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World J Gastroenterol. Feb 21, 2013; 19(7): 994-1004
Published online Feb 21, 2013. doi: 10.3748/wjg.v19.i7.994
Nutritional modulators of ulcerative colitis: Clinical efficacies and mechanistic view
Mi-Kyung Sung, Mi-Young Park
Mi-Kyung Sung, Department of Food and Nutrition, Sookmyung Women’s University, Seoul 140-742, South Korea
Mi-Young Park, Department of Pharmacy, the Catholic University of Korea, Bucheon 420-743, South Korea
Author contributions: Sung MK and Park MY contributed equally to this paper.
Supported by Mid-career Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (2012R1A2A2A01046228)
Correspondence to: Mi-Kyung Sung, PhD, Department of Food and Nutrition, Sookmyung Women’s University, 100, Cheongparo 47-gil, Yongsan-gu, Seoul 140-742, South Korea. mksung@sm.ac.kr
Telephone: +82-2-7109395 Fax: +82-2-7109453
Received: September 19, 2012
Revised: November 17, 2012
Accepted: December 22, 2012
Published online: February 21, 2013
Processing time: 155 Days and 17.8 Hours
Abstract

Ulcerative colitis (UC) is an inflammation-associated disease of the colon and rectum. The onset and progress of the disease are directly influenced by the nature of the intestinal microflora, the intestinal barrier function, and the immunological responses of the host. The epithelial invasion of pathogenic bacteria due to excess contact and/or barrier dysfunction is related to inflammation mediated by intestinal immune responses. Although the etiology of UC is not clearly understood, recent studies have shown a rising incidence of UC worldwide, and this phenomenon is more prominent in Asian countries and in Asian immigrants in Western countries. The increased prevalence of UC also contributes to an increased risk of developing colorectal cancer. Environmental factors, including changes in dietary habits, have been suggested as major risk factors of UC. A systematic review showed a negative association between UC risk and vegetable intake, whereas total fat, omega-6 fatty acids and meat intake were positively associated with an increased risk of UC. Individual dietary factors and energy balance have been suggested as having important roles in inducing changes in the microbial population and intestinal barrier integrity and in regulating inflammatory immune responses, directly or indirectly. Excess energy intake is now known to increase pathogenic microbial populations. Likewise, the application of appropriate probiotics may reverse the pathogenic progression of the disease. In the meantime, dietary anti-inflammatory compounds, including omega-3 fatty acids and other phytochemicals, may directly suppress inflammatory responses in the course of UC development. In this review, the increased prevalence of UC and its management are interpreted from the standpoint of nutritional modulation to regulate the intestinal microflora population, intestinal epithelium permeability, and inflammatory responses.

Keywords: Ulcerative colitis; Intestinal microflora; Immunity; Inflammation; Clinical; Obesity; Probiotics; Omega-3 fatty acids; Antioxidants