The Effects Of Synbiotic Supplementation On Enteral Feeding Tolerance, Protein Homeostasis And Muscle Wasting Of Critically Ill Adult Patients: A Randomized Controlled Trial

Abstract

Background: Enteral feeding intolerance, energy-protein malnutrition, and muscle wasting are common conditions in the critical care setting. The primary aim of this study was to investigate the effect of synbiotic supplementation on enteral feed volume, energy and protein homeostasis, and muscle mass maintenance in critically ill adult patients. Methods: A consecutive of 42 patients admitted to the Edalatian Medical ICU, requiring enteral nutrition (EN) were prospectively randomized to receive the synbiotic capsule (containing a combination of Lactobacillus, Bifidobacterium, Streptococcus, and fructooligosaccharides) or placebo (21 patients in each group) for a maximum of 14 days.Results: Mean EN volume, energy, and protein intake were 962.5±533.82 ml, 770±427.05 kcal and 38.5±21.35 g (fourth day) vs. 590±321.1 ml, 472±256.81 kcal, and 23.6±12.84 g (first day) in the synbiotic group (p<0.05). Changes in the placebo group were not statistically significant. On day 1 nitrogen balance (NB) was -19.84±8.03 in the synbiotic vs. -10.99±9.12 in the placebo group (p=0.003). On day 14, NB was -14.18±13.05 in the synbiotic and -9.59±7.71 in the placebo group (p=0.41). Mid-arm circumference (MAC), 24-hour urine creatinine, and creatinine-height index were almost steady in the synbiotic group, while they decreased in the placebo group.Conclusion: Overall, it can be concluded that enteral nutrition supplemented with synbiotics may increase enteral feed volume, energy and protein intake during the first four days. It is also associated with nitrogen balance improvement and muscle mass maintenance of critically ill adult patients.Clinical Trial Registration Number: The trial protocol has been approved in Iranian Registry of Clinical Trials at 2019-03-17. The registration reference is IRCT20190227042857N1.