Fiber and prebiotic supplementation in enteral nutrition: A systematic review and meta-analysis.
What this study found
Fiber supplementation in enteral nutrition reduced diarrhea overall, with the clearest benefit in non-critically ill patients. Across pooled studies, diarrhea incidence was lower with fiber than control (OR = 0.47; 95% CI: 0.29-0.77; P = 0.02), and the subgroup of non-critically ill patients showed a stronger effect (OR = 0.31; 95% CI: 0.19-0.51; P < 0.01). In critically ill patients, diarrhea reduction was not clear (OR = 0.89; 95% CI: 0.41-1.92; P = 0.77). Effects on fecal microbiota and short-chain fatty acids were inconsistent or inconclusive, and prebiotic supplementation did not…
- Study & population
- Systematic review and meta-analysis of 26 studies in adult patients receiving enteral nutrition across hospital, long-term care, outpatient, and intensive care settings.
- Intervention
- Fiber supplementation was added to enteral nutrition formulas or given as fiber-enriched enteral feeding, using a range of sources and doses across trials, including soy polysaccharide, partially hydrolyzed guar gum, psyllium, inulin, fructooligosaccharides, galactomannan, banana flakes, oat fiber, and mixed fiber…
- Key limitation
- The included trials were heterogeneous in fiber type, dose, duration, and patient population, which limits direct comparability.
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Open PDFOriginal abstract
AIM To investigate fiber and prebiotic supplementation of enteral nutrition (EN) for diarrhea, fecal microbiota and short-chain fatty acids (SCFAs). METHODS MEDLINE, EMBASE, Cochrane Library, CINAHL, Academic Search Premier, and Web of Science databases were searched for human experimental and observational cohort studies conducted between January 1990 and June 2014. The keywords used for the literature search were fiber, prebiotics and enteral nutrition. English language studies with adult patient populations on exclusive EN were selected. Abstracts and/or full texts of selected studies were reviewed and agreed upon by two independent researchers for inclusion in the meta-analysis. Tools used for the quality assessment were Jadad Scale and the Scottish Intercollegiate Guidelines Network Critical Appraisal of the Medical Literature. RESULTS A total of 456 possible articles were retrieved, and 430 were excluded due to lack of appropriate data. Of the 26 remaining studies, only eight investigated the effects of prebiotics. Results of the meta-analysis indicated that overall, fiber reduces diarrhea in patients receiving EN (OR = 0.47; 95%CI: 0.29-0.77; P = 0.02). Subgroup analysis revealed a positive effect of fiber supplementation in EN towards diarrhea in stable patients (OR = 0.31; 95%CI: 0.19-0.51; P < 0.01), but not in critically ill patients (OR = 0.89; 95%CI: 0.41-1.92; P = 0.77). Prebiotic supplementation in EN does not improve the incidence of diarrhea despite its manipulative effect on bifidobacteria concentrations and SCFA in healthy humans. In addition, the effect of fiber and/or prebiotic supplementation towards fecal microbiota and SCFA remain disputable. CONCLUSION Fiber helps minimize diarrhea in patients receiving EN, particularly in non-critically ill patients. However, the effect of prebiotics in moderating diarrhea is inconclusive.