The Addition of Fiber and the Use of Continuous Infusion Decrease the Incidence of Diarrhea in Elderly Tube-fed Patients in Medical Wards of a General Regional Hospital

Shimoni, Zvi; Averbuch, Yael; Shir, Esther; Gottshalk, Tzippi; Kfir, Dalia; Niven, Mark; Moshkowitz, Menachem; Froom, Paul

doi:10.1097/01.mcg.0000225662.23179.b6

Cited by 15 publications

(10 citation statements)

References 32 publications

(33 reference statements)

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“…In contrast, use of an enteral formula supplemented with 10 g soy polysaccharide/500 mL for 5 days resulted in a significantly lower diarrhea score compared with a fiber‐free control in postoperative patients (n = 60) who had undergone antibiotic treatment 36 . Similarly, in elderly tube‐fed patients (n = 148), use of a formula with 13.2 g soy fiber/L decreased the rate EN‐associated diarrhea compared with fiber‐free control, independent of antibiotic use 37 …”

Section: Summary Of Current Recommendationsmentioning

confidence: 92%

“…36 Similarly, in elderly tube-fed patients (n = 148), use of a formula with 13.2 g soy fiber/L decreased the rate EN-associated diarrhea compared with fiber-free control, independent of antibiotic use. 37 These studies suggest that the effects of soy fiber supplementation may vary according to patient population and medication use. It is possible that because of its high fermentability, soy polysaccharide may be less effective at altering laxation compared with other insoluble fibers.…”

Section: Soy Polysaccharidesmentioning

confidence: 99%

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Benefits of Dietary Fiber in Clinical Nutrition

Klosterbuer

Roughead²,

Slavin

2011

Nut in Clin Prac

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Dietary fiber is widely recognized as an important part of a healthy diet and is a common addition to enteral nutrition (EN) formulas. Fiber sources differ in characteristics such as solubility, fermentability, and viscosity, and it is now well known that different types of fiber exert varying physiological effects in the body. Clinical studies suggest fiber can exert a wide range of benefits in areas such as bowel function, gut health, immunity, blood glucose control, and serum lipid levels. Although early clinical nutrition products contained fiber from a single source, it is now thought that blends of fiber from multiple sources more closely resemble a regular diet and may provide a greater range of benefits for the patient. Current recommendations support the use of dietary fiber in clinical nutrition when no contraindications exist, but little information exists about which types and combinations of fibers provide the relevant benefit in certain patient populations. This article summarizes the different types of fiber commonly added to EN products and reviews the current literature on the use of fiber blends in clinical nutrition.

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Section: Summary Of Current Recommendationsmentioning

confidence: 92%

Section: Soy Polysaccharidesmentioning

confidence: 99%

Benefits of Dietary Fiber in Clinical Nutrition

Klosterbuer

Roughead²,

Slavin

2011

Nut in Clin Prac

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“…Out of the 432 participants, 51 % were male. Ten studies were conducted on hospitalised elderly, of which two were admitted into general medical wards (33,34) , two were in general surgery wards (35,36) , one in the geriatric ward (37) and others non-specified (38)(39)(40)(41)(42) . The remaining studies were conducted on older adults in long-term care settings (n 3) (43)(44)(45) .…”

Section: Resultsmentioning

confidence: 99%

Effects of fibre-supplemented enteral feeds on bowel function of non-critically ill tube-fed adults: a meta-analysis of randomised controlled trials

2023

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Diarrhoea is common in enterally-fed patients and can impact their nutritional and overall outcomes. This meta-analysis evaluates the potential benefits of fibre-supplemented (FS) feeds on incidence of diarrhoea and stool frequency in non-critically ill tube-fed adults. Databases including PubMed, Embase and CINAHL with full text were searched for randomised controlled trials (RCTs) with adults on exclusive tube feeding, published until August 2022. The Cochrane Collaboration’s tool was used for quality assessment. Studies with published results on incidence of diarrhoea and stool frequency were analysed using RevMan 5. Thirteen RCTs with 847 non-critically ill patients between 20 and 90 years old without diarrhoea at the onset of enteral feeding were included. Study duration ranged from 3 to 35 days. Nine papers investigated the incidence of diarrhoea where intervention group was given FS and control was given non-fibre supplemented (NFS) enteral feeds. Those receiving FS feeds were significantly less likely to experience diarrhoea as compared to those using NFS feeds (OR 0.44; 95% CI: 0.20 to 0.95; p=0.04; I2=71%). Combined analysis from five out of 13 RCTs showed no differences in stool frequency in those receiving NFS feeds (SMD 0.32; 95% CI: -0.53 to 1.16; p=0.47; I2 = 90%). Results should be interpreted with caution due to considerable heterogeneity between study population, assessment tool for diarrhoea, potential conflict of interest, and short duration of studies. This meta-analysis shows that FS feeds can reduce the incidence of diarrhoea in non-critically ill adults, however, the effects of stool frequency remain debatable.

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“…Perhaps, the low detection rate in this study could be attributed to the nutrition management methods. Reportedly, parenteral nutrition of this condition is widely used in hospitalized patients, especially elderly, who are unable to eat to aid in patients' ability to recover from illness (24). The most common adverse effect of such treatment is diarrhea, which is reported in 68% of intensive care unit patients (25) and 96% of patients with dysphagia (26).…”

Section: Discussionmentioning

confidence: 99%

Constipation in the elderly in a Japanese long-term medical facility: An ultrasonographic investigation

Yabunaka

Nakagami

Tabata

et al. 2018

DD&T

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This study aims to assess the fecal retention in elderly patients using colonic ultrasonography (US) in Japanese long-term care facility and determine the correlation between nutrition management methods and the fecal retention by US. This cross-sectional, single-center study was conducted in a long-term care facility in Japan. Patients with chronic constipation fulfilled the Rome III criteria for the diagnosis of functional constipation. US was performed on constipation patients with 4-day fecal retention before starting the standard management of constipation. After patients had defecated, nurses checked the outside of feces using King's Stool Chart and Bristol Stool Chart. All of 32 patients underwent the management of suppository laxative, the daily life independence level in grade C. In all cases, the King's Stool Chart did not detect > 200 g of fecal matter; the Bristol Stool Chart revealed type 5-7 in 56.2% of patients. The total parenteral nutrition and tube feeding did not completely detect type 1-2 in 0%. While the fecal retention groups comprised 15.6%, the non-fecal retention groups comprised 84.4%. The total parenteral nutrition did not completely detect the fecal retention in 0%. In the non-fecal retention groups, the King's Stool Chart indicated < 100 g in 81.8%, and the Bristol Stool Chart indicated type 5-7 in 100%. In conclusion, fecal properties of elderly constipation patients with the long-term parenteral nutrition should be assessed in follow-up examination by US, which is possible for personalized medical care by US, to avoid the administered regular management of constipation.

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The Addition of Fiber and the Use of Continuous Infusion Decrease the Incidence of Diarrhea in Elderly Tube-fed Patients in Medical Wards of a General Regional Hospital

Abstract: We conclude that in elderly well-nourished hospitalized patients with acute diseases prohibiting oral intake, continuous and closed enteral feedings with the addition of fiber is effective in reducing the rate of diarrhea.

Cited by 15 publications

References 32 publications

Benefits of Dietary Fiber in Clinical Nutrition

Benefits of Dietary Fiber in Clinical Nutrition

Effects of fibre-supplemented enteral feeds on bowel function of non-critically ill tube-fed adults: a meta-analysis of randomised controlled trials

Constipation in the elderly in a Japanese long-term medical facility: An ultrasonographic investigation

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