Fibers in enteral nutrition formulas: from theory to practice

Abstract

Even though enteral nutrition has gained an indisputable position in the intensive care unit (ICU), the use of fiber-enriched formulas remains controversial. Healthpromoting features of dietary fibers (DF) outside the ICU reach a good level of evidence: alongside functional properties, DF have metabolic effects, mediated by short-chain fatty acids from colonic fermentation; some DF, named prebiotics, are a specific substrate of beneficial bacteria in the intestinal microbiota. However, the number and variety of compounds amongst DF make comparisons difficult, with consequently conflicting results of ICU clinical trials. The most promising results come from soluble fibers that help improve glycemic control. Although DF may help improve digestive health, prevention studies on diarrhea (except from partially hydrolysed guar gum) or constipation are not convincing. Reduced intestinal barrier permeability, leading to fewer bacterial translocation episodes, is a feature of synbiotic (prebiotics and probiotics together) use. A consensus on the use of DF in enteral nutrition formulas in the ICU is therefore difficult to reach. Only larger studies using the same DF (including prebiotics) may result in new recommendations for clinical practice.