Fiber Supplementation May Decrease Diarrhea Risk for Inpatients on Enteral Nutrition

Results of a systematic review and meta-analysis published in Frontiers in Nutrition suggest fiber supplementation may reduce the occurrence of diarrhea among inpatients receiving enteral nutrition (EN).

Researchers at Prince of Songkla University in Thailand searched publication databases through September 2022 for randomized controlled trials that assessed fiber supplementation among inpatients receiving EN. The outcome of interest was the incidence of postfeeding diarrhea. A total of 16 trials met the inclusion criteria and were included in this analysis.

Most trials were conducted in the intensive care unit (ICU; n=11) setting, followed by the postoperative (n=3) and general hospital (n=2) settings. The fiber supplements included soy polysaccharides (n=4), mixed soluble or insoluble fiber (n=3), psyllium (n=3), partially-hydrolyzed guar gum (n=2), pectin (n=2), polydextrose (n=1), and Shen jia (n=1), all of which were administered over a period of 5 to 21 days.

In the pooled analysis, fiber supplementation was associated with reduced risk for diarrhea compared with fiber-free enteral nutrition (risk ratio [RR], 0.64; 95% CI, 0.49-0.82; I², 45.1%; P =.005). Similar findings were observed in the sensitivity analysis that stratified studies by low (RR, 0.59) and high (RR, 0.65) risk of bias.

Stratified by setting, fiber was preferred in the ICU (RR, 0.64; 95% CI, 0.47-0.87; I² =41.7%) and non-ICU (RR, 0.61; 95% CI, 0.37-1.02; I² =57%) settings compared with no fiber supplementation. Stratified by fiber intervention, only mixed soluble/insoluble fiber (RR, 0.54; 95% CI, 0.39-0.75; I² =0%) and PHGG (RR, 0.47; 95% CI, 0.27-0.83; I² =0%) were associated with decreased diarrhea risk compared with fiber-free enteral nutrition.

This analysis may have been biased as the definition of incident diarrhea differed among the included studies.

According to the researchers, “[T]his is the first study to show a novel finding of the significance of fiber types on the outcomes of diarrhea in hospitalized patients receiving EN.”