Soluble Dietary Fiber Reduces Feeding Intolerance in Severe Acute Pancreatitis: A Randomized Study

Abstract

Background Feeding intolerance of enteral nutrition (EN) frequently occurs in patients with severe acute pancreatitis (SAP) because of intestinal motility disorders. Soluble dietary fiber (SDF) modulates the intestinal motility. The present study examined whether SDF can improve intestinal motility and permeability, and thereby reduce feeding intolerance, in patients with SAP. Methods This study was a single‐blind, randomized, controlled, single‐center trial. Forty‐nine patients with SAP were included. The control and SDF groups received the same EN solution via a nasojejunal tube. The SDF group additionally received 20‐g/d polydextrose. The primary outcome was the time to reach the energy goal. Follow‐up was continued for 28 days after admission or until discharge from the hospital. Results Among 49 randomized patients, 46 patients (n = 22, control group; n = 24, SDF group) were included in the intent‐to‐treat analysis. The time to reach the energy goal was 7.00 (6.00, 8.25) days and 5.00 (4.25, 6.00) days in the control and SDF groups, respectively (P < 0.001). The rates of feeding intolerance were significantly reduced in the SDF group (59.09% vs 25.00%, P < .05). SDF was associated with decreases in the incidence of abdominal distension (72.73% vs 29.17%, P < .01), diarrhea (40.91% vs 8.33%, P < .05), and constipation (72.73% vs 12.50%, P < .001). The time to first flatus and first defecation were significantly shorter in the SDF group (P < .001). The intestinal mucosal barrier function and levels of gastrointestinal hormone were improved by SDF, as evidenced by significantly reduced blood levels of diamine oxidase, D‐lactic acid, endotoxin, and vasoactive intestinal peptide (P < .05). Conclusions SDF shortens the time to reach the energy goal during EN and improves intestinal permeability and motility disorders, thus reducing the incidence of feeding intolerance in SAP patients.

Effect of dietary fiber on gut barrier function, gut microbiota, short‐chain fatty acids, inflammation, and clinical outcomes in critically ill patients: A systematic review and meta‐analysis

“…The types of DF were fiber, 3,8,22–24,26,27,29,30,33,37–40 probiotic, 25,28,31,34–36 and fiber combined with probiotics 32 . The DF supplement doses <20 and ≥20 g were used in 13 studies 22,24,27,28,30–35,37,39,40 and eight studies, 3,8,23,25,26,29,36,38 respectively. Eleven studies did not report the results of adverse outcomes of DF supplement, 23–26,28,30,31,34–36,39 and six studies showed no significant difference in adverse outcomes between the DF group and fiber‐free group 3,22,27,29,33,40 .…”

“…A study showed that gut microbiota provide energy for the gut epithelium to maintain the mechanical barrier's integrity and continuity of gut epithelial lining by fermenting carbohydrate and indigestible oligosaccharides 6,7 . Therefore, the addition of adequate and reasonable dietary ingredients has become an important factor in maintaining the intestinal barrier function 8,9 …”

Leaky Gut: Effect of Dietary Fiber and Fats on Microbiome and Intestinal Barrier

“…These results also suggest that MACs have beneficial effects on the intestinal barrier. Nevertheless, whether MAC supplementation is really recommended to maintain intestinal health including barrier function is not confirmed yet since some clinical studies show beneficial effects of fructo-oligosaccharides and polydextrose on intestinal barrier function in healthy subjects or patients of pancreatitis [ 82 , 83 ], but administration of oat β-glucan, arabinoxylan (soluble hemicellulose) do not show significant effects on acute indomethacin-induced intestinal hyperpermeability [ 84 , 85 ]. Oligofructose-enriched inulin also does not improve intestinal barrier function effective in the patients of celiac disease [ 84 , 85 ].…”

Exploration of the Curative Effect of Early Enteral Nutrition Nursing on Patients with Severe Acute Pancreatitis and the Improvement of Patients’ Mental Health and Inflammation Level

“…In addition to the nutritional approach and timing, scholars have also discussed the optimal formula of the nutrient solution. Chen et al [ 14 ] studied the two formulas of semi-element type (using short peptide as nitrogen source) and polymeric type (using whole protein as nitrogen source). It was found that SAP patients had better tolerance to both, but the semi-element formula group had less hospital stay and lower weight loss.…”