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Effects of fibre-supplemented enteral feeds on bowel function of non-critically ill tube-fed adults: a meta-analysis of randomised controlled trials

Published online by Cambridge University Press:  05 June 2023

Valerie Xin Pei Tay Open the ORCID record for Valerie Xin Pei Tay [Opens in a new window] ,
Nur Asyikin Mohamed Noor  and
Lee Boo Tan
Valerie Xin Pei Tay*
Affiliation:
Department of Dietetics, Singapore General Hospital, Outram Road Singapore 169608, Singapore
Nur Asyikin Mohamed Noor
Affiliation:
Department of Dietetics, Singapore General Hospital, Outram Road Singapore 169608, Singapore
Lee Boo Tan
Affiliation:
Department of Dietetics, Singapore General Hospital, Outram Road Singapore 169608, Singapore
*
*Corresponding author: Valerie Tay Xin Pei, email valerie.tay.x.p@sgh.com.sg
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Abstract

Diarrhoea is common in enterally fed patients and can impact their nutritional and overall outcomes. This meta-analysis evaluates the potential benefits of fibre-supplemented (FS) feeds on incidence of diarrhoea and stool frequency in non-critically ill tube-fed adults. Databases including PubMed, Embase and CINAHL with full text were searched for randomised controlled trials (RCT) with adults on exclusive tube feeding, published until August 2022. The Cochrane Collaboration’s tool was used for quality assessment. Studies with published results on incidence of diarrhoea and stool frequency were analysed using RevMan 5. Thirteen RCT with 847 non-critically ill patients between 20 and 90 years old without diarrhoea at the onset of enteral feeding were included. Study duration ranged from 3 to 35 d. Nine papers investigated the incidence of diarrhoea where intervention group was given FS and control was given non-fibre-supplemented (NFS) enteral feeds. Those receiving FS feeds were significantly less likely to experience diarrhoea as compared with those using NFS feeds (OR 0·44; 95 % CI 0·20, 0·95; P = 0·04; I2 = 71 %). Combined analysis showed no differences in stool frequency in those receiving NFS feeds (SMD 0·32; 95 % CI −0·53, 1·16; P = 0·47; I2 = 90 %). Results should be interpreted with caution due to considerable heterogeneity between study population, assessment tool for diarrhoea, potential conflict of interest and short duration of studies. This meta-analysis shows that FS feeds can reduce the incidence of diarrhoea in non-critically ill adults; however, the effects of stool frequency remain debatable.

Keywords

Dietary fibreEnteral feedingBowel functionAdults
Type
Systematic Review and Meta-Analysis
Information
British Journal of Nutrition , Volume 130 , Issue 12 , 28 December 2023 , pp. 2076 - 2087
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of The Nutrition Society

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References

Ojo, O & Brooke, J (2016) The use of enteral nutrition in the management of stroke. Nutrients 8, 827.CrossRefGoogle ScholarPubMed
Doan, TN, Ho, WC, Wang, LH, et al. (2022) Prevalence and methods for assessment of oropharyngeal dysphagia in older adults: a systematic review and meta-analysis. J Clin Med 11, 2605.CrossRefGoogle ScholarPubMed
Wong, A, Marcin Sowa, P, Banks, MD, et al. (2019) Home enteral nutrition in Singapore’s long-term care homes-incidence, prevalence, cost, and staffing. Nutrients 11, 2492.CrossRefGoogle ScholarPubMed
Lin, LC, Wu, SC, Chen, HS, et al. (2002) Prevalence of impaired swallowing in institutionalized older people in taiwan. J Am Geriatr Soc 50, 1118–1123.CrossRefGoogle ScholarPubMed
Mitchell, SL, Teno, JM, Roy, J, et al. (2003) Clinical and organizational factors associated with feeding tube use among nursing home residents with advanced cognitive impairment. JAMA 290, 73–80.CrossRefGoogle ScholarPubMed
Wirth, R, Bauer, JM, Willschrei, HP, et al. (2010) Prevalence of percutaneous endoscopic gastrostomy in nursing home residents–a nationwide survey in Germany. Gerontology 56, 371–377.CrossRefGoogle ScholarPubMed
Michiko, S, Kento, T, Manami, S, et al. (2014) National survey of the prevalence of swallowing difficulty and tube feeding use as well as implementation of swallowing evaluation in long-term care settings in Japan. Geriatr Gerontol Int 14, 577–581.Google Scholar
Bentur, N, Sternberg, S, Shuldiner, J, et al. (2015) Feeding tubes for older people with advanced dementia living in the community in Israel. Am J Alzheimers Dis Other Demen 30, 165–172.CrossRefGoogle ScholarPubMed
Gungabissoon, U, Hacquoil, K, Bains, C, et al. (2015) Prevalence, risk factors, clinical consequences, and treatment of enteral feed intolerance during critical illness. JPEN J Parenter Enteral Nutr 39, 441–448.CrossRefGoogle ScholarPubMed
Whelan, K, Judd, PA, Tuohy, KM, et al. (2009) Fecal microbiota in patients receiving enteral feeding are highly variable and may be altered in those who develop diarrhea. Am J Clin Nutr 89, 240–247.CrossRefGoogle ScholarPubMed
Field, M (2003) Intestinal ion transport and the pathophysiology of diarrhea. J Clin Investig 111, 931–943.CrossRefGoogle ScholarPubMed
Eisenberg, PG (1993) Causes of diarrhea in tube-fed patients: a comprehensive approach to diagnosis and management. Nutr Clin Pract 8, 119–123.CrossRefGoogle ScholarPubMed
Bowling, TE (2010) Diarrhoea in the enterally fed patient. Frontline Gastroenterol 1, 140–143.CrossRefGoogle ScholarPubMed
Sripongpun, P, Lertpipopmetha, K, Chamroonkul, N, et al. (2021) Diarrhea in tube-fed hospitalized patients: feeding formula is not the most common cause. J Gastroenterol Hepatol 36, 2441–2447.10.1111/jgh.15484CrossRefGoogle Scholar
Anbazhagan, AN, Priyamvada, S, Alrefai, WA, et al. (2018) Pathophysiology of IBD associated diarrhea. Tissue Barriers 6, e1463897.CrossRefGoogle ScholarPubMed
Chowdhury, AH & Lobo, DN (2011) Fluids and gastrointestinal function. Curr Opin Clin Nutr Metab Care 14, 469–476.CrossRefGoogle ScholarPubMed
Chang, SJ & Huang, HH (2013) Diarrhea in enterally fed patients: blame the diet? Curr Opin Clin Nutr Metab Care 16, 588–594.CrossRefGoogle ScholarPubMed
Yang, G, Wu, XT, Zhou, Y, et al. (2005) Application of dietary fiber in clinical enteral nutrition: a meta-analysis of randomized controlled trials. World J Gastroenterol 7, 3935–3938.CrossRefGoogle Scholar
Soleimani, A, Foroozanfard, F & Tamadon, MR (2016) Evaluation of water and electrolytes disorders in severe acute diarrhea patients treated by WHO protocol in eight large hospitals in Tehran; a nephrology viewpoint. J Renal Inj Prev 6, 109–112.CrossRefGoogle ScholarPubMed
Zada´k, Z & Kent-Smith, L (2009) Basics in clinical nutrition: commercially prepared formulas. Eur e-J Clin Nutr Metab 4, e212–e215.CrossRefGoogle Scholar
Institute of Medicine (US) (2001) Dietary Reference Intakes Proposed Definition of Dietary Fiber. vol. 2, Panel on the Definition of Dietary Fiber and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Washington, DC: National Academies Press.Google Scholar
Dai, F-J & Chau, C-F (2017) Classification and regulatory perspectives of dietary fiber. J Food Drug Anal 25, 37–42.CrossRefGoogle ScholarPubMed
Gidley, MJ (2013) Hydrocolloids in the digestive tract and related health implications. Curr Opin Coll Interf Sci 18, 371–378.CrossRefGoogle Scholar
Lampe, JW, Slavin, JL, Melcher, EA, et al. (1992) Effects of cereal and vegetable fiber feeding on potential risk factors for colon cancer. Cancer Epidemiol Biomarkers Prev 1, 207–211.Google ScholarPubMed
Ruiz, MSA, Espinosa, MDB, Contreras Fernandez, CJ, et al. (2016) Digestion-resistant maltodextrin effects on colonic transit time and stool weight: a randomized controlled clinical study. Eur J Nutr 55, 2389–2397.CrossRefGoogle Scholar
Tarleton, SM, Kraft, CA & DiBaise, JK (2013) Fiber-enriched enteral formulae: advantageous or adding fuel to the fire? Pract Gastroenterol 37, 11–22.Google Scholar
Reis, AMD, Fruchtenicht, AV, Loss, SH, et al. (2018) Use of dietary fibers in enteral nutrition of critically ill patients: a systematic review. Rev Bras Terapia Intensiva 30, 358–365.Google ScholarPubMed
Cara, KC, Beauchesne, AR, Wallace, TC, et al. (2021) Safety of using enteral nutrition formulations containing dietary fiber in hospitalized critical care patients: a systematic review and meta-analysis. JPEN 45, 882–906.CrossRefGoogle ScholarPubMed
Tirlapur, N, Puthucheary, ZA, Cooper, JA, et al. (2016) Diarrhoea in the critically ill is common, associated with poor outcome, and rarely due to Clostridium difficile. Sci Rep 6, 24691.CrossRefGoogle ScholarPubMed
Dionne, JC, Sullivan, K, Mbuagbaw, L, et al. (2019) Diarrhoea: interventions, consequences and epidemiology in the intensive care unit (DICE-ICU): a protocol for a prospective multicentre cohort study. BMJ Open 9, e028237.CrossRefGoogle ScholarPubMed
Higgins, JPT & Altman, DG (2008) Cochrane Handbook for Systematic Reviews of Interventions, Assessing Risk of Bias in Included Studies. England: Wiley.Google Scholar
The Cochrane Collaboration (2014) Review Manager (RevMan) (Computer Program), 5.3 ed. Copenhagen: The Nordic Cochrane Centre.Google Scholar
Shimoni, Z, Averbuch, Y, Shir, E, et al. (2007) The addition of fiber and the use of continuous infusion decrease the incidence of diarrhea in elderly tube-fed patients in medical wards of a general regional hospital: a controlled clinical trial. J Clin Gastroenterol 41, 901–905.CrossRefGoogle Scholar
Lertpipopmetha, K, Kongkamol, C & Sripongpun, P (2018) Effect of psyllium fiber supplementation on diarrhea incidence in enteral tube-fed patients: a prospective, randomized, and controlled trial. J Parenteral Enteral Nutr 43, 759–767.CrossRefGoogle ScholarPubMed
de Kruif, JT & Vos, A (1993) The influence of soyfibre supplemented tube feeding on the occurrence of diarrhoea in postoperative patients. Clin Nutr 12, 360–364.CrossRefGoogle ScholarPubMed
Khalil, L, Ho, KH, Png, D, et al. (1998) The effect of enteral fibre-containing feeds on stool parameters in the post-surgical period. Singap Med J 39, 156–159.Google ScholarPubMed
Vandewoude, MF, Paridaens, KM, Suy, RA, et al. (2005) Fibre-supplemented tube feeding in the hospitalised elderly Age Ageing 34, 120–124.CrossRefGoogle ScholarPubMed
Zarling, EJ, Edison, T, Berger, S, et al. (1994) Effect of dietary oat and soy fiber on bowel function and clinical tolerance in a tube feeding dependent population. J Am Coll Nutr 13, 565–568.CrossRefGoogle Scholar
De Luis, DA, Aller, R, Izaola, O, et al. (2002) Postsurgery enteral nutrition in head and neck cancer patients. Eur J Clin Nutr 56, 1126–1129.CrossRefGoogle ScholarPubMed
De Luis, DA, Izaola, O, Cuellar, L, et al. (2009) High dose of arginine enhanced enteral nutrition in postsurgical head and neck cancer patients. A randomized clinical trial. Eur Rev Med Pharmacol Sci 13, 279–283.Google ScholarPubMed
Jakobsen, LH, Wirth, R, Smoliner, C, et al. (2017) Gastrointestinal tolerance and plasma status of carotenoids, EPA and DHA with a fiber-enriched tube feed in hospitalized patients initiated on tube nutrition: randomized controlled trial. Clin Nutr 36, 380–388.CrossRefGoogle ScholarPubMed
Zhao, R, Wang, Y, Huang, Y, et al. (2017) Effects of fiber and probiotics on diarrhea associated with enteral nutrition in gastric cancer patients. A prospective randomized and controlled trial. Medicine 96, e8418.CrossRefGoogle Scholar
Shankardass, K, Chuchmach, S, Chelswick, K, et al. (1990) Bowel function of long-term tube-fed patients consuming formulae with and without dietary fiber. J Parenteral Enteral Nutr 14, 508–512.CrossRefGoogle ScholarPubMed
Grant, LP, Wanger, LI & Neill, KM (1994) Fiber-fortified feedings in immobile patients. Clin Nurs Res 3, 166–172.CrossRefGoogle ScholarPubMed
Tabei, I, Tsuchida, S, Akashi, T, et al. (2018) Effects of a novel method for enteral nutrition infusion involving a viscosity-regulating pectin solution: a multicenter randomized controlled trial. Eur Soc for Clin Nutr Metab 23, 34–40.Google ScholarPubMed
Elia, M, Engfer, MB, Green, CJ, et al. (2008) Systematic review and meta-analysis: the clinical and physiological effects of fibre-containing enteral formulae. Aliment Pharmacol Ther 27, 120–145.CrossRefGoogle ScholarPubMed
Kamarul Zaman, M, Chin, KF, Rai, V, et al. (2015) Fiber and prebiotic supplementation in enteral nutrition: a systematic review and meta-analysis. World J Gastroenterol 21, 5372–5381.CrossRefGoogle ScholarPubMed
Konstantinos, E & Davies, R (2022) Do patients fed enterally post-gastrointestinal surgery experience more complications when fed a fiber-enriched feed compared with a standard feed? A systematic review. Nutr Clin Pract 37, 797–810.Google Scholar
Wierdsma, NJ, Kruizenga, HM, Droop, A, et al. (2001) Comparison of two tube feeding formulas enriched with guar gum or mixed dietary fibres – English translation. Nederlands Tijdschrift voor Dietisten 56, 243–247.Google Scholar
Whelan, K (2007) Enteral-tube-feeding diarrhoea: manipulating the colonic microbiota with probiotics and prebiotics. Proc Nutr Soc 66, 299–306.CrossRefGoogle ScholarPubMed
Nakao, M, Ogura, Y, Satake, S, et al. (2002) Usefulness of soluble dietary fiber for the treatment of diarrhea during enteral nutrition in elderly patients. Nutrition 18, 35–39.CrossRefGoogle ScholarPubMed
Kato, Y, Nakao, M, Iwasa, M, et al. (2012) Soluble fiber improves management of diarrhea in elderly patients receiving enteral nutrition Food Nutr Sci 3, 1547–1552 Google Scholar
Watson, AW, Houghton, D, Avery, PJ, et al. (2019) Changes in stool frequency following chicory inulin consumption, and effects on stool consistency, quality of life and composition of gut microbiota. Food Hydrocolloids 96, 688–698.CrossRefGoogle ScholarPubMed
McRorie, JWJ, Gibb, RD, Sloan, KJ, et al. (2021) Psyllium: the gel-forming nonfermented isolated fiber that delivers multiple fiber-related health benefits. Nutr Today 56, 169–182.CrossRefGoogle Scholar
Khongcharoensombat, T, Khemtong, A & Lakananurak, N (2021) Pectin-containing compared with standard polymeric formula in enteral nutrition: a randomized controlled parallel study in Thailand. Asia Pac J Clin Nutr 30, 67–74.Google ScholarPubMed
Maruyama, M, Goshi, S, Kashima, Y, et al. (2020) Clinical effects of a pectin-containing oligomeric formula in tube feeding patients: a multicenter randomized clinical trial. Nutr Clin Pract 35, 464–470.CrossRefGoogle ScholarPubMed
BeMiller, JN (2001) Handbook of Dietary Fiber. Classification, Structure and Chemistry of Polysaccharides of Foods. New York: Marcel Dekker, Inc.Google Scholar
Deehan, EC, Duar, RM, Armet, AM, et al. (2017) Modulation of the gastrointestinal microbiome with nondigestible fermentable carbohydrates to improve human health. Microbiol Spectr 5, BAD-0019-2017.CrossRefGoogle ScholarPubMed
Mcrorie, JW & Fahey, GC (2013) A review of gastrointestinal physiology and the mechanisms underlying the health benefits of dietary fiber: matching an effective fiber with specific patient needs. Clin Nurs Stud 1, 82–92.CrossRefGoogle Scholar
Koropatkin, NM, Cameron, EA & Martens, EC (2012) How glycan metabolism shapes the human gut microbiota. Nat Rev Microbiol 10, 323–335.CrossRefGoogle ScholarPubMed
Cummings, JH, Pomare, EW, Branch, HWJ, et al. (1987) Short chain fatty acids in human large intestine, portal, hepatic and venous blood. Gut 28, 122–121.CrossRefGoogle ScholarPubMed
Ruppin, H, Bar-Meir, S, Soergel, KH, et al. (1980) Absorption of short-chain fatty acids by the colon. Gastroenterology 78, 1500–1517.CrossRefGoogle ScholarPubMed
Homann, HH, Kemen, M, Fuessenich, C, et al. (1994) Reduction in diarrhea incidence by soluble fiber in patients receiving total or supplemental enteral nutrition. J Parenteral Enteral Nutr 18, 486–490.CrossRefGoogle ScholarPubMed
Mullish, BH & Williams, HRT (2018) Clostridium difficile infection and antibiotic-associated diarrhoea. Clin Med 18, 237–241.CrossRefGoogle ScholarPubMed