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DOI: 10.1055/s-2003-36671
Ernährung
NutritionPublikationsverlauf
Publikationsdatum:
16. Januar 2003 (online)

Ernährungsfaktoren in der Ätiopathogenese von Morbus Crohn
Konsens
Es gibt derzeit keinerlei überzeugende Hinweise, dass Ernährungsgewohnheiten und/oder bestimmte Nahrungsmittelinhaltsstoffe ursächlich an der Entstehung des M. Crohn beteiligt sind (B).
Erläuterung
Die Beobachtung, dass chronisch entzündliche Darmkrankheiten bis Ende der 50er-Jahre extrem selten waren und seit dieser Zeit in allen westlichen Industrieländern erheblich zugenommen haben, veranlasste zur Annahme, dass Änderungen in der Ernährung eine wesentliche oder gar eine mögliche Ursache für die Häufigkeitszunahme, insbesondere für M. Crohn sind.
Angeschuldigt wurden der nach Kriegsende angestiegene Konsum an raffinierten Kohlenhydraten, chemisch aufbereitete Fette, die Abnahme des Verzehrs an Ballaststoffen, allergische Reaktionen auf Bäckerhefe sowie wie der Ersatz von Muttermilch durch Kuhmilch in der Säuglingsernährung [15].
Trotz der steigenden Inzidenz von CED und der geänderten Lebens- und Ernährungsweise in den modernen Industriestaaten konnte in keiner der bisher publizierten Studien ein zwingender Beweis für eine mögliche Rolle von Ernährungsfaktoren in der Ätiopathogenese von M. Crohn erbracht werden. Prospektive Studien zur Auslösung des M. Crohn durch bestimmte Nahrungsmittel fehlen.
Literatur
- 1 
            Weinand I, Jordan A, Caspary W F. et al .
            Nutrition in the etiopathogenesis of chronic inflammatory 
            					 bowel diseases. 
            Z Gastroenterol. 
            1997; 
            35 
            637-649 (III) 
            
            Reference Ris Wihthout Link
- 2 
            Tragnone A, Valpiani D, Miglio F. et al .
            Dietary habits as risk factors for inflammatory bowel 
            					 disease. 
            Eur J Gastroenterol Hepatol. 
            1995; 
            7 
            47-51 (IIb) 
            
            Reference Ris Wihthout Link
- 3 
            Riordan A M, Ruxton C H, Hunter J O. 
            A review of associations between Crohn’s disease and 
            					 consumption of sugars. 
            Eur J Clin Nutr. 
            1998; 
            52 
            229-238 (III) 
            
            Reference Ris Wihthout Link
- 4 
            Shoda R, Matsueda K, Yamato S. et al .
            Epidemiologic analysis of Crohn disease in Japan: increased 
            					 dietary intake of n-6 polyunsaturated fatty acids and animal protein relates
            to 
            					 the increased incidence of Crohn disease in Japan. 
            Am J Clin Nutr. 
            1996; 
            63 
            741-745 (IIb) 
            
            Reference Ris Wihthout Link
- 5 
            Koletzko S, Sherman P, Corey M. et al .
            Role of infant feeding practices in development of 
            					 Crohn’s disease in childhood. 
            BMJ. 
            1989; 
            298 
            1617-1618 (IIb) 
            
            Reference Ris Wihthout Link
- 6 
            Rath H C, Caesar I, Roth M. et al .
            Nutritional deficiencies and complications in chronic 
            					 inflammatory bowel diseases. 
            Med Klin. 
            1998; 
            93 
            6-10 (III) 
            
            Reference Ris Wihthout Link
- 7 
            Kastin D A, Buchman A L. 
            Malnutrition and gastrointestinal disease. 
            Curr Opin Clin Nutr Metab Care. 
            2002; 
            5 
            699-706 (III) 
            
            Reference Ris Wihthout Link
- 8 
            Sentongo T A, Semaeo E J, Stettler N. et al .
            Vitamin D status in children, adolescents, and young adults 
            					 with Crohn disease. 
            Am J Clin Nutr. 
            2002; 
            76 
            1077-1081 (Ib) 
            
            Reference Ris Wihthout Link
- 9 
            Sentongo T A, Semeao E J, Piccoli D A. et al .
            Growth, body composition, and nutritional status in children 
            					 and adolescents with Crohn’s disease. 
            J Pediatr Gastroenterol Nutr. 
            2000; 
            31 
            33-40 (IIa) 
            
            Reference Ris Wihthout Link
- 10 
            Philipsen-Geerling B J, Brummer R J. 
            Nutrition in Crohn’s disease. 
            Curr Opin Clin Nutr Metab Care. 
            2000; 
            3 
            305-309 (III) 
            
            Reference Ris Wihthout Link
- 11 
            Gassull M A, Cabre E. 
            Nutrition in iflammatory bowel disease. 
            Curr Opin Clin Nutr Metab Care. 
            2001; 
            4 
            561-569 (III) 
            
            Reference Ris Wihthout Link
- 12 
            Geerling B J, Badart-Smook A, Stockbruegger R W. et al .
            Comprehensive nutritional status in recentely diagnosed 
            					 patients with inflammatory bowel disease compred with population controls. 
            Eur J Clin Nutr. 
            2000; 
            54 
            514-521 (IIa) 
            
            Reference Ris Wihthout Link
- 13 
            Capristo E. 
            Body composition and metabolic features in Crohn’s 
            					 disease: an update. 
            Eur Rev Med Pharmacol Sci. 
            1998; 
            2 
            111-113 (III) 
            
            Reference Ris Wihthout Link
- 14 
            Barot L R, Rombeau J L, Feurer I D. et al .
            Caloric requirements in patients with inflammatory bowel 
            					 disease. 
            Ann Surg. 
            1982; 
            195 
            214-218 (Ib) 
            
            Reference Ris Wihthout Link
- 15 
            Chan A TH, Fleming R, OŽFallon W M. et al .
            Estimated versus measured basal energy requirements in 
            					 patients with CrohnŽdisease. 
            Gastroenterology. 
            1986; 
            91 
            75-80 (IIb) 
            
            Reference Ris Wihthout Link
- 16 
            Stokes M A, Hill G L. 
            Total energy expenditure in patients with Crohn‘s 
            					 disease: measurement by the combined body scan technique. 
            J Parent Ent Nutr. 
            1993; 
            17 
            3-7 (IIa) 
            
            Reference Ris Wihthout Link
- 17 
            Schneeweiss B, Lochs H, Zauner C. et al .
            Energy and substrate metabolism in patients with active 
            					 crohnŽs disease. 
            J Nutr. 
            1999; 
            129 
            844-848 (Ib) 
            
            Reference Ris Wihthout Link
- 18 
            Al-Jaouni R, Hebuterne X, Pouget I. et al .
            Energy metabolism and substrate oxidation in patients with 
            					 crohnŽs disease. 
            Nutrition. 
            2000; 
            16 
            173-178 (Ib) 
            
            Reference Ris Wihthout Link
- 19 
            Mingrone G, Capristo E, Greco A V. et al .
            Elevetated diet-induced thermogenesis and lipid oxidation 
            					 rate in CrohnŽs disease patients. 
            Am J Clin Nutr. 
            1999; 
            69 
            235-330 (Ib) 
            
            Reference Ris Wihthout Link
- 20 
            Galland L. 
            Magnesium and inflammatory bowel disease. 
            Magnesium. 
            1988; 
            7 
            78-83 (III) 
            
            Reference Ris Wihthout Link
- 21 
            Swinson C M, Perry J, Lumb M. et al .
            Role of sulphasalazine in the aetiology of folate deficiency 
            					 in ulcerative colitis. 
            Gut. 
            1981; 
            22 
            456-461 (IIa) 
            
            Reference Ris Wihthout Link
- 22 
            Montori V M, Basu A, Erwin P J. et al .
            Posttransplantation diabetes: a systematic review of the 
            					 literature. 
            Diabetes Care. 
            2002; 
            25 
            583-592 (Ia) 
            
            Reference Ris Wihthout Link
- 23 
            Higgens C S, Keighley M R, Allan R N. 
            Impact of preoperative weight loss and body composition 
            					 changes on postoperative outcome in surgery for inflammatory bowel 
            					 disease. 
            Gut. 
            1984; 
            25 
            732-736 (III) 
            
            Reference Ris Wihthout Link
- 24 
            Lindor K D, Fleming C R, Ilstrup D M. 
            Preoperative nutritional status and other factors that 
            					 influence surgical outcome in patients with Crohn’s disease. 
            Mayo Clin Proc. 
            1985; 
            60 
            393-396 (III) 
            
            Reference Ris Wihthout Link
- 25 
            Capristo E, Mingrone G, Addolorato G. et al .
            Effect of a vegetable-protein-rich polymeric diet treatment 
            					 on body composition and energy metabolism in inactive Crohn’s 
            					 disease. 
            Eur J Gastroenterol Hepatol. 
            2000; 
            12 
            5-11 (IIa) 
            
            Reference Ris Wihthout Link
- 26 
            Anstee Q M, Forbes A. 
            The safe use of percutaneous gastrostomy for enteral 
            					 nutrition in patients with Crohn’s disease. 
            Eur J Gastroenterol Hepatol. 
            2000; 
            12 
            1089-1093 (IIa) 
            
            Reference Ris Wihthout Link
- 27 
            Thomas T S, Berto E, Scribano M L. et al .
            Treatment of esophageal Crohn’s disease by enteral 
            					 feeding via percutaneous endoscopic gastrostomy. 
            JPEN J Parenter Enteral Nutr. 
            2000; 
            24 
            176-179 (III) 
            
            Reference Ris Wihthout Link
- 28 
            Gasche C, Dejaco C, Waldhoer T. et al .
            Intravenous iron and erythropoietin for anemia associated 
            					 with Crohn disease. A randomized, controlled trial. 
            Ann Intern Med. 
            1997; 
            126 
            782-787 (Ia) 
            
            Reference Ris Wihthout Link
- 29 
            Fernandez-Banares F, Cabre E, Esteve-Comas M. et al .
            How effective is enteral nutrition in inducing clinical 
            					 remission in active Crohn’s disease? A meta-analysis of the randomized 
            					 clinical trials. 
            J Parenter Enteral Nutr. 
            1995; 
            19 
            356-364 (Ia) 
            
            Reference Ris Wihthout Link
- 30 
            Griffiths A M, Ohlsson A, Sherman P M. et al .
            Meta-analysis of enteral nutrition as a primary treatment of 
            					 active Crohn’s disease. 
            Gastroenterology. 
            1995; 
            108 
            1056-1067 (Ia) 
            
            Reference Ris Wihthout Link
- 31 
            Zachos M, Tondeur M, Griffiths A M. 
            Enteral nutritional therapy for inducing remission of 
            					 Crohn’s disease. 
            Cochrane Database Syst Rev. 
            2001; 
            3 CD000542 (Ia) 
            
            Reference Ris Wihthout Link
- 32 
            González-Huix F, De León R, Fernández-Bañares F. et al .
            Polymeric enteral diets as primary treatment of active 
            					 Crohn’s disease: a prospective steroid controlled trial. 
            Gut. 
            1993; 
            34 
            778-782 (Ib) 
            
            Reference Ris Wihthout Link
- 33 
            Lochs H, Steinhardt H J, Klaus-Wentz B. et al .
            Comparison of enteral nutrition and drug treatment in active 
            					 Crohn’s disease. Results of European Co-operative Crohn’s disease 
            					 Study IV. 
            Gastroenterology. 
            1991; 
            101 
            881-888 (Ib) 
            
            Reference Ris Wihthout Link
- 34 
            Osullivan M, Omorain C. 
            Liquid diets in Crohn disease. 
            Gut. 
            2001; 
            48 
            757 (III) 
            
            Reference Ris Wihthout Link
- 35 
            Verma S, Brown S, Kirkwood B. et al .
            Polymeric versus elemental diet as primary treatment in 
            					 active Crohn’s disease: a randomized, double-blind trial. 
            Am J Gastroenterol. 
            2000; 
            95 
            735-739 (Ib) 
            
            Reference Ris Wihthout Link
- 36 
            Sanderson I R, Udeen S, Davies P SW. et al .
            Remission induced by an elemental diet in small bowel 
            					 Crohn’s disease. 
            Arch Dis Child. 
            1987; 
            61 
            123-127 (IIa) 
            
            Reference Ris Wihthout Link
- 37 
            Thomas A G, Taylor F, Miller V. 
            Dietary intake and nutritional treatment in childhood 
            					 Crohn’s disease. 
            J Pediatr Gastroenterol Nutr. 
            1993; 
            17 
            75-81 (IIa) 
            
            Reference Ris Wihthout Link
- 38 
            Ruemmele F M, Roy C C, Levy E. et al .
            Nutrition as primary therapy in pediatric Crohn’s 
            					 disease: fact or fantasy?. 
            J Pediatr. 
            2000; 
            136 
            285-289 (III) 
            
            Reference Ris Wihthout Link
- 39 
            Heuschkel R B, Menache C C, Megerian J T. et al .
            Enteral nutrition and corticosteroids in the treatment of 
            					 acute Crohn’s disease in children. 
            J Pediatr Gastroenterol Nutr. 
            2000; 
            31 
            8-15 (Ib) 
            
            Reference Ris Wihthout Link
- 40 
            Fell J M, Paintin M, Arnaud-Battandier F. et al .
            Mucosal healing and a fall in mucosal pro-inflammatory 
            					 cytokine mRNA induced by a specific oral polymeric diet in paediatric 
            					 Crohn’s disease. 
            Aliment Pharmacol Ther. 
            2000; 
            14 
            281-289 (Ib) 
            
            Reference Ris Wihthout Link
- 41 
            Akobeng A K, Miller V, Stanton J. et al .
            Double-blind randomized controlled trial of 
            					 glutamine-enriched polymeric diet in the treatment of active Crohn’s 
            					 disease. 
            J Pediatr Gastroenterol Nutr. 
            2000; 
            30 
            78-84 (Ib) 
            
            Reference Ris Wihthout Link
- 42 
            Verma S, Holdsworth C D, Giaffer M H. 
            Does adjuvant nutritional support diminish steroid dependency 
            					 in Crohn disease?. 
            Scand J Gastroenterol. 
            2000; 
            36 
            383-388 (IIa) 
            
            Reference Ris Wihthout Link
- 43 
            Lashner B A, Evans A A, Hanauer S B. 
            Preoperative total parenteral nutrition for bowel resection 
            					 in Crohn’s disease. 
            Dig Dis Sci. 
            1988; 
            34 
            741-746 (IIa) 
            
            Reference Ris Wihthout Link
- 44 
            Klein S, Kinney J, Jeejeebhoy K. et al .
            Nutrition support in clinical practice: review of published 
            					 data and recommendations for future research directions. 
            Am J Clin Nutr. 
            1997; 
            66 
            683-706 (III) 
            
            Reference Ris Wihthout Link
- 45 
            Makhdoom Z A, Komar M J, Still C D. 
            Nutrition and enterocutaneous fistulas. 
            J Clin Gastroenterol. 
            2000; 
            31 
            195-204 (III) 
            
            Reference Ris Wihthout Link
- 46 
            Ettinger B, Pak C Y, Citron J T. et al .
            Potassium-magnesium citrate is an effective prophylaxis 
            					 against recurrent calcium oxalate nephrolithiasis. 
            J Urol. 
            1997; 
            158 
            2069-2073 (Ib) 
            
            Reference Ris Wihthout Link
- 47 
            Carlsson E, Berglund B, Nordgren S. 
            Living with an ostomy and short bowel syndrome: practical 
            					 aspects and impact on daily life. 
            J Wound Ostomy Continence Nurs. 
            2001; 
            28 
            96-105 (III) 
            
            Reference Ris Wihthout Link
- 48 
            Eusufzai S. 
            Bile acid malabsorption: mechanisms and treatment. 
            Dig Dis 1995; 13: 312-321 (III). 
            
            Reference Ris Wihthout Link
- 49 
            Wilschanski M, Sherman P, Pencharz P. et al .
            Supplementary enteral nutrition maintains remission in 
            					 paediatric Crohn’s disease. 
            Gut. 
            1996; 
            38 
            543-548 (IIa) 
            
            Reference Ris Wihthout Link
- 50 
            Verma S, Kirkwood B, Brown S. et al .
            Oral nutritional supplementation is effective in the 
            					 maintenance of remission in Crohn’s disease. 
            Dig Liver Dis. 
            2000; 
            32 
            769-774 (IIa) 
            
            Reference Ris Wihthout Link
- 51 
            Norday A. 
            Is there a rational role for N-3 fatty acids (fish oil) in 
            					 clinical medicine?. 
            Drugs. 
            1991; 
            42 
            331 (III) 
            
            Reference Ris Wihthout Link
- 52 
            Tsujikawa T, Satoh J, Uda K. et al .
            Clinical importance of n-3 fatty acid-rich diet and 
            					 nutritional education for the maintenance of remission in Crohn’s 
            					 disease. 
            J Gastroenterol. 
            2000; 
            35 
            99-104 (IIa) 
            
            Reference Ris Wihthout Link
- 53 
            Belluzzi A, Brignola C, Campieri M. et al .
            Effect of an enteric-coated fish-oil preparation on relapses 
            					 in Crohn’s disease. 
            N Engl J Med. 
            1996; 
            334 
            1557-1560 (Ib) 
            
            Reference Ris Wihthout Link
- 54 
            Lorenz-Meyer H, Bauer P, Nicolay C. et al .
            Omega-3 fatty acids and low carbohydrate diet for maintenance 
            					 of remission in Crohn’s disease. A randomized controlled multicenter 
            					 trial. 
            Study Group Members. Scand J Gastroenterol. 
            1996; 
            31 
            778-785 (Ib) 
            
            Reference Ris Wihthout Link
- 55 
            Stange E F, Schmid U, Fleig W E. et al .
            Exclusion diet in Crohn disease: controlled, randomised 
            					 study. 
            Z Gastroenterol. 
            1990; 
            28 
            561-564 (Ib) 
            
            Reference Ris Wihthout Link
- 56 
            Ballegaard M, Bjergstrom A, Brondum S. et al .
            Self-reported food intolerance in chronic inflammatory bowel 
            					 disease. 
            Scand J Gastroenterol. 
            1997; 
            32 
            569-571 (IIb) 
            
            Reference Ris Wihthout Link
- 57 
            Van den Bogarde J, Cahill J, Emmanuel A V. et al .
            Gut mucosal response to food antigens in CrohnŽs 
            					 disease. 
            Aliment Pharmacol Ther. 
            2002; 
            16 
            1903-915 (IIa) 
            
            Reference Ris Wihthout Link
- 58 
            Kobayashi K, Katsumata T, Yokoyama K. et al .
            A randomised controlled trial of total parenteral nutrition 
            					 and enteral nutrition by elemental and polymeric diet as primary therapy in
            
            					 active phase of Crohn’s disease. 
            Jap J Gastroenterol. 
            1998; 
            95 
            1212-1221 (Ib) 
            
            Reference Ris Wihthout Link
- 59 
            Scolapio J S. 
            The role of total parenteral nutrition in the management of 
            					 patients with acute attacks of IBD. 
            J Clin Gastroenterol. 
            1999; 
            29 
            223-224 (III) 
            
            Reference Ris Wihthout Link
- 60 
            Seo M, Okada M, Yao T. et al .
            The role of total parenteral nutrition in the management of 
            					 patients with acute attacks of inflammatory bowel disease. 
            J Clin Gastroenterol. 
            1999; 
            29 
            270-275 (IIa) 
            
            Reference Ris Wihthout Link
 
     
      
    