乳糜泻是一种自身免疫性疾病,其中遗传易感个体的免疫系统引起对麸质的反应,从而导致小肠损伤。如果没有诊断和治疗,由此产生的营养吸收不良会导致贫血,骨病,增长步履蹒跚,或其他后果。这种情况是终身的,缺乏治愈方法;唯一的治疗方法是终身坚持无麸质饮食(GFD)。这种饮食具有挑战性,并对生活质量产生不利影响;然而,确保肠道恢复和防止未来负面健康后果至关重要。营养与饮食学会召集了一个由乳糜泻患者倡导者补充的专家小组,以评估六个主题的证据,包括医学营养治疗;GFD;燕麦消费;微量营养素;益生菌/益生元;和低可发酵寡糖,二糖,单糖,和多元醇饮食。本出版物概述了用于完成系统审查和指南制定的营养与饮食学会证据分析库方法,并总结了建议和支持证据。指南确认,所有患有乳糜泻的个体都应遵循GFD(1C,势在必行),可能包括成人的无麸质燕麦(2D,有条件)。儿童应遵循营养充足的GFD,以支持健康成长和发展(共识,势在必行),并且不会不必要地限制无麸质燕麦(共识,有条件)。指南指出营养护理应包括常规营养评估(共识,势在必行)和医学营养治疗(共识,势在必行)。此时,该指南不支持添加低可发酵寡糖的建议,二糖,单糖,和多元醇饮食(2C,有条件);益生元或益生菌补充剂(2D,有条件);或微量营养素补充剂(在没有营养缺乏的情况下)(共识,有条件)。2021年乳糜泻循证营养指南将协助注册营养师提供适当的循证医学营养疗法,以支持乳糜泻患者实现和维持营养健康,并避免其一生的不良乳糜泻后果。
Celiac disease is an autoimmune disorder in which the immune system of genetically susceptible individuals elicits a reaction to gluten causing small intestine damage. If left undiagnosed and untreated, the resulting nutrition malabsorption can lead to anemia, bone disease, growth faltering, or other consequences. The condition is lifelong and lacks a cure; the only treatment is lifelong adherence to a gluten-free diet (GFD). This diet is challenging to follow and adversely influences quality of life; however, it is essential to ensure intestinal recovery and prevent future negative health consequences. The Academy of Nutrition and Dietetics convened an expert panel complemented by a celiac disease patient advocate to evaluate evidence for six topics, including medical nutrition therapy; the GFD; oat consumption; micronutrients; pro-/prebiotics; and the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet. This publication outlines the Academy of Nutrition and Dietetics Evidence Analysis Library methods used to complete the systematic review and
guideline development, and summarizes the recommendations and supporting evidence. The guidelines affirm that all individuals with celiac disease should follow a GFD (1C, Imperative) that may include gluten-free oats in adults (2D, Conditional). Children should follow a nutritionally adequate GFD that supports healthy growth and development (Consensus, Imperative) and does not unnecessarily restrict gluten-free oats (Consensus, Conditional). The
guidelines indicate nutritional care should include routine nutritional assessment (
Consensus, Imperative) and medical nutrition therapy (
Consensus, Imperative). At this time, the
guidelines do not support a recommendation for the addition of the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet (2C, Conditional); prebiotic or probiotic supplementation (2D, Conditional); or micronutrient supplementation (in the absence of nutritional deficiency) (Consensus, Conditional). The 2021 Celiac Disease Evidence-Based Nutrition
Guideline will assist registered dietitian nutritionists in providing appropriate evidence-based medical nutrition therapy to support people with celiac disease in achieving and maintaining nutritional health and avoiding adverse celiac disease consequences throughout their lives.