fibers in nutrition

Q: What is the difference between gelatinous fibers and highly soluble fibers used to decrease diarrhea in ICU patients?


Answer:

It is a common practice to add fiber with enteral nutrition in ICU patients who experience diarrhea. There are two major types of fibers

• gelatinous fiber
• highly soluble fiber 

Gelatinous fibers are effective but they are less soluble and tend to clog the feeding tube. The most commonly used gelatinous fiber is psyllium. To prevent this complication, highly soluble fibers have been utilized but they are not as effective, and in some cases may even make diarrhea worse due to their osmotic effect. The commonly used highly soluble fibers are guar gum, wheat dextrin, inulin, and fructooligosaccharides.

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#gastroenterology


References:

1. Hart GK, Dobb GJ. Effect of a fecal bulking agent on diarrhea during enteral feeding in the critically ill. JPEN J Parenter Enteral Nutr 1988; 12:465. 

2. Kamarul Zaman M, Chin KF, Rai V, Majid HA. Fiber and prebiotic supplementation in enteral nutrition: A systematic review and meta-analysis. World J Gastroenterol 2015; 21:5372. 

3.  Spapen H, Diltoer M, Van Malderen C, et al. Soluble fiber reduces the incidence of diarrhea in septic patients receiving total enteral nutrition: a prospective, double-blind, randomized, and controlled trial. Clin Nutr 2001; 20:301. 

4.  Rushdi TA, Pichard C, Khater YH. Control of diarrhea by fiber-enriched diet in ICU patients on enteral nutrition: a prospective randomized controlled trial. Clin Nutr 2004; 23:1344. 

5.  Taylor BE, McClave SA, Martindale RG, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Crit Care Med 2016; 44:390.