Department of Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA.
Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
JPEN J Parenter Enteral Nutr. 2019 Sep;43(7):899-911. doi: 10.1002/jpen.1504. Epub 2019 Jan 15.
Dietary intake sharply impacts the structure and function of the gut microbiota, which is important for childhood health. However, little is known about the microbiota of children who cannot eat by mouth. Standard enteral formulas for supplemental nutrition are low in fiber and high in processed sugars and are commonly associated with gastrointestinal side effects. In this pilot study, we examined the effects of plant-based enteral nutrition (PBEN) upon the gut bacteria of chronically ill children.
Ten children (median age 3.5 years, age range 2-8 years) dependent upon conventional enteral formula were transitioned to PBEN for 2 months. Microbial diversity within fecal samples collected before and after PBEN was assessed by 16S ribosomal RNA gene sequence analysis and was compared with rectal swabs from healthy children. Fecal short-chain fatty acids and bile acids were measured in parallel.
Relative to control samples, fecal samples from study subjects were depleted of commensals (eg, Faecalibacterium) and enriched with pathogens (eg, Enterococcus). Postintervention samples from study subjects were more similar to healthy controls. Most subjects experienced PBEN-induced alterations in the gut microbiota, but these changes varied significantly across individuals. Clinical diaries indicated that PBEN was well tolerated, with improvement in symptoms noted in several subjects.
Results from this pilot study suggest that PBEN is well tolerated and could improve the health of the microbiota in chronically ill children. This trial provides a rationale for systematic evaluation of PBEN in clinical trials of children who require supplemental nutrition.
饮食摄入会显著影响肠道微生物群的结构和功能，这对儿童健康很重要。然而，对于无法经口进食的儿童的微生物群了解甚少。用于补充营养的标准肠内配方纤维含量低，加工糖含量高，通常与胃肠道副作用有关。在这项初步研究中，我们研究了植物性肠内营养（PBEN）对慢性疾病儿童肠道细菌的影响。
10 名（中位数年龄 3.5 岁，年龄范围 2-8 岁）依赖常规肠内配方的儿童在 2 个月内转换为 PBEN。通过 16S 核糖体 RNA 基因序列分析评估 PBEN 前后粪便样本中的微生物多样性，并与健康儿童的直肠拭子进行比较。同时测量粪便短链脂肪酸和胆汁酸。
与对照样本相比，研究对象的粪便样本中丰度较低的共生菌（如粪杆菌）减少，丰度较高的病原体（如肠球菌）增加。干预后研究对象的样本与健康对照更相似。大多数受试者的肠道微生物群发生了 PBEN 诱导的改变，但这些变化在个体间差异很大。临床日记表明，PBEN 耐受良好，有几位受试者的症状有所改善。
这项初步研究的结果表明，PBEN 耐受良好，并可能改善慢性疾病儿童的微生物群健康。该试验为在需要补充营养的儿童中进行 PBEN 的临床试验系统评估提供了依据。
