Safety of using enteral nutrition formulations containing dietary fiber in hospitalized critical care patients: A systematic review and meta-analysis.

Abstract

Enteral nutrition (EN) is the preferred route of nutritional support for critically ill patients undergoing intensive care. Consensus from experts in the field caution against using fiber during EN due to perceived adverse patient outcomes; however, a quantitative assessment of data on this topic is not evident to date. In this systematic review and meta-analysis, we searched four databases from inception to 4/20/20 for studies and case reports on adverse events or health outcomes associated with using EN formulations containing fiber in hospitalized critically ill adults. Nineteen articles were included. Random effects meta-analysis models showed significantly lower diarrhea scores for fiber groups compared to non-fiber groups (pooled mean difference: -2.78; 95% CI: -4.10, -1.47) but mixed results for risk of diarrhea between groups depending on measures used for diarrhea (Hart & Dobb scale, pooled RR: 0.68; 95% CI: 0.45, 1.02; other diarrhea scales, pooled RR: 0.42; 95% CI: 0.20, 0.89). Models showed 39% lower risk of any GI complication overall for fiber compared with non-fiber groups (pooled RR: 0.61; 95% CI: 0.47, 0.79) but no groups differences for individual GI complications, mortality, and ICU or hospital length of stay. Analyses stratified by soluble or mixed fiber interventions reduced heterogeneity in models but showed identical conclusions. Enteral nutrition formulas with fiber may help reduce incidence and severity of diarrhea and gastrointestinal (GI) complications overall in critically ill patients without increased risk of other adverse events. Bias among specific GI measures indicate more high-quality studies are needed to verify these conclusions. This article is protected by copyright. All rights reserved.