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"Pain. Joints. Spine." Том 9, №3, 2019

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Nutrition as both risk factor and intervention in rheumatic diseases

Authors: Пузанова О.Г.
Киевский медицинский университет, г. Киев, Украина

Categories: Rheumatology, Traumatology and orthopedics

Sections: Specialist manual

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Summary

Мета публікації — огляд ефектів харчування як чинника ризику та втручання в аспекті ревматичних захворювань. З використанням методів інформаційного аналізу досліджено понад 100 джерел спеціальної літератури та комп’ютерних ресурсів доказової медицини. У великих обсерваційних дослідженнях, систематичних оглядах і мета­аналізах, присвячених профілактичному, терапевтичному потенціалу та безпеці застосування різних харчових продуктів, дієт, мікронутрієнтів і пробіотиків, у тому числі за наявності пов’язаних провідних чинників ризику неінфекційних захворювань (вживання тютюну, алкоголю, підвищеного індексу маси тіла тощо), встановлено, що значущість харчування як чинника ризику розвитку та кінцевих результатів доведено насамперед для ревматоїдного артриту та подагри. Патогенетичну роль харчування розглянуто в контексті його впливу на кишкову мікробіоту. Показано необхідність проведення рандомізованих контрольованих досліджень для оцінки протективного потенціалу різних моделей харчування й ефектів дотримання модифікованої середземноморської дієти та вживання певних дієтичних добавок і пробіотиків при ревматичних захворюваннях, а в кінцевому результаті — для розробки спеціальних настанов із харчування для хворих ревматологічного профілю. Відзначено достатню доказову базу профілактичного консультування таких пацієнтів з питань харчування з метою зниження кардіоваскулярного ризику.

Цель публикации — обзор эффектов питания как фактора риска и вмешательства в аспекте ревматических заболеваний. С применением методов информационного анализа изучено более 100 источников специальной литературы и компьютерных ресурсов доказательной медицины. В крупных обсервационных исследованиях, систематических обзорах и метаанализах, предметом которых были профилактический, терапевтический потенциал и безопасность применения различных пищевых продуктов, диет, микронутриентов и пробиотиков, в том числе в связи с сопряженными ведущими факторами риска неинфекционных заболеваний (курением, употреблением алкоголя, повышенным индексом массы тела), доказана значимость питания как фактора риска развития и исходов прежде всего ревматоидного артрита и подагры. Патогенетическая роль питания рассмотрена в контексте его влияния на кишечную микробиоту. Показана необходимость проведения рандомизированных контролируемых исследований для оценки протективного потенциала различных моделей питания и эффектов применения модифицированной средиземноморской диеты, ряда диетических добавок и пробиотиков при ревматических заболеваниях, а в конечном итоге — для разработки специальных рекомендаций по питанию больных ревматологического профиля. Отмечена достаточная доказательная база профилактического консультирования таких пациентов по вопросам питания с целью снижения кардиоваскулярного риска.

The purpose of the paper is to provide a review of the effects of nutrition as a risk factor and intervention in the aspect of rheumatic diseases. Using information analysis methods, more than 100 special literature sources have been studied, including evidence based medicine computer databases. The significance of nutrition as a risk factor for the development and outcomes, first of all for rheumatoid arthritis and gout, is proved in large observational studies, systematic reviews and meta-analysis dedicated to both preventive and therapeutic potential as well as to safety of different food products, diets, micronutrients and probiotics, including in connection with associated main risk factors of non-infectious diseases (tobacco smoking, alcohol consumption, increased body mass index). The pathogenetic role of nutrition is considered in the context of its influence on gut microbiota. Necessity of the randomized controlled trials is shown in order to assess the protective potential of different nutritional patterns, as well as the effects of modified Mediterranean diet, some dietary supplements and probiotics intake in rheumatic diseases, and as a result — to develop special guidelines on nutrition in rheumatic patients. There is a sufficient evidence base of preventive counse­ling of such patients on nutritional issues with the aim of cardiovascular risk reduction.


Keywords

ревматичні захворювання; харчування; чинник ризику; втручання; огляд

ревматические заболевания; питание; фактор риска; вмешательство; обзор

rheumatic diseases; nutrition; risk factor; intervention; review


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