Abstract
Introduction: Inflammatory bowel diseases (IBD) have an increasing incidence and prevalence, such as Crohn's disease (CD) and ulcerative colitis (UC). Gut dysbiosis is affected by host genetics, nutrition, antibiotics, and inflammation, and is associated with the development of IBD, which can be attributed to impaired miRNA expression functions. Micro and macronutrient deficiencies and overabundance of calories and macronutrients trigger inflammatory processes and susceptibility to infections. Objective: To present the nutrological, microbiological, and extracellular vesicle (exosome-microRNAs) evidence in the modulation and control of symptoms of inflammatory bowel diseases. Methods: The systematic review rules of the PRISMA Platform were followed. The literary search process was carried out from March to May 2025 in the Web of Science, Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 189 articles were found. A total of 27 articles were fully evaluated and 21 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 21 studies with a high risk of bias and 29 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=85.7%>50%. It was concluded that miRNAs are important regulators of cellular function and homeostasis, and their abnormal activity has been demonstrated in several diseases, including IBD. Thus, new treatment options could be developed to alter imbalances in miRNA expression. miRNAs affect the intestinal barrier and inflammatory reactions through several pathological mechanisms. The use of miRNAs as biomarkers and therapeutic targets may help monitor IBD treatment and support the development of new, more individualized therapies that minimize common side effects. Extracellular vesicles may attenuate the inflammatory response by inhibiting the TLR4-NF-κB signaling pathway and activating the NLRP3 inflammasome. Dietary manipulation of microRNAs through prebiotics and probiotics may selectively manipulate the gut microbiota, with the bacterium Faecalibacterium prausnitzii being prevalent in healthy adults, being beneficial and producing short-chain fatty acids, such as butyrate, which serves as an energy source for intestinal epithelial cells and induces protective regulatory immune responses.