Abolfotouh Mostafa A, Alolayan Rawan A, Binhusain Heba, Alsayegh Abdulrahman, Al Babtain Ibrahim T
King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh 11426, Saudi Arabia.
Family Health Department, High Institute of Public Health, Alexandria University, Alexandria 21544, Egypt.
Nutrients. 2025 Feb 13;17(4):676. doi: 10.3390/nu17040676.
There is controversy regarding whether using fiber-enriched formula affects the incidence of diarrhea among enterally fed patients in our setting. Also, there is a lack of clinical studies about enterally fed patients' tolerance for feeding and the incidence of diarrhea among patients in the Middle East. This study aimed to assess fiber enrichment's efficacy in reducing post-enteral feeding bowel intolerance in non-critically ill patients.
This was a prospective cohort study of 55 fiber-free (FF) and 119 fiber-enriched (FE) tube-fed adult patients admitted for five or more days with medical or surgical conditions. Data on patients' demographics, antibiotics and laxative medications, and gastrointestinal complications were collected. Absolute risk reduction (ARR), relative risk reduction (RRR), and relative risks (RR) were calculated to assess the efficacy of fiber enrichment in reducing post-enteral feeding bowel intolerance. Statistical significance was set at ≤ 0.05.
The rate of diarrhea dropped from 54.5% for FF to 29% for FE groups, with an ARR of 25.1% (95% CI 24.6-25.6, < 0.001) and an RRR of 64.1%, and RR was 0.54, reflecting a reduction in the rate of diarrhea by 46% after fiber enrichment. The rate of significant weight loss dropped from 45.5% without enrichment to only 26.9% with enrichment, with an ARR of 18.6% (95% CI: 18.0-19.2, < 0.001) and RRR of 40.9%, and RR was 0.59, reflecting a 41% reduction in significant weight loss after fiber enrichment. After adjusting for some potential confounders, FF formula was a significant predictor of diarrhea (OR = 3.04, 95% CI 1.49-6.19, = 0.002) and significant weight loss (OR = 2.37, 95% CI 1.16-4.84, = 0.018) in tube feeding, while antibiotic intake was also a significant predictor of only diarrhea (OR = 2.68, 95% CI 1.12-6.38, = 0.026).
This study demonstrated the beneficial effect of fiber supplementation in minimizing diarrhea in hospitalized patients receiving tube feeding. Antibiotic usage must be scrutinized and stopped if possible. Overall, the study provides compelling evidence supporting fiber-enriched enteral feeding, though further discussion on potential confounders and clinical applications would enhance its impact. Further, well-designed RCTs are needed to prove the efficacy of fiber-enriched feeds used in enteral tube feeding in non-critically ill patients.
在我们的环境中，关于使用富含纤维的配方奶粉是否会影响肠内喂养患者腹泻的发生率存在争议。此外，中东地区缺乏关于肠内喂养患者对喂养的耐受性以及腹泻发生率的临床研究。本研究旨在评估纤维强化在降低非危重症患者肠内喂养后肠道不耐受方面的疗效。
这是一项前瞻性队列研究，纳入了55名无纤维（FF）和119名富含纤维（FE）的管饲成年患者，他们因内科或外科疾病入院5天或更长时间。收集了患者的人口统计学数据、抗生素和泻药使用情况以及胃肠道并发症的数据。计算绝对风险降低率（ARR）、相对风险降低率（RRR）和相对风险（RR），以评估纤维强化在降低肠内喂养后肠道不耐受方面的疗效。设定统计学显著性为≤0.05。
腹泻率从FF组的54.5%降至FE组的29%，ARR为25.1%（95%CI 24.6 - 25.6，<0.001），RRR为64.1%，RR为0.54，表明纤维强化后腹泻率降低了46%。显著体重减轻率从未强化时的45.5%降至强化后的仅26.9%，ARR为18.6%（95%CI：18.0 - 19.2，<0.001），RRR为40.9%，RR为0.59，表明纤维强化后显著体重减轻减少了41%。在调整了一些潜在混杂因素后，FF配方奶粉是管饲中腹泻（OR = 3.04，95%CI 1.49 - 6.19，= 0.002）和显著体重减轻（OR = 2.37，95%CI 1.16 - 4.84，= 0.018）的显著预测因素，而抗生素摄入也是仅腹泻的显著预测因素（OR = 2.68，95%CI 1.12 - 6.38，= 0.026）。
本研究证明了补充纤维在减少接受管饲的住院患者腹泻方面的有益作用。必须仔细审查并尽可能停止使用抗生素。总体而言，该研究提供了支持富含纤维的肠内喂养的有力证据，不过对潜在混杂因素和临床应用进行进一步讨论将增强其影响。此外，需要设计良好的随机对照试验来证明富含纤维的饲料在非危重症患者肠内管饲中的疗效。
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