,Motley AK,Lintel MK,Matafonova E,Bradley AM,Ning W,Poindexter SV,Parang B,Reddy VK,Chaturvedi R,Fingleton BM,Washington MK,Wilson KT,Davies SS,Hill KE,Burk RF,Williams CS.Dietary selenium deficiency exacerbates DSS-induced epithelial injury and AOM/DSS-induced tumorigenesis.PLo S One 2013;8:e67845[PMID:23861820 DOI:10.1371/journal.pone.0067845]
22 Krehl S,Loewinger M,Florian S,Kipp AP,Banning A,Wessjohann LA,Brauer MN,Iori R,Esworthy RS,Chu FF,Brigelius-FlohéR.Glutathione peroxidase-2 and selenium decreased inflammation and tumors in a mouse model of inflammation-associated carcinogenesis whereas sulforaphane effects differed with selenium supply.Carcinogenesis 2012;33:620-628[PMID:22180572 DOI:10.1093/carcin/bgr288]
23 Suibhne TN,Cox G,Healy M,O'Morain C,O'Sullivan M.Vitamin D deficiency in Crohn's disease:prevalence,risk factors and supplement use in an outpatient setting.J Crohns Colitis2012;6:182-188[PMID:22325172 DOI:10.1016/j.crohns.2011.08.002]
24 Froicu M,Weaver V,Wynn TA,Mc Dowell MA,Welsh JE,Cantorna MT.A crucial role for the vitamin D receptor in experimental inflammatory bowel diseases.Mol Endocrinol 2003;17:2386-2392[PMID:14500760 DOI:10.1210/me.2003-0281]
25 Torki M,Gholamrezaei A,Mirbagher L,Danesh M,Kheiri S,Emami MH.Vitamin D Deficiency Associated with Disease Activity in Patients with Inflammatory Bowel Diseases.Dig Dis Sci 2015;60:3085-3091[PMID:26031421 DOI:10.1007/s10620-015-3727-4]
26 Bartels LE,Bendix M,Hvas CL,J?rgensen SP,Agnholt J,Agger R,Dahlerup JF.Oral vitamin D3 supplementation reduces monocyte-derived dendritic cell maturation and cytokine production in Crohn's disease patients.Inflammopharmacology2014;22:95-103[PMID:24374976 DOI:10.1007/s10787-013-0197-1]
27 Dadaei T,Safapoor MH,Asadzadeh Aghdaei H,Balaii H,Pourhoseingholi MA,Naderi N,Zojaji H,Azimzadeh P,Mohammadi P,Zali MR.Effect of vitamin D3 supplementation on TNF-αserum level and disease activity index in Iranian IBDpatients.Gastroenterol Hepatol Bed Bench 2015;8:49-55[PMID:25584176]
28 Vagianos K,Bector S,Mc Connell J,Bernstein CN.Nutrition assessment of patients with inflammatory bowel disease.JPEN J Parenter Enteral Nutr 2007;31:311-319[PMID:17595441]
29 Singhal N,Alam S,Sherwani R,Musarrat J.Serum zinc levels in celiac disease.Indian Pediatr2008;45:319-321[PMID:18451454]
30 Wong CP,Rinaldi NA,Ho E.Zinc deficiency enhanced inflammatory response by increasing immune cell activation and inducing IL6promoter demethylation.Mol Nutr Food Res2015;59:991-999[PMID:25656040 DOI:10.1002/mnfr.201400761]
31 Cho DD,Austin PC,Atzema CL.Management of Discharged Emergency Department Patients with a Primary Diagnosis of Hypertension:AMulticentre Study.CJEM 2015;17:523-531[PMID:26062927 DOI:10.1017/cem.2015.36]
32 Costantini A,Pala MI.Thiamine and fatigue in inflammatory bowel diseases:an open-label pilot study.J Altern Complement Med 2013;19:704-708[PMID:23379830 DOI:10.1089/acm.2011.0840]
33 Urbano AP,Sassaki LY,Dorna MS,Carvalhaes MA,Martini LA,Ferreira AL.Nutritional intake according to injury extent in ulcerative colitis patients.J Hum Nutr Diet 2013;26:445-451[PMID:23560822 DOI:10.1111/jhn.12064]
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