无麸质饮食是唯一被认可的乳糜泻治疗方法。应咨询营养师,因为:坚持无麸质饮食很困难;饮食的变化可能会导致膳食纤维和其他营养素的缺乏;无麸质饮食可能导致摄入更多的热量、单一碳水化合物和饱和脂肪。[63]Bledsoe AC, King KS, Larson JJ, et al. Micronutrient deficiencies are common in contemporary celiac disease despite lack of overt malabsorption symptoms. Mayo Clin Proc. 2019 Jul;94(7):1253-60.
http://www.ncbi.nlm.nih.gov/pubmed/31248695?tool=bestpractice.com
[96]Vici G, Belli L, Biondi M, et al. Gluten free diet and nutrient deficiencies: a review. Clin Nutr. 2016 Dec;35(6):1236-41.
http://www.ncbi.nlm.nih.gov/pubmed/27211234?tool=bestpractice.com
乳糜泻患者有超重/肥胖的风险。[97]Bascuñán KA, Vespa MC, Araya M. Celiac disease: understanding the gluten-free diet. Eur J Nutr. 2017 Mar;56(2):449-59.
http://www.ncbi.nlm.nih.gov/pubmed/27334430?tool=bestpractice.com
在患者达到临床缓解前应避免食用燕麦,然后可逐渐将无小麦成分的燕麦食品添加到饮食中。有大量证据表明,未受小麦或大麦污染的燕麦对绝大多数乳糜泻患者是安全的。[107]Holm K, Maki M, Vuolteenaho N, et al. Oats in the treatment of childhood coeliac disease: a 2-year controlled trial and a long-term clinical follow-up study. Aliment Pharmacol Ther. 2006 May 15;23(10):1463-72.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2006.02908.x/full
http://www.ncbi.nlm.nih.gov/pubmed/16669961?tool=bestpractice.com
[108]Hogberg L, Laurin P, Falth-Magnusson K, et al. Oats to children with newly diagnosed coeliac disease: a randomised double blind study. Gut. 2004 May;53(5):649-54.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1774046/
http://www.ncbi.nlm.nih.gov/pubmed/15082581?tool=bestpractice.com
[109]Garsed K, Scott BB. Can oats be taken in a gluten-free diet? A systematic review. Scand J Gastroenterol. 2007 Feb;42(2):171-8.
http://www.ncbi.nlm.nih.gov/pubmed/17327936?tool=bestpractice.com
然而,部分患者可能很敏感。[110]Pinto-Sánchez MI, Causada-Calo N, Bercik P, et al. Safety of adding oats to a gluten-free diet for patients with celiac disease: systematic review and meta-analysis of clinical and observational studies. Gastroenterology. 2017 Aug;153(2):395-409;e3.
https://www.gastrojournal.org/article/S0016-5085(17)35474-4/fulltext?referrer=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F28431885%2F
http://www.ncbi.nlm.nih.gov/pubmed/28431885?tool=bestpractice.com
在某些国家/地区,不建议将燕麦作为无麸质饮食的一部分,并且在推荐燕麦之前,应先查阅当地指南。