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Recommendations Summary

CI: Enteral Nutrition and Fiber 2012

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    CI: Addition of Fiber to Enteral Nutrition to Reduce Diarrhea

    If the critically ill adult patient is receiving enteral nutrition (EN) and the use of fiber is not contraindicated (e.g., by hemodynamic instability, severe dysmotility,  or positive clostridium difficile), the Registered Dietitian (RD) should consider using soluble fiber (e.g.,  guar gum) to prevent and/or manage diarrhea. Research indicates that diarrhea may be reduced in adult critically ill patients when guar gum is included in the EN regimen. The impact of other types of fiber on reducing diarrhea is unclear due to variations in the fiber combinations and amounts used in the studies. 

    Rating: Fair
    Conditional

    • Risks/Harms of Implementing This Recommendation

      Use of fiber is contraindicated in the following:

      • Hemodynamic instability
      • High risk for bowel ischemia
      • Severe dysmotility
      • Positive clostridium diff. (McClave et al, 2009).

    • Conditions of Application

      • Ability to identify the presence of contraindications
      • Receiving EN.

    • Potential Costs Associated with Application

      Costs may be increased with the use of fiber in EN.

    • Recommendation Narrative

      A total of six studies were included in the evidence analysis for this recommendation:

      • Five positive quality randomized controlled trials (RCTs) (Chittawatanarat et al, 2010; Dobb and Towler, 1990; Hart and Dobb, 1988; Rushdi et al, 2004; and Spapen et al, 2001)
      • One neutral quality RCT (Emery et al, 1997).

      EN and Fiber

      • Six studies provide evidence that diarrhea may be reduced in adult critically ill patients when guar gum is included in the EN regimen. The impact of other types of fiber on reducing diarrhea is unclear due to variations in the fiber combinations and amounts used in the studies.
      • Evidence is based on the following studies: Chittawatanarat et al, 2010; Dobb and Towler, 1990; Emery et al, 1997; Hart and Dobb, 1988; Rushdi et al, 2004; and Spapen et al, 2001).

    • Recommendation Strength Rationale

      • Subjects were primarily middle-aged and elderly
      • Grade II evidence is available for the conclusion statement regarding addition of fiber to EN in critically ill adult patients. 

    • Minority Opinions

      None.