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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EInflammatory bowel disease is causally related to nutrition, particularly the westernized diet that emphasizes refined processed foods. But nutrition can be medicinal in pediatric and adult patients. Short-term replacement of food with a formulation or a modified diet can ease symptoms. A tailored diet can provide long-term relief, but this approach requires further rigorous study.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ediet\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EIBD\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Enutrition\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epediatric patients\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EInflammatory bowel disease (IBD) is a chronic inflammation of any portion of the gastrointestinal tract. Two types of IBD, Crohn disease (CD) and ulcerative colitis (UC), are characterized by lifelong remissions and relapses. Malnutrition can manifest as weight loss, growth failure, and anemia. A session on nutritional therapy for IBD focused on the latest data and strategies to use nutrition to treat clinical symptoms and inflammation in patients with IBD.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EDale Lee, MD, Seattle Children\u2019s Hospital, Seattle, Washington, USA, first discussed nutrition-based anti-inflammation therapy. IBD is more prevalent in industrialized nations that feature diets elevated in saturated fat, polyunsaturated fatty acids, and meat. The fact that second-generation immigrants have a higher risk of developing IBD than the prior generation has implicated the diet as a potential risk factor for the development of IBD [Li X et al. \u003Cem\u003EInflamm Bowel Dis.\u003C\/em\u003E 2010].\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003ETumor necrosis factor-\u03b1 (TNF-\u03b1) has a central role in IBD [Neurath MF. \u003Cem\u003ENat Rev Immunol\u003C\/em\u003E. 2014]. Consequences of TNF-\u03b1 on a variety of cell types include tissue destruction, angiogenesis, and hypervascularization. Anti-TNF-\u03b1 therapy can promote mucosal healing in some, but not all, patients with IBD. Other strategies include corticosteroid- and immunomodulator-mediated immunosuppression and exclusive enteral nutrition (EEN).\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EIn EEN, a formula-based diet provides the majority of the daily energy requirements, replacing solid-food consumption. The practice began in the 1930s and was substantiated by Voitk and colleagues in the 1970s. Studies in the decades since have found that EEN appears most effective for ileal or ileocolonic CD in the majority of children and some adults, but success is often hindered by poor compliance.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EEEN formulations can reduce the level of inflammatory cytokines and promote mucosal healing, Dr Lee said; this may reflect avoidance of food and\/or changes in the intestinal microbiome, since remissions tend to occur as formula is decreased and food is reintroduced. Research is focusing on the potential of certain foods to trigger intestinal inflammation; as yet, no specific recommendations have been determined.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EDr Lee went on to discuss the use of nutrition to manage IBD in pediatric patients, which is important given that one-quarter of all IBD cases are diagnosed by age 20 years, with a lifelong decline in incidence of IBD thereafter.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EIBD involves the immune system, the environment, and the individual\u2019s genetic proclivity (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Conventional therapies work to suppress the immune system, whereas nutritional management works on environmental factors.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/3\/29\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Etiology of IBDIBD, inflammatory bowel disease.Reproduced with permission from A.S.P.E.N.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-2103256841\u0022 data-figure-caption=\u0022Etiology of IBDIBD, inflammatory bowel disease.Reproduced with permission from A.S.P.E.N.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/3\/29\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/3\/29\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/3\/29\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16137\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003EEtiology of IBD\u003C\/p\u003E\n               \u003Cp id=\u0022p-10\u0022\u003EIBD, inflammatory bowel disease.\u003C\/p\u003E\n               \u003Cp id=\u0022p-11\u0022\u003EReproduced with permission from A.S.P.E.N.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EInduction of remission involves corticosteroids and anti-TNF-\u03b1, with azathioprine and methotrexate used to maintain remission. This immune system\u2013oriented approach does not address environmental factors and cannot address the underlying genetic contributors. Immunosuppression also increases the risks of infection, cancer, and drug-related side effects [Siegel CA. \u003Cem\u003EGastroenterol Hepatol (NY)\u003C\/em\u003E. 2009].\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EEEN modifies the nutritional environment. A small randomized controlled trial comparing EEN and corticosteroids documented greater benefits in mucosal healing in the EEN group of pediatric patients with CD [Borrelli O et al. \u003Cem\u003EClin Gastroenterol Hepatol\u003C\/em\u003E. 2006]. A randomized controlled comparison of EEN with partial enteral nutrition (PEN), in which about half of the daily calories were derived from solid food, revealed the superiority of EEN in children with active CD [Johnson T et al. \u003Cem\u003EGut\u003C\/em\u003E. 2006]. The as-yet-unpublished, prospective-cohort PLEASE study compared outcomes of 8-week regimens of PEN, EEN, and anti-TNF-\u03b1 therapies in children with IBD.\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EAs compelling as these improvements are, complete solid-food exclusion is a short-term therapy. In the longer term, PEN has the potential to maintain clinical remission of CD compared with untreated patients [Yamamoto T et al. \u003Cem\u003EInflamm Bowel Dis\u003C\/em\u003E. 2007], and it has been found to be as effective as and less toxic than 6-mercaptopurine-mediated immunosuppression [Hanai H. \u003Cem\u003EDig Liver Dis\u003C\/em\u003E. 2012]. Another factor to consider is changes in the microbiome of the intestinal tract with EEN, which may be a cause or an effect of inflammation [Leach ST. \u003Cem\u003EAliment Pharmacol Ther\u003C\/em\u003E. 2008].\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EThe focus shifted to the potential of other alternative diets in IBD, as discussed by Jennifer Burgis, MD, Stanford University, Palo Alto, California, USA. The typical diet in North America, which emphasizes refined processed foods, has been implicated as a risk factor for IBD. Increased risk for CD and UC has been linked to consumption of diets high in total fat, omega-6 fatty acids, and animal proteins. But nutrition can also be medicinal; the risk for CD can be decreased by consuming more fruits and fiber, and for UC by eating more vegetables [Hou JK et al. \u003Cem\u003EAm J Gastroenterol\u003C\/em\u003E. 2011].\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EThe benefits of nutrition in IBD can be gauged only experimentally, and diet therapies and studies are challenging for many reasons, including compliance issues, difficulty with capturing and measuring data, and inability to blind patients or conduct placebo-controlled trials.\u003C\/p\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EA diet enriched in specific carbohydrates and restricted in others was formulated in the 1950s to treat celiac disease. More recently, several small studies involving children with CD who adhered to this diet found evidence for improvements in parameters, including height, weight, body mass index, and various protein markers [Cohen SA et al. \u003Cem\u003EJ Pediatr Gastroenterol Nutr\u003C\/em\u003E. 2014; Suskind DL et al. \u003Cem\u003EJ Pediatr Gastroenterol Nutr\u003C\/em\u003E. 2014].\u003C\/p\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EThis traditional specific-carbohydrate diet has been modified with individual dietary tailoring, such as the exclusion of lactose and refined\/processed carbohydrates and fortification with omega-3 fatty acids, oats, flax seeds, and cocoa. In one review of 11 patients, compliance with the diet was good, with all participants experiencing improved symptoms of IBD and reduced use of medications [Olendzki BC et al. \u003Cem\u003ENutr J\u003C\/em\u003E. 2014]. The benefits, if any, of the Gut and Psychology Syndrome diet and the Paleo diet on IBD are unclear. The influence of a variety of other diets and the effect of systematic food exclusion on IBD have been explored with mixed results, said Dr Burgis.\u003C\/p\u003E\n         \u003Cp id=\u0022p-19\u0022\u003EThe science of nutrition-related treatment of IBD is being clarified. For patients, this information becomes part of an effort to produce success. The effort also includes patient awareness of the diet and its purpose, a solid support team that provides help and encourages achievements, and determination of a backup plan ahead of time.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/3\/29.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlry2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlry2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}