Partial enteral nutrition combined with an exclusion diet promotes a healthy gut microbiome in patients with mild to moderately active ulcerative colitis: a quasi-experimental study.
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引用次数: 0
Abstract
Background and aims: The therapeutic role of enteral nutrition and diet in patients with ulcerative colitis (UC) has not been adequately explored. We aimed to evaluate the effectiveness of partial enteral nutrition (PEN) in combination with an exclusion diet (ED) in patients with UC.
Methods: In this prospective, open-label, non-randomized, quasi-experimental study, patients with mild-to-moderate UC (simple clinical colitis activity index [SCCAI]3-9) were non-randomly allocated to either PEN+ED along with standard of care (SOC) or SOC alone for 4 weeks. The primary outcome was clinical remission (SCCAI ≤2) at week 4. In addition, fecal microbiota analysis was performed at baseline and at week 4 for 14 participants in the PEN+ED group.
Results: Sixty patients were included (PEN+ED = 30; SOC = 30). Baseline disease activity parameters were similar between the two groups. At week 4, 66.7% (20/30) of patients in the PEN+ED arm achieved clinical remission compared to 83.3% (25/30) receiving SOC. The proportion of patients with rectal bleeding score "0" was significantly lower in PEN+ED (56.7% vs 86.7%, P = .01) arm at week 4. A numerically higher number of patients required steroids in SOC arm compared to the PEN+ED arm, but it was not significant (23.3% vs 16.7%, P = .748). Microbiome analysis showed significant improvements in alpha diversity, increased relative abundance of beneficial gut microbes, depletion of pathobionts, and shift toward a healthier microbial profile, which was in turn shown to be negatively associated with disease severity.
Conclusions: Although PEN+ED does not appear to have additional clinical benefit to SOC at week 4, it was associated with significant improvement in gut microbiota. Long-term benefits of dietary interventions should be explored in future studies.
背景和目的：肠内营养和饮食在溃疡性结肠炎（UC）患者中的治疗作用尚未得到充分的探讨。我们的目的是评估部分肠内营养（PEN）联合排他饮食（ED）治疗UC患者的有效性。方法：在这项前瞻性、开放标签、非随机、准实验研究中，轻度至中度UC（单纯性临床结肠炎活动指数[SCCAI]3-9）患者被非随机分配到PEN+ED联合标准护理（SOC）或单独SOC治疗4周。第4周的主要终点是临床缓解（SCCAI≤2）。此外，在基线和第4周对PEN+ED组的14名参与者进行了粪便微生物群分析。结果：共纳入60例患者（PEN+ED = 30; SOC = 30）。两组的基线疾病活动参数相似。在第4周，66.7%（20/30）的PEN+ED组患者达到临床缓解，而接受SOC的患者为83.3%（25/30）。直肠出血评分为0分的患者比例在PEN+ED组明显较低(56.7% vs 86.7%, P =；1)第4周。与PEN+ED组相比，SOC组需要类固醇的患者数量更高，但并不显著（23.3% vs 16.7%, P = .748）。微生物组分析显示，α多样性显著改善，有益肠道微生物的相对丰度增加，病原体的消耗，以及向更健康的微生物谱的转变，这反过来又被证明与疾病严重程度呈负相关。结论：尽管在第4周时PEN+ED似乎对SOC没有额外的临床益处，但它与肠道微生物群的显着改善有关。饮食干预的长期效益应在未来的研究中探讨。临床试验注册号：ISRCTN15559229。
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