Estudo das interações entre a terapia dietética e a microbiota intestinal na doença inflamatória intestinal: Uma revisão sistemática e meta-análise

Abstract

Inflammatory bowel diseases (IBD) has shown an increase in incidence worldwide. The main proven risk factor for both IBD is a positive family history in 10-25% of patients. Crohn's disease (CD) can affect individuals aged 15 to 40 years and 50 to 80 years, has a higher percentage in women, and has increased around 15 times in the last decades. Ulcerative colitis (UC), the disease can start at any age. The peak of incidence seems to occur from 20 to 40 years and many studies show a second peak of incidence in the elderly. The pathogenesis of IBD is that genetically susceptible individuals develop intolerance to the dysregulated gut microbiota (dysbiosis) and chronic inflammation develops as a result of poor food triggers. Thus, the diet plays an important role in the modulation of the intestinal microbiota and can be applied as a therapeutic tool to improve the course of the disease. To carry out a systematic review and meta-analysis on the main interactions between dietary therapy, gut microbiota, and inflammatory bowel disease, to elucidate the main clinical outcomes of the disease after nutritional treatment. The present study followed the international model of systematic review and meta-analysis, following the rules of PRISMA. The inclusion criteria were clinical studies, involving randomized controlled, prospective, and retrospective (observational/epidemiological) studies, published from 2010 to 2020 on the main clinical outcomes of the nutritional treatment of inflammatory bowel diseases. The quality of scientific evidence in the studies covered was classified as high, moderate, low, or very low, according to the GRADE rules and the risk of bias according to a Cochrane instrument. The present study found seventeen important prospective randomized controlled clinical studies in the last ten years that showed the important role of dietary modulation in the control of IBD. In this sense, they showed important reductions in persistent intestinal symptoms, improvement in intestinal microbiota, reduction in circulating markers of inflammation, and improvement in quality of life, with p<0.05 (95% CI). Most of the studies listed were homogeneous (98.95%) in their clinical responses, suggesting the broad impact of dietary interventions on inflammation and clinical outcomes. The important role of modulation of the diet in the control and even in the remission of IBD was evidenced.