Green Caitlin H, Busch Rebecca A, Patel Jayshil J
Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Curr Gastroenterol Rep. 2021 Aug 2;23(9):14. doi: 10.1007/s11894-021-00814-5.
To highlight the controversy of fiber use in the current critical care nutrition guidelines; review the effect of fiber on the gut microbiota in the critically ill; and examine the data on fiber and outcomes in the intensive care setting.
Fiber is increasingly recognized as a necessary component of colonic health and nutrition support. In critical illness there is a shift toward gut dysbiosis and immune dysregulation. Through fermentation and the generation of short-chain fatty acids, fiber has a role in maintaining intestinal homeostasis, immune function, and supporting commensal bacteria. In contrast to fermentable fiber, recent animal models suggest that non-fermentable fiber can also favorably alter intestinal homeostasis in a mechanism distinct from short chain fatty acids. In the critically ill, RCTs and meta-analyses suggest that soluble and mixed fiber supplemented enteral nutrition can reduce diarrhea and is well tolerated. Based on limited data, there may be benefits in reducing length of hospital stay, certain infections, and glucose metabolism. Nonetheless, the role of fiber enriched nutrition in critically ill patients is controversial as evident in the conflicting guidelines. Despite shortcomings in the literature, soluble and mixed fiber supplemented enteral nutrition is safe and beneficial in most hemodynamically stable intensive care patients. More research is necessary to determine optimal fiber composition.
强调当前重症监护营养指南中纤维使用的争议；回顾纤维对重症患者肠道微生物群的影响；并审视重症监护环境下关于纤维与预后的数据。
纤维越来越被认为是结肠健康和营养支持的必要组成部分。在危重病中，会出现向肠道菌群失调和免疫失调的转变。通过发酵和产生短链脂肪酸，纤维在维持肠道内环境稳定、免疫功能以及支持共生细菌方面发挥作用。与可发酵纤维相反，最近的动物模型表明，不可发酵纤维也可以通过一种不同于短链脂肪酸的机制有利地改变肠道内环境稳定。在重症患者中，随机对照试验和荟萃分析表明，补充可溶性和混合纤维的肠内营养可以减少腹泻，并且耐受性良好。基于有限的数据，在缩短住院时间、某些感染和葡萄糖代谢方面可能有好处。尽管如此，富含纤维的营养在重症患者中的作用仍存在争议，这在相互冲突的指南中很明显。尽管文献存在不足，但补充可溶性和混合纤维的肠内营养对大多数血流动力学稳定的重症监护患者是安全有益的。需要更多研究来确定最佳纤维组成。
