Fiber-supplemented enteral nutrition clinically beneficial in critically ill patients, finds study

A new systematic review and meta-analysis (SRMA) published in the BMC Critical Care journal found the potential benefits of fiber-supplemented enteral nutrition (EN) in critically ill patients. Despite existing inconsistencies in past research, this comprehensive investigation highlighted a promising yet tentative link between fiber-enriched EN and improved patient outcomes, notably lower mortality rates and reduced diarrhea incidence.

The SRMA analyzed data from randomized controlled trials (RCTs), systematically collating evidence from major electronic databases such as MEDLINE, EMBASE, and CENTRAL up to June 2024. A total of 20 studies encompassed 1405 adult patients and were selected to compare the effects of fiber-supplemented EN against conventional EN or placebo. Each trial was reviewed by two independent experts who extracted data and assessed potential biases by ensuring a rigorous approach to the meta-analysis.

To evaluate the primary outcome of overall mortality and a key secondary outcome, the incidence of diarrhea, this research employed both random-effect meta-analysis and trial sequential analysis (TSA). The results revealed that fiber-supplemented EN was significantly associated with a reduction in overall mortality, with a risk ratio (RR) of 0.66 (95% confidence interval [CI] 0.47–0.92; p = 0.01) based on 12 studies, and no observed heterogeneity (I² = 0%). Also, the incidence of diarrhea was notably reduced, with an RR of 0.70 (95% CI 0.51–0.96; p = 0.03), though with moderate heterogeneity (I² = 51%) across 11 studies.

The outcomes were rated as having a "very serious risk of bias," suggesting that current evidence is insufficiently robust to eliminate the risk of type-1 error, as indicated by the TSA. The research emphasized that while the reduction in mortality and diarrhea is encouraging, the low certainty of the evidence highlights the need for high-quality, large-scale multicenter RCTs to confirm these findings.

The heterogeneity in existing studies, combined with the potential biases noted, means that clinical guidelines should wait further substantiation from well-structured future studies. Overall, the findings of this study serve as a vital reminder of the complexity of nutrition in critical care and the importance of strong evidence to inform guidelines and best practices.

Reference:

Koch, J. L., Lew, C. C. H., Kork, F., Koch, A., Stoppe, C., Heyland, D. K., Dresen, E., Lee, Z.-Y., & Hill, A. (2024). The efficacy of fiber-supplemented enteral nutrition in critically ill patients: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. In Critical Care (Vol. 28, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s13054-024-05128-2