原标题：IBD缓解期营养建议

爱在延长炎症性肠病基金会微信公众平台相继转载了来自瑞金医院营养科医护人员倾力翻译的ESPEN实用指南（2020）：炎症性肠病的临床营养Part1和Part2，医护人员和患者反馈非常受用，今天推送第三部分 。

此指南是基于2017年的ESPEN原指南推荐的40条 （几乎没有变动），进行了简化并添加了流程图。

感谢瑞金医院营养科施咏梅教授及其团队成员的辛苦付出。

IBD缓解期饮食建议

04

Recommendation 28

All IBD patients in remission should undergo counseling by a dietician as part of the multidisciplinary approach to improve nutritional therapy and to avoid malnutrition and nutrition-related disorders.

Grade of recommendation GPP-strong consensus (100% agreement).

推荐意见28： 鼓励所有IBD患者应咨询营养师（多学科协作的一部分），在其指导下加强营养治疗、避免营养不良和营养相关紊乱。（GPP-强烈共识，100%同意）

Recommendation 29

No specific diet needs to be followed during remission phases of IBD.

Grade of recommendation 0-strong consensus (96%agreement).

推荐意见29： IBD缓解期无需遵循特殊饮食（0-强烈共识，96%同意）

Recommendation 30

Supplementation with n-3 fatty acids should not be advised to support maintenance of remission in patients with IBD.

Grade of recommendation B -strong consensus (100% agreement).

推荐意见30： 不推荐IBD患者额外补充n-3多不饱和脂肪酸来维持缓解。（B-强烈共识，100%同意）

Recommendation 31

Non-specific high fiber diets should not normally be recommended for maintenance of remission in IBD.

Grade of recommendation 0 -strong consensus (96% agreement).

推荐意见31： 不常规推荐使用非特定高膳食纤维饮食用来维持IBD缓解。（0-强烈共识，96%同意）

Recommendation 32A

Probiotic therapy should be considered for the maintenance of remission in UC.

Grade of recommendation B -strong consensus (96% agreement).

推荐意见32A： 缓解期UC可以考虑使用益生菌来维持缓解。（B-强烈共识，96%同意）

Recommendation 32B

Probiotic therapy should not be used for maintenance of remission in CD.

Grade of recommendation 0 -strong consensus (100% agreement).

推荐意见32B： 不推荐缓解期CD患者使用益生菌用来维持缓解。（0-强烈共识，100%同意）

Recommendation 33A

Colectomized patients with a pouch and pouchitis should be treated with a probiotic mixture (“VSL#3”*), if antibiotic treatment has failed.

Grade of recommendation B -strong consensus (96% agreement).

推荐意见33A： 对于结直肠切除后伴有储袋和储袋炎的患者，若抗生素治疗失败，应考虑使用益生菌混合制剂（“VSL#3”*）治疗。（B-强烈共识，96%同意）

Recommendation 33B

The probiotic mixture “VSL#3”* may be used for primary and secondary prevention of pouchitis in patients with UC who have undergone colectomy and pouch-anal anastomosis.

Grade of recommendation B -strong consensus (100% agreement).

推荐意见33B： 经结直肠切除术和肛管吻合术的UC患者，可以考虑使用益生菌混合制剂（“VSL#3”*）作为储袋炎的一级、二级预防。（B-强烈共识，100%同意）

Recommendation 34A

Neither EN nor PN is recommended as primary therapy for maintaining remission in IBD.

Grade of recommendation GPP -strong consensus (100% agreement).

推荐意见34A： 不推荐使用EN或PN作为维持IBD缓解的基本治疗。（GPP-强烈共识，100%同意）

Recommendation 34B

ONS or EN can be recommended in patients with CD in remission, if undernutrition cannot be treated sufficiently by dietary counseling.

Grade of recommendation GPP -strong consensus (100% agreement).

推荐意见34B： 若缓解期CD患者通过膳食咨询无法有效纠正营养不足，应推荐使用ONS或EN。

Recommendation 35

Standard diet or ONS should be followed in patients with IBD in remission, giving attention to nutrition screening and generic nutritional support where needed.

Grade of recommendation: GPP-strong consensus (95% agreement).

推荐意见35： 缓解期IBD患者应遵循标准饮食或ONS，注重营养筛查，在需要时给予常规营养支持。

Recommendation 36

When more than 20 cm of distal ileum, whether or not in combination with the ileo-cecal valve, is resected, vitamin B12 shall be administered to patients with CD.

Grade of recommendation A-strong consensus (100% agreement).

推荐意见36： CD患者远端回肠切除超过20厘米时，无论是否与回盲瓣结合，都应服用维生素B12（A-强烈共识，100%同意）

Recommendation 37

Selected IBD patients, e.g. those treated with sulphasalazine and methotrexate, should be supplemented with vitamin B9/folic acid.

Grade of recommendation B - strong consensus (100% agreement).

推荐意见37： 使用柳氮磺胺吡啶和甲氨蝶呤治疗的IBD患者，应补充叶酸。（B-强烈共识，100%同意）

Recommendation 38A

In IBD patients who are pregnant, iron status and folate levels should be monitored regularly and in the case of deficiencies, iron and/or vitamin B9/folic acid should be additionally supplemented.

Grade of recommendation: GPP-strong consensus (95% agreement).

推荐意见38A： 孕期IBD患者需常规监测铁和叶酸水平，若缺乏，则应额外补充铁剂和/或叶酸。（GPP-强烈共识，95%同意）

Recommendation 38B

In IBD patients who are breastfeeding, nutritional status should be monitored regularly and in case of deficiencies, they should be supplemented.

Grade of recommendation: GPP-strong consensus (100% agreement).

推荐意见38B： 哺乳期IBD患者需常规监测营养状况，若发现营养缺乏，应及时补充。（GPP-强烈共识，100%推荐）

Recommendation 39

In all IBD patients, endurance training should be encouraged. In IBD patients with decreased muscle mass and/or muscle performance, appropriate physical activity should be recommended.

Grade of recommendation: GPP-strong consensus (95% agreement).

推荐意见39： 应鼓励所有IBD患者进行耐力训练。对肌肉量减少和/或肌功能减退的患者应推荐进行恰当的体力活动。（GPP-强烈共识，95%推荐）

Recommendation 40

Obese IBD patients should be advised to reduce weight only in phases of stable remission and then according to current obesity guidelines.

Grade of recommendation: GPP-strong consensus (100% agreement).

推荐意见40： 肥胖的IBD患者应在疾病稳定缓解期根据当前肥胖指南进行减重。（GPP-强烈共识，100%推荐）

翻译：罗茜、金倩雯、陶静、小冬冬

编辑：小冬冬

审校：施咏梅

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