Importance of fibre in enteral nutrition

1、Importance of fibre in enteral nutrition,Definition of fibre,Dietary fibre is the edible part of plants or analogous carbohydrates that is resistant to digestion and absorption in the human small intestine with complete or partial fermentation in the large intestine promotes beneficial physiological

2、 effects including laxation, reduction in blood cholesterol and/or modulation of blood glucose,Various definitions exist worldwide,American Association of Cereal Chemists Expert Committee, 2001,Different fibres have different chemical compositions and physiological effects,Varieties of fibres,Physio

3、logical effects of fibre,Microflora balance,Physiolog. effect,Healthbenefit,Mode of action,Stool bulking,Prebiotic effect Gut barrier,Water holding Microbial mass Speed transit time,Maintenance of normal bowel function and gut health/integrity,Fermentation to produce SCFA,Mucosal integrity Colonic r

4、eabsorption,Recommendations for fibre intake,ESPEN Guidelines 2006: Since a fibre intake of 15-30 g/day is recommended for normal food in healthy persons a similar intake is considered advisable also in patients on enteral nutrition (EN). The main purpose using fibre-containing formulae is feeding t

5、he gut to maintain gut physiology, improving gastrointestinal tolerance and for glycaemic and lipid control. In non-ICU patients or in patients requiring long-term EN the use of a mixture of bulking and fermentable fibre would appear to be the best approach,Lochs et al, 2006,Recommendations in child

6、ren,ESPGHAN Committee 2010: “Feeds with dietary fibre are appropriate for most patients. Fibre and its fermentation products (short-chain fatty acids) have potential beneficial effects on intestinal physiology and the prevention of both diarrhoea and constipation .,Braegger et al, 2010 ESPGHAN = Eur

7、opean Society for Paediatric Gastroenterology, Hepatology and Nutrition,Bowel function in healthy adults comparing fibre-free enteral formulas versus normal diet,Negative effects of fibre-free formulas,Use of fibre-containing enteral formulas,Enteral formula selection worldwide, in Central Europe (C

8、E) and Eastern Europe (EE,Evidence of fibre in enteral nutrition,Systematic review and meta-analysis Elia et al, Aliment Pharmacol Ther 2008; 27: 120-145,Systematic review: set up,Elia et al, 2008,Systematic review: diarrhoea,16 studies (13 RCTs): fibre n = 338, fibre-free n = 345; OR 0.68 95% CI 0.

9、48-0.96; p= 0.03,Fibre significantly reduces the incidence of diarrhoea,Fibre improves bowel function in healthy adults,Systematic review: bowel function,Elia et al, 2008,Systematic review: bowel function,Meta-regression shows modulating effect of fibre on bowel function in healthy adults,Fibre is s

10、afe and generally well-tolerated in patients,Systematic review: safety,Elia et al, 2008,Systematic review: conclusions,Elia et al, 2008,Multi Fibre MF6,Multi Fibre is a fibre mixture which reflects the fibre pattern provided by a healthy diet 6 components,Multi Fibre (MF6) patent protection,MF6 show

11、s positive effects in adults,MF6 shows good tolerance,Silk et al, 2001,10 healthy volunteers Randomised, cross-over (fibre-free vs MF6 formula) 3 x 7 days with washout 7 days,With Nutrison MF less bloating and less nausea was seen,MF6 reduces diarrhoea,78 cancer patients Randomised, single fibre (hy

12、dr. guar gum) vs MF6 10 days postoperative,Wierdsma et al, 2001,With Nutrison MF the duration of diarrhoea was significantly reduced compared to a single fibre formula,MF6 improves transit time,10 healthy volunteers Randomised, cross-over (fibre-free vs MF6) 3 x 7 days with washout 7 days,Silk et al

13、, 2001,MF6 increases short chain fatty acids (SCFA,12 long term tube fed patients RCT, cross over (fibre-free vs MF6) 2 x 2 weeks,Schneider et al, 2001,With Nutrison MF butyrate and total faecal SCFA were significantly increased,MF6 reduces hospital stay,30 acute pancreatitis patients Randomised, fi

14、bre-free vs MF6 formula Duration of hospital stay,Karakan et al, 2007,Fibre-free,MF6,p0.05,33% reduction,With Nutrison Protein Plus MF the duration of hospital stay was significantly reduced,MF6 shows positive effects in children,MF6 is well tolerated,25 tube fed children (10 y, 7-14 y) Randomised,

15、cross-over (fibre-free vs MF6) 2 x 6 weeks plus 6 months,Evans et al, 2009,NutriniMax Energy MF was very well tolerated; occurrence of constipation and use of laxatives decreased,MF6 leads to increased fibre intake,60 children with chronic illness (1-6 y) Randomised (fibre-free vs MF6 sip feed) 12 w

16、eeks,Daly et al, 2004; * Southgate method,With Nutrini Drink MF dietary fibre intake was significantly increased,MF6 shows prebiotic effects,27 tube fed children (11.9 3.9 y) Randomised, cross-over (fibre-free vs MF6) 2 x 3 months,Guimber et al, 2010,With NutriniMax MF whole faecal bifidobacteria co

17、unts significantly increased and pH decreased,MF6 relieves constipation,16 tube fed children (5 y, 1-10 y) Double blind, cross-over (fibre-free vs MF6) 2 x 2 weeks,Trier et al, 1999,With Nutrini MF duration of constipation significantly decreased as well as use of laxatives,MF6 reduces laxative use,

18、31 tube fed children (5 y, 1-10 y) Randomized, double blind (fibre-free vs MF6) 15 days,Hofman et al, 1999,Fibre-free,MF6,p0.05,37% reduction,With MF6 containing formula use of laxatives was significantly reduced,Fibre as the new standard,Given the poor fibre intake and absence of adverse effects,us

19、e of fibre-containing formulae should become standard practice for the majority of children on enteral feeds.” Evans et al, 2009,Benefits of fibre in diabetes,Importance of blood glucose control,High glucose levels (hyperglycaemia) are associated with cardiovascular and microvascular complications E

20、ffective diabetes management includes the control of glucose levels,Importance of blood glucose control,High glucose levels (hyperglycaemia) are associated with cardiovascular and microvascular complications Effective diabetes management includes the control of glucose levels Two forms of glucose control Short term: post-prandial glucose (PPG) Long-term: HbA1c,44% reduction in post-prandial (post-meal) glucose response,Post-prandial glucose control,Ceriello et al, 2009,12 type 2 diabetic patients RCT, double-blind, parallel group s