Fiber supplementation of enteral formulas: effects on the bioavailability of major nutrients and gastrointestinal tolerance

Abstract

Two fiber-supplemented enteral formulas were recently introduced for patient application, Susta II and Enrich (12.4-g and 38.5-g soy polysaccharide/2000 kcal, respectively). This investigation had a 3-fold purpose: to determine if and to what extent fiber-supplementation changes the chemical composition of stool relative to a fiber-free formula (Ensure); to establish the clinical tolerance of the two new formulas; and to quantify the effects of soy polysaccharide on nutrient bioavailability. The study was conducted in two consecutive phases: A (n = 6 subjects; random assignment to either Ensure or Susta II for 1-2 weeks followed by isocaloric cross-over to the alternate formula for an equal period of time) and B (n = 8 subjects evaluated as in phase A except Enrich replaced Ensure). Each balance week consisted of clinical/subjective monitoring, evaluation of stool composition (H2O and dry weight), apparent nutrient absorption (energy, fat, N, P, K, Ca, Mg, Zn, Na, and Cl), and metabolic balance (N, P, K, Ca, Mg, Na, and Cl). Relative to the fiber-free formula the two fiber-supplemented solutions produced increases in fecal N, fat, H2O, and minerals of variable magnitude; there were corresponding reductions in net absorption of organic compounds and minerals. The additional minerals added to the fiber-supplemented formulas and the minimal effects on N absorption preserved balance; the retention of N, P, K, Ca, Mg, Na, and Cl were similar for all three formulas. No adverse clinical effects of the fiber-supplemented formulas were noted.(ABSTRACT TRUNCATED AT 250 WORDS)

Systematic review and meta‐analysis: the clinical and physiological effects of fibre‐containing enteral formulae

“…In 18 of 38 (47%) studies, feeding was administered via a nasogastric tube; 28–31, 35, 36, 39, 40, 42, 49, 50, 53, 58, 60, 65, 66, 68, 71 …”

Effect of dietary oat and soy fiber on bowel function and clinical tolerance in a tube feeding dependent population.

“…At the beginning of the fiber arm of the study, the albumin was 3.2 ± 0.3 g/dL (normal 3.5-5), cholesterol was 152 ± 9 mg/dL (normal <200), and hemoglobin was 12.6 ± 2.0 g/dL (normal [14][15][16][17][18]. At the conclusion of this arm of the study values of 3.3 ± 0.2, 155 ± 11, and 12.9 ± 1.8, respectively, were noted.…”

“…On the other hand, other normal subjects studied in a crossover manner using 25 g of soy fiber had no change in transit time, but did have an increase in fecal output [14]. In patients receiving tube feedings which contained fiber at dosages of 15-40 g/day, no changes were noted in fecal output [15,16]. Thus, the effects of soy polysaccharide upon fecal weight and transit time appear to be clinically inconsistent.…”

Medical Foods from Natural Sources

“…The soy polysaccharides (Scheppach et al, 1990;Kapadia et al, 1995;Lien et al, 1996) are being used as sources of dietary fiber in most of the enteral foods. The breakdown fraction of the dietary fiber of the enteral foods serves as a major fuel to the intestinal villi in the form of short-chain fatty acids (mainly butyrates), besides contributing to the other well-known physiological benefits of the dietary fiber (Heymsfield et al, 1988;Frankenfield and Bayer, 1989;Rays et al, 2005). Several investigators have reported the beneficial effects of probiotics especially of lactic acid bacteria (LAB) in terms of colonization of intestinal microflora, reduction in lactose intolerance, minimization of bacterial translocation, and enhancement of immune status among others (Gilliland and Speck, 1977;Puhan and Zambrini, 1992;Schiffrin et al, 1995;Helander et al ., 1997;Patider and Prajapati, 1997;Klaenhammer et al, 2005;Rays et al, 2005;Xiao et al, 2006).…”