نقش تغذیه و میکروبیوتای دستگاه گوارش در بیماری التهابی روده کودکان
سلامت اجتماعی,
دوره 10 شماره 4,
5 September 2023
,
صفحه 1-18
https://doi.org/10.22037/ch.v10i4.31661
چکیده
میکروبیوتای دستگاه گوارش می تواند با تأثیر بر مسیرهای سیگنالینگ داخل سلولی در بهبود یا تشدید بیماری ها از جمله بیماری التهابی روده نقش داشته باشد. در حدود 25درصد از موارد بیماری التهابی روده در کودکان رخ می دهد و شباهت ها و تفاوت های متعددی بین بیماری التهابی روده اطفال و بزرگسالان وجود دارد. در کودکان مبتلا به بیماری التهابی روده انتروکوک افزایش و آنایروستیپس، بلوتیا، کوپروکوکوس، فکالیباکتریوم، رزبوریا، رومینوکوکوس و لاکنوسپیرا کاهش قابل توجهی می یابد. این یافتهها نشان میدهد که رژیم غذایی و دیسبیوزیس ناشی از آن که در بزرگسالان مبتلا به بیماری التهابی روده دیده میشود، ممکن است در طول دوره کودکی ایجاد شود. در نتیجه مطالعه پروفایل میکروبیوتای دستگاه گوارش و ارتباط آن با رژیم غذایی در کودکان مبتلا به بیماری التهابی روده میتواند در تشخیص، غربالگری و درمان آنها نقش داشته باشد. در مقاله حاضر مفاهيم پايه مربوط به میکروبیوتای دستگاه گوارش کودکان، و ارتباط آن با رژیم غذایی در بیماری التهابی روده کودکان و ارتباط آنها با یکدیگر، و مکانیسمهای داخل سلولی و دورنماي کاربرد آنها در آينده مرور شده است.
- میکروبیوتای دستگاه گوارش، تغذیه، رژیم غذایی، بیماری التهابی روده
ارجاع به مقاله
مراجع
Bouhuys M, Lexmond WS, van Rheenen PF. Pediatric Inflammatory Bowel Disease. Pediatrics. 2023;151(1).
Comito D, Romano C. Dysbiosis in the pathogenesis of pediatric inflammatory bowel diseases. Int J Inflam. 2012;2012:687143.
Rosen MJ, Dhawan A, Saeed SA. Inflammatory Bowel Disease in Children and Adolescents. JAMA Pediatr. 2015;169(11):1053-60.
Walker AW, Sanderson JD, Churcher C, Parkes GC, Hudspith BN, Rayment N, et al. High-throughput clone library analysis of the mucosa-associated microbiota reveals dysbiosis and differences between inflamed and non-inflamed regions of the intestine in inflammatory bowel disease. BMC Microbiol. 2011;11:7.
Binienda A, Twardowska A, Makaro A, Salaga M. Dietary Carbohydrates and Lipids in the Pathogenesis of Leaky Gut Syndrome: An Overview. Int J Mol Sci. 2020;21(21).
Fritsch J, Abreu MT. The Microbiota and the Immune Response: What Is the Chicken and What Is the Egg? Gastrointest Endosc Clin N Am. 2019;29(3):381-93.
Rowland M, Fleming P, Bourke B. Looking in the mouth for Crohn's disease. Inflamm Bowel Dis. 2010;16(2):332-7.
Griffiths AM, Nicholas D, Smith C, Munk M, Stephens D, Durno C, et al. Development of a quality-of-life index for pediatric inflammatory bowel disease: dealing with differences related to age and IBD type. J Pediatr Gastroenterol Nutr. 1999;28(4):S46-52.
Bousvaros A, Antonioli DA, Colletti RB, Dubinsky MC, Glickman JN, Gold BD, et al. Differentiating ulcerative colitis from Crohn disease in children and young adults: report of a working group of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the Crohn's and Colitis Foundation of America. J Pediatr Gastroenterol Nutr. 2007;44(5):653-74.
Abramson O, Durant M, Mow W, Finley A, Kodali P, Wong A, et al. Incidence, prevalence, and time trends of pediatric inflammatory bowel disease in Northern California, 1996 to 2006. J Pediatr. 2010;157(2):233-9.e1.
Kappelman MD, Moore KR, Allen JK, Cook SF. Recent trends in the prevalence of Crohn's disease and ulcerative colitis in a commercially insured US population. Dig Dis Sci. 2013;58(2):519-25.
Kelsen J, Baldassano RN. Inflammatory bowel disease: the difference between children and adults. Inflamm Bowel Dis. 2008;14 Suppl 2:S9-11.
Loftus EV, Jr., Guérin A, Yu AP, Wu EQ, Yang M, Chao J, et al. Increased risks of developing anxiety and depression in young patients with Crohn's disease. Am J Gastroenterol. 2011;106(9):1670-7.
Szigethy EM, Youk AO, Benhayon D, Fairclough DL, Newara MC, Kirshner MA, et al. Depression subtypes in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2014;58(5):574-81.
Ley D, Duhamel A, Behal H, Vasseur F, Sarter H, Michaud L, et al. Growth Pattern in Paediatric Crohn Disease Is Related to Inflammatory Status. J Pediatr Gastroenterol Nutr. 2016;63(6):637-43.
Gupta N, Lustig RH, Kohn MA, McCracken M, Vittinghoff E. Sex differences in statural growth impairment in Crohn's disease: role of IGF-1. Inflamm Bowel Dis. 2011;17(11):2318-25.
Peneau A, Savoye G, Turck D, Dauchet L, Fumery M, Salleron J, et al. Mortality and cancer in pediatric-onset inflammatory bowel disease: a population-based study. Am J Gastroenterol. 2013;108(10):1647-53.
Kappelman MD, Farkas DK, Long MD, Erichsen R, Sandler RS, Sørensen HT, et al. Risk of cancer in patients with inflammatory bowel diseases: a nationwide population-based cohort study with 30 years of follow-up evaluation. Clin Gastroenterol Hepatol. 2014;12(2):265-73.e1.
Canavan C, Abrams KR, Hawthorne B, Mayberry JF. Long-term prognosis in Crohn's disease: An epidemiological study of patients diagnosed more than 20 years ago in Cardiff. Aliment Pharmacol Ther. 2007;25(1):59-65.
Imanzadeh F, Nasri P, Sadeghi S, Sayyari A, Dara N, Abdollah K, et al. Food allergy among Iranian children with inflammatory bowel disease: A preliminary report. J Res Med Sci. 2015;20(9):855-9.
Nagpal R, Mainali R, Ahmadi S, Wang S, Singh R, Kavanagh K, et al. Gut microbiome and aging: Physiological and mechanistic insights. Nutr Healthy Aging. 2018;4(4):267-85.
Cresci GAM, Izzo K. Chapter 4 - Gut Microbiome. In: Corrigan ML, Roberts K, Steiger E, editors. Adult Short Bowel Syndrome: Academic Press; 2019. p. 45-54.
Vemuri R, Shankar EM, Chieppa M, Eri R, Kavanagh K. Beyond Just Bacteria: Functional Biomes in the Gut Ecosystem Including Virome, Mycobiome, Archaeome and Helminths. Microorganisms. 2020;8(4).
Rinninella E, Raoul P, Cintoni M, Franceschi F, Miggiano GAD, Gasbarrini A, et al. What is the Healthy Gut Microbiota Composition? A Changing Ecosystem across Age, Environment, Diet, and Diseases. Microorganisms. 2019;7(1).
Rastelli M, Knauf C, Cani PD. Gut Microbes and Health: A Focus on the Mechanisms Linking Microbes, Obesity, and Related Disorders. Obesity (Silver Spring). 2018;26(5):792-800.
Guinane CM, Cotter PD. Role of the gut microbiota in health and chronic gastrointestinal disease: understanding a hidden metabolic organ. Therap Adv Gastroenterol. 2013;6(4):295-308.
Ettehad Marvasti F, Moshiri A, Taghavi MS, Riazi S, Taati M, Sadati SF, et al. The First Report of Differences in Gut Microbiota Composition between Obese and Normal Weight Iranian Subjects. Iran Biomed J. 2020;24(3):148-54.
Thursby E, Juge N. Introduction to the human gut microbiota. Biochem J. 2017;474(11):1823-36.
Chelakkot C, Ghim J, Ryu SH. Mechanisms regulating intestinal barrier integrity and its pathological implications. Exp Mol Med. 2018;50(8):1-9.
Kumbhare SV, Patangia DVV, Patil RH, Shouche YS, Patil NP. Factors influencing the gut microbiome in children: from infancy to childhood. J Biosci. 2019;44(2).
Meyer KM, Mohammad M, Bode L, Chu DM, Ma J, Haymond M, et al. 20: Maternal diet structures the breast milk microbiome in association with human milk oligosaccharides and gut-associated bacteria. American Journal of Obstetrics & Gynecology. 2017;216(1):S15.
Huurre A, Kalliomäki M, Rautava S, Rinne M, Salminen S, Isolauri E. Mode of delivery - effects on gut microbiota and humoral immunity. Neonatology. 2008;93(4):236-40.
Clark RH, Bloom BT, Spitzer AR, Gerstmann DR. Reported medication use in the neonatal intensive care unit: data from a large national data set. Pediatrics. 2006;117(6):1979-87.
Zhuang X, Liu C, Zhan S, Tian Z, Li N, Mao R, et al. Gut Microbiota Profile in Pediatric Patients With Inflammatory Bowel Disease: A Systematic Review. Front Pediatr. 2021;9:626232.
Ring C, Klopfleisch R, Dahlke K, Basic M, Bleich A, Blaut M. Akkermansia muciniphila strain ATCC BAA-835 does not promote short-term intestinal inflammation in gnotobiotic interleukin-10-deficient mice. Gut Microbes. 2019;10(2):188-203.
Rolhion N, Darfeuille-Michaud A. Adherent-invasive Escherichia coli in inflammatory bowel disease. Inflamm Bowel Dis. 2007;13(10):1277-83.
Seishima J, Iida N, Kitamura K, Yutani M, Wang Z, Seki A, et al. Gut-derived Enterococcus faecium from ulcerative colitis patients promotes colitis in a genetically susceptible mouse host. Genome Biol. 2019;20(1):252.
Wilson DC, Russell RK. Overview of paediatric IBD. Semin Pediatr Surg. 2017;26(6):344-8.
Ni J, Wu GD, Albenberg L, Tomov VT. Gut microbiota and IBD: causation or correlation? Nat Rev Gastroenterol Hepatol. 2017;14(10):573-84.
Kolho KL, Korpela K, Jaakkola T, Pichai MV, Zoetendal EG, Salonen A, et al. Fecal Microbiota in Pediatric Inflammatory Bowel Disease and Its Relation to Inflammation. Am J Gastroenterol. 2015;110(6):921-30.
Papa E, Docktor M, Smillie C, Weber S, Preheim SP, Gevers D, et al. Non-invasive mapping of the gastrointestinal microbiota identifies children with inflammatory bowel disease. PLoS One. 2012;7(6):e39242.
Sila S, Jelić M, Trivić I, Tambić Andrašević A, Hojsak I, Kolaček S. Altered Gut Microbiota Is Present in Newly Diagnosed Pediatric Patients With Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr. 2020;70(4):497-502.
Schwiertz A, Jacobi M, Frick JS, Richter M, Rusch K, Köhler H. Microbiota in pediatric inflammatory bowel disease. J Pediatr. 2010;157(2):240-4.e1.
Olbjørn C, Småstuen MC, Moen AEF. Targeted Analysis of the Gut Microbiome for Diagnosis, Prognosis and Treatment Individualization in Pediatric Inflammatory Bowel Disease. Microorganisms. 2022;10(7).
Maukonen J, Kolho KL, Paasela M, Honkanen J, Klemetti P, Vaarala O, et al. Altered Fecal Microbiota in Paediatric Inflammatory Bowel Disease. J Crohns Colitis. 2015;9(12):1088-95.
Olbjørn C, Cvancarova Småstuen M, Thiis-Evensen E, Nakstad B, Vatn MH, Jahnsen J, et al. Fecal microbiota profiles in treatment-naïve pediatric inflammatory bowel disease - associations with disease phenotype, treatment, and outcome. Clin Exp Gastroenterol. 2019;12:37-49.
Gevers D, Kugathasan S, Denson LA, Vázquez-Baeza Y, Van Treuren W, Ren B, et al. The treatment-naive microbiome in new-onset Crohn's disease. Cell Host Microbe. 2014;15(3):382-92.
Kaakoush NO, Day AS, Huinao KD, Leach ST, Lemberg DA, Dowd SE, et al. Microbial dysbiosis in pediatric patients with Crohn's disease. J Clin Microbiol. 2012;50(10):3258-66.
Borody TJ, Paramsothy S, Agrawal G. Fecal microbiota transplantation: indications, methods, evidence, and future directions. Curr Gastroenterol Rep. 2013;15(8):337.
Benjamini Y, Hochberg Y. Controlling The False Discovery Rate - A Practical And Powerful Approach To Multiple Testing. J Royal Statist Soc, Series B. 1995;57:289-300.
Fasano A. All disease begins in the (leaky) gut: role of zonulin-mediated gut permeability in the pathogenesis of some chronic inflammatory diseases. F1000Res. 2020;9.
Sitjà-Bobadilla A, Gil-Solsona R, Estensoro I, Piazzon MC, Martos-Sitcha JA, Picard-Sánchez A, et al. Disruption of gut integrity and permeability contributes to enteritis in a fish-parasite model: a story told from serum metabolomics. Parasit Vectors. 2019;12(1):486.
Chelakkot C, Ghim J, Ryu SH. Mechanisms regulating intestinal barrier integrity and its pathological implications. Experimental & Molecular Medicine. 2018;50(8):1-9.
Fuke N, Nagata N, Suganuma H, Ota T. Regulation of Gut Microbiota and Metabolic Endotoxemia with Dietary Factors. Nutrients. 2019;11(10).
Ejtahed H-S, Hoseini-Tavassol Z, Khatami S, Zangeneh M, Behrouzi A, Ahmadi Badi S, et al. Main gut bacterial composition differs between patients with type 1 and type 2 diabetes and non-diabetic adults. Journal of Diabetes & Metabolic Disorders. 2020;19(1):265-71.
Shilova ON, Shilov ES, Lieber A, Deyev SM. Disassembling a cancer puzzle: Cell junctions and plasma membrane as targets for anticancer therapy. J Control Release. 2018;286:125-36.
Nalle SC, Turner JR. Intestinal barrier loss as a critical pathogenic link between inflammatory bowel disease and graft-versus-host disease. Mucosal Immunol. 2015;8(4):720-30.
Shen L, Weber CR, Raleigh DR, Yu D, Turner JR. Tight junction pore and leak pathways: a dynamic duo. Annu Rev Physiol. 2011;73:283-309.
Allaire JM, Crowley SM, Law HT, Chang SY, Ko HJ, Vallance BA. The Intestinal Epithelium: Central Coordinator of Mucosal Immunity. Trends Immunol. 2018;39(9):677-96.
Ulluwishewa D, Anderson RC, McNabb WC, Moughan PJ, Wells JM, Roy NC. Regulation of tight junction permeability by intestinal bacteria and dietary components. J Nutr. 2011;141(5):769-76.
González-Mariscal L, Raya-Sandino A, González-González L, Hernández-Guzmán C. Relationship between G proteins coupled receptors and tight junctions. Tissue Barriers. 2018;6(1):e1414015.
Miyauchi E, Morita H, Tanabe S. Lactobacillus rhamnosus alleviates intestinal barrier dysfunction in part by increasing expression of zonula occludens-1 and myosin light-chain kinase in vivo. J Dairy Sci. 2009;92(6):2400-8.
Resta-Lenert S, Barrett KE. Probiotics and commensals reverse TNF-alpha- and IFN-gamma-induced dysfunction in human intestinal epithelial cells. Gastroenterology. 2006;130(3):731-46.
Zyrek AA, Cichon C, Helms S, Enders C, Sonnenborn U, Schmidt MA. Molecular mechanisms underlying the probiotic effects of Escherichia coli Nissle 1917 involve ZO-2 and PKCzeta redistribution resulting in tight junction and epithelial barrier repair. Cell Microbiol. 2007;9(3):804-16.
Ukena SN, Singh A, Dringenberg U, Engelhardt R, Seidler U, Hansen W, et al. Probiotic Escherichia coli Nissle 1917 inhibits leaky gut by enhancing mucosal integrity. PLoS One. 2007;2(12):e1308.
Anderson RC, Cookson AL, McNabb WC, Park Z, McCann MJ, Kelly WJ, et al. Lactobacillus plantarum MB452 enhances the function of the intestinal barrier by increasing the expression levels of genes involved in tight junction formation. BMC Microbiol. 2010;10:316.
Karczewski J, Troost FJ, Konings I, Dekker J, Kleerebezem M, Brummer RJ, et al. Regulation of human epithelial tight junction proteins by Lactobacillus plantarum in vivo and protective effects on the epithelial barrier. Am J Physiol Gastrointest Liver Physiol. 2010;298(6):G851-9.
Hsiao EY, McBride SW, Hsien S, Sharon G, Hyde ER, McCue T, et al. Microbiota modulate behavioral and physiological abnormalities associated with neurodevelopmental disorders. Cell. 2013;155(7):1451-63.
Knoll RL, Forslund K, Kultima JR, Meyer CU, Kullmer U, Sunagawa S, et al. Gut microbiota differs between children with Inflammatory Bowel Disease and healthy siblings in taxonomic and functional composition: a metagenomic analysis. Am J Physiol Gastrointest Liver Physiol. 2017;312(4):G327-g39.
Cheng H, Ma Z, Yu B, Liu X, Tian C, Zhong X, et al. Quality assessment of clinical guidelines on probiotics therapy in children with IBD using the AGREE II instrument. J Clin Pharm Ther. 2021;46(4):1155-65.
Ventin-Holmberg R, Höyhtyä M, Saqib S, Korpela K, Nikkonen A, Salonen A, et al. The gut fungal and bacterial microbiota in pediatric patients with inflammatory bowel disease introduced to treatment with anti-tumor necrosis factor-α. Sci Rep. 2022;12(1):6654.
Hart L, Farbod Y, Szamosi JC, Yamamoto M, Britz-McKibbin P, Halgren C, et al. Effect of Exclusive Enteral Nutrition and Corticosteroid Induction Therapy on the Gut Microbiota of Pediatric Patients with Inflammatory Bowel Disease. Nutrients. 2020;12(6).
Shoda, R.; Matsueda, K.; Yamato, S.; Umeda, N. 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.
Hou, J.K.; Abraham, B.; El-Serag, H. Dietary intake and risk of developing inflammatory bowel disease: A systematic review of the literature. Am. J. Gastroenterol. 2011, 106, 563–573.
Miura, S.; Imaeda, H.; Shiozaki, H.; Ohkubo, N.; Tashiro, H.; Serizawa, H.; Tsuchiya, M.; Tso, P. Increased proliferative response of lymphocytes from intestinal lymph during long chain fatty acid absorption. Immunology 1993, 78, 142–146.
Pendyala, S.; Walker, J.M.; Holt, P.R. A high-fat diet is associated with endotoxemia that originates from the gut. Gastroenterology 2012, 142, 1100–1101.e2.
Sartor, R.B. Microbial influences in inflammatory bowel diseases. Gastroenterology 2008, 134, 577–594.
Jantchou, P.; Morois, S.; Clavel-Chapelon, F.; Boutron-Ruault, M.-C.; Carbonnel, F. Animal protein intake and risk of inflammatory bowel disease: The E3N prospective study. Am. J. Gastroenterol. 2010, 105, 2195–2201.
Jowett, S.L.; Seal, C.J.; Pearce, M.S.; Phillips, E.; Gregory, W.; Barton, J.R.; Welfare, M.R. Influence of dietary factors on the clinical course of ulcerative colitis: A prospective cohort study. Gut 2004, 53, 1479–1484.
Hart, A.R.; Luben, R.; Olsen, A.; Tjonneland, A.; Linseisen, J.; Nagel, G.; Berglund, G.; Lindgren, S.; Grip, O.; Key, T.; et al. Diet in the aetiology of ulcerative colitis: A European prospective cohort study. Digestion 2008, 77, 57–64.
James, A.H. Breakfast and Crohn’s disease. Br. Med. J. 1977, 1, 943–945.
Barrett, J.S.; Irving, P.M.; Shepherd, S.J.; Muir, J.G.; Gibson, P.R. Comparison of the prevalence of fructose and lactose malabsorption across chronic intestinal disorders. Aliment. Pharmacol. Ther. 2009, 30, 165–174.
Laudisi, F.; Stolfi, C.; Monteleone, G. Impact of Food Additives on Gut Homeostasis. Nutrients 2019, 11, 2334.
Lewis, J.D.; Abreu, M.T. Diet as a Trigger or Therapy for Inflammatory Bowel Diseases. Gastroenterology 2017, 152, 398–414.e6.
Weber, A.T.; Shah, N.D.; Sauk, J.; Limketkai, B.N. Popular Diet Trends for Inflammatory Bowel Diseases: Claims and Evidence. Curr. Treat. Options Gastroenterol. 2019, 17, 564–576.
Gottschall, E. Breaking the Vicious Cycle: Intestinal Health through Diet; Kirkton Press: Ontario, CA, USA, 1994.
Limketkai, B.N.; Wolf, A.; Parian, A.M. Nutritional Interventions in the Patient with Inflammatory Bowel Disease. Gastroenterol. Clin. N. Am. 2018, 47, 155–177.
Barrett, J.S.; Gearry, R.B.; Muir, J.G.; Irving, P.M.; Rose, R.; Rosella, O.; Haines, M.L.; Shepherd, S.J.; Gibson, P.R. Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon. Aliment. Pharmacol. Ther. 2010, 31, 874–882.
Barrett, J.S. How to institute the low-FODMAP diet. J. Gastroenterol. Hepatol. 2017, 32 (Suppl. S1), 8–10.
Elli, L.; Tomba, C.; Branchi, F.; Roncoroni, L.; Lombardo, V.; Bardella, M.T.; Ferretti, F.; Conte, D.; Valiante, F.; Fini, L.; et al. Evidence for the Presence of Non-Celiac Gluten Sensitivity in Patients with Functional Gastrointestinal Symptoms: Results from a Multicenter Randomized Double-Blind Placebo-Controlled Gluten Challenge. Nutrients 2016, 8, 84.
Niland, B.; Cash, B.D. Health Benefits and Adverse Effects of a Gluten-Free Diet in Non-Celiac Disease Patients. Gastroenterol. Hepatol. (N. Y.) 2018, 14, 82–91.
Olendzki, B.C.; Silverstein, T.D.; Persuitte, G.M.; Ma, Y.; Baldwin, K.R.; Cave, D. An anti-inflammatory diet as treatment for inflammatory bowel disease: A case series report. Nutr. J. 2014, 13, 5.
Willett, W.C.; Sacks, F.; Trichopoulou, A.; Drescher, G.; Ferro-Luzzi, A.; Helsing, E.; Trichopoulos, D. Mediterranean diet pyramid: A cultural model for healthy eating. Am. J. Clin. Nutr. 1995, 61, 1402S–1406S.
Hou, J.K.; Abraham, B.; El-Serag, H. Dietary intake and risk of developing inflammatory bowel disease: A systematic review of the literature. Am. J. Gastroenterol. 2011, 106, 563–573.
Tsujikawa, T.; Satoh, J.; Uda, K.; Ihara, T.; Okamoto, T.; Araki, Y.; Sasaki, M.; Fujiyama, Y.; Bamba, T. 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.
Endres, S.; Lorenz, R.; Loeschke, K. Lipid treatment of inflammatory bowel disease. Curr. Opin. Clin. Nutr. Metab. Care 1999, 2, 117–120.
Feagan, B.G.; Sandborn, W.J.; Mittmann, U.; Bar-Meir, S.; D’Haens, G.; Bradette, M.; Cohen, A.; Dallaire, C.; Ponich, T.P.; McDonald, J.W.D.; et al. Omega-3 free fatty acids for the maintenance of remission in Crohn disease: The EPIC Randomized Controlled Trials. JAMA 2008, 299, 1690–1697.
Uchiyama, K.; Nakamura, M.; Odahara, S.; Koido, S.; Katahira, K.; Shiraishi, H.; Ohkusa, T.; Fujise, K.; Tajiri, H. N-3 polyunsaturated fatty acid diet therapy for patients with inflammatory bowel disease. Inflamm. Bowel Dis. 2010, 16, 1696–1707.
Ruppin, D.; Middleton, W. Clinical use of medium chain triglycerides. Drugs 1980, 20, 214–216.
- چکیده مشاهده شده: 274 بار
- pdf دانلود شده: 54 بار