Проблема качества питания пациентов с воспалительными заболеваниями кишечника, получающих биологическую терапию

Abstract

Food nutrients can directly regulate the function of the immune system and determine the composition of the intestinal microbiota and its activity in relation to the production of biologically active metabolites. Patients with inflammatory bowel disease (IBD) receiving biological therapy should be attentive to the quality of their diet to reduce the risk of negative disease scenarios. Objective. To evaluate the features of dietary patterns in patients with IBD receiving biological therapy and compare them with nutritional indicators of patients with irritable bowel syndrome (IBS). Patients and methods. The study included 56 patients who were divided into two groups: IBS group (n = 28) and a control group comprising of patients with IBS and diarrhea (n = 28). All patients were pair-matched by sex and age. Data on actual intake were collected from all participants using the 24-h dietary recall method. The dishes of the obtained diets were converted into constituent products according to the tab of dishes, which were summed up by weight per day and compared with dietary reference intakes according to the concept of the healthy eating pyramid for the calculated caloric content of the diet. To assess food diversity, the method of calculating the unique values (count base diversity) of food products from the diet by 11 groups was used: cereals, meat and eggs, fish and non-fish products of the sea, fatty foods, dairy products, vegetables, legumes and nuts, fruits and berries, confectionery, beverages, sauces, and spices with counting the number of positions in each of the studied food groups. A comparison of the mean values of the number of positions in each of the studied food groups was used to compare the dietary diversity in patients. The analysis of diets according to the method of culinary processing of dishes and products was performed by dividing them into 6 categories: cooked without heat treatment, boiled, stewed, fried, baked in the oven, or grilled. The total weight of food consumed per day by the individual (excluding thermostable components – water and salt) and the percentage of each of the categories of culinary processing in the diet (calculated by weight) were considered. As an integral indicator of the quality of diet, the participants’ diets were assessed using the criteria of the Healthy Eating Index 2015 (HEI 2015), which reflects the percentage of compliance with the optimal diet according to the American guidelines on healthy eating. Results. A comparison of the diets of the studied food groups in patients with IBD revealed a low intake of dietary fiber (17.3 ± 5.8 vs. 22.9 ± 7.6 g/day, p = 0.006) and a decrease in the frequency of meals (4.0 ± 0.9 vs. 4.9 ± 0.8 times per day, p = 0.003). Their diets were characterized by lower consumption of fruits (0.19 ± 0.26 vs. 0.55 ± 0.54, p = 0.002), vegetables (0.61 ± 0.37 vs. 0.95 ± 0.47, p = 0.01) and meat and fish products (1.43 ± 0.76 vs. 2.03 ± 1.15, p = 0.042), and higher consumption of fatty foods (1.62 ± 0.71 vs. 1.15 ± 0.97, p = 0.019). The profile of heat treatment of foods in patients with IBD differed significantly with a higher proportion of fried foods (13.79 ± 13.34% vs. 7.55 ± 9.32%, p = 0.047) and baked foods (16.00 ± 8.54% vs. 12.00 ± 11.36%, p = 0.013). The results of the assessment of dietary diversity showed that patients in the IBD group consumed significantly fewer types of fruits (1.00 ± 1.13 vs. 1.96 ± 1.47, p = 0.013) and grain products (2.07 ± 1.12 vs. 2.64 ± 1.12, p = 0.05) and more varieties of confectionery (1.57 ± 0.90 vs. 1.10 ± 0.78, p = 0.035). An integral assessment of the quality of the diet based on HEI 2015 showed a significantly lower value in individuals with IBD compared with those of patients with IBS (40.11 ± 12.04% vs. 51.53 ± 9.31%, p = 0.001). Conclusion. Currently, the role of diet therapy in supporting pharmacotherapy for IBD is greatly underestimated. Most of patients with IBD have disordered and unbalanced diets, and measures aimed at optimizing their nutritional status may improve the quality of life of patients and reduce the burden of spending health resources on expensive therapies and surgical interventions. Key words: healthy diet, dietary pattern, dietary assessment, IBD