Advancement Of Enteral Nutrition Research Articles

Biomarkers and Functional Assays of Epithelial Barrier Disruption and Gastrointestinal Dysmotility in Critical Illness-A Narrative Review.

Enteral nutrition in critically ill children has been associated with improved clinical outcomes. Gastrointestinal dysfunction often impedes the timely initiation and advancement of enteral nutrition and can contribute to immune dysregulation and systemic inflammation. Therefore, assessing gastrointestinal function, at a cellular and functional level, is important to provide optimal enteral nutrition therapy and reduce the gastrointestinal tract's contribution to the inflammatory cascade of critical illness. In this narrative review, we present an overview of biomarker and functional assays for gastrointestinal dysfunction, including epithelial barrier disruption and gastrointestinal dysmotility, that have been considered for critically ill patients.

Motility disorders in children with intestinal failure: a national tertiary referral center experience.

Intestinal dysmotility (ID) problems are common in patients with pediatric-onset intestinal failure (IF) and short bowel syndrome (SBS), leading to significant morbidity and delays in the advancement of enteral nutrition (EN). We aimed to investigate the clinical features and complications of ID in children with IF and SBS. Retrospective chart review of all children with IF and/or SBS who required parenteral nutrition (PN) > 6weeks or small-intestinal resection ≥ 50%. Patients were divided into SBS and non-SBS groups. SBS group was divided into two subgroups: with and without ID. Patients with ID were identified (clinically, radiologically and functionally) and analyzed with regard to demographics, intestinal anatomy, complications and outcomes (short and long term). A total of 42 children with IF were treated in our institution during 2003-2022. In non-SBS group (n = 10), ID was the most common cause of IF (80%). SBS-group included 32 children; 18 children (56%) developed ID. The clinical profile of SBS-ID patients (vs SBS) was: female gender (56%), remaining small bowel length ≤ 55cm, estimated residual small bowel ≤ 28% (p = 0.045) and absence of ICV (56%). Common symptoms of the SBS-ID group were: food intolerance (61%), abdominal distension (50%), vomiting (44%), malabsorption and severe constipation. Complications included FTT (67%) (p = 0.003), bacterial overgrowth with subsequent bloodstream infection (33%) (p = 0.75), and lactic acidosis (11%). Lengthening procedure (STEP) was performed in 11 SBS-ID patients (61%) (p = 0.002). In all patients, STEP operation "rescued" their dysfunctional intestine. Eight of these patients (73%) were weaned from TPN. Survival rate was 100%; however, one SBS-ID patient is a candidate for combined intestinal and liver transplantation. ID is the most common complication of SBS and is the most common cause of IF in non-SBS patients. ID has a high morbidity rate and various clinical manifestations. Successful treatment of these infants may be achieved with the use of tapering enteroplasty.

Effect of standardized vs. local preoperative enteral feeding practice on the incidence of NEC in infants with duct dependent lesions: Protocol for a randomized control trial.

BackgroundInfants with duct dependent heart lesions often require invasive procedures during the neonatal or early infancy period. These patients remain a challenge for pediatric cardiologists, neonatologists, and intensive care unit personnel. A relevant portion of these infant suffer from respiratory, cardiac failure and may develop NEC, which leads to inadequate growth and nutrition, causing delayed or complicated cardiac surgery.MethodsThis randomized control trial will recruit term infants diagnosed with a duct dependant lesion within the first 72 h of life. After obtaining written parental consent patients will be randomized to either the physician led enteral feeding or protocol-based feeding group. The intervention will continue up to 28 days of life or day of cardiosurgical treatment, whichever comes first. The primary outcomes include NEC and death related to NEC. Secondary outcomes include among others, number of interrupted feedings, growth velocity, daily protein and caloric intake, days to reach full enteral feeding and on mechanical ventilation.DiscussionOur study will be the first randomized control trial to evaluate if standard (as in healthy newborns) initiation and advancement of enteral feeding is safe, improves short term outcomes and does not increase the risk of NEC. If the studied feeding regime proves to be intact, swift implementation and advancement of enteral nutrition may become a recommendation.Trial registrationThe study protocol has been approved by the local ethical board. It is registered at ClinicalTrials.gov NCT05117164.

Challenges and advances in nutrition for the critically ill child

Malnutrition remains prevalent in critically ill children and is associated with worse clinical outcomes. Conversely, nutrition provision has been associated with improved survival. Nutritional challenges must be addressed to guide best nutrition practices for the critically ill child. In this narrative review, we summarize findings from research published between July 2020 and January 2022 on nutrition in critically ill children. Findings from these articles build on previous work to guide next steps in both research and clinical practice in this cohort. A comprehensive literature review was performed. We identified the following common themes for research published between July 2020 and January 2022-metabolism, enteral nutrition, including timing, dosing, protein prescription and delivery in special populations, gastrointestinal function, and enteral nutrition adjunctive therapies. Research continues to support early initiation and advancement of enteral nutrition. Achieving nutritional adequacy is challenging, but research associated with the timing and dosing of enteral nutrition, alternative methods of enteral nutrition delivery and the use of adjuncts are expanding our understanding of best practices for this cohort. Areas for further research continue to be the use of measured energy requirements, protein dosing and inclusion of functional outcomes to assess the benefit of nutritional interventions.

Enteral Nutrition With High-Dose Vasopressors.

Q Initiation and advancement of enteral nutrition (EN) are often delayed clinically because of the use of “high-dose” vasopressors. Are there standards for high-dose vasopressors? Does their use require delaying either initiation or advancement of EN?A Jan Powers, PhD, RN, CCNS, CCRN, NE-BC, replies:This question is a relevant one that many have struggled with for decades. Enteral nutrition (EN) has many positive benefits in critically ill patients, and early initiation of EN leads to fewer complications and improved patient outcomes. Just a few of the benefits of EN include improved wound healing, less loss of lean muscle mass, and maintenance of structural and functional gut integrity, which helps to bolster immunity and reduce infection. Even consuming only 20% of nutrition via EN can provide to a patient protective functions through innate immunity, for example, by attenuating the loss of function of the gut barrier.1Even with the known benefits of early EN, the main concern stems from EN with the use of vasopressors, as these agents can reduce splanchnic perfusion. Vasopressors commonly used for patients with shock—norepinephrine, vasopressin, phenylephrine, and epinephrine—are potent vasoconstrictors and shunt blood from the splanchnic circulation. In circulatory shock, blood is diverted from nonvital organs such as the gut and toward vital organs, resulting in hypoperfusion of the gut. This hypoperfusion can lead to intestinal ischemia. If nutrition is delivered to a hypoperfused gut, the increased workload predisposes the patient to nonocclusive mesenteric ischemia (NOMI) and potential progression to nonocclusive bowel necrosis (NOBN).2 Most cases of NOMI involve spasm or constriction of branches of the superior mesenteric artery, which supplies the small intestine and proximal colon.3Ischemic bowel is a rare complication associated with EN,4 and NOMI and NOBN have been reported in fewer than 1% of patients receiving EN.3,5 Although the incidence of small-bowel ischemia secondary to enteral feeding is low, the overall clinical outcome is still poor; the high mortality rate (80%) is the main concern.4Many well-respected consensus guidelines state that EN should be withheld from patients who are hemodynamically compromised until they have been fully resuscitated (Table 1).5–8 The most recent updated guidelines from the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine addressing nutrition in patients with coronavirus disease 2019 state that circulatory shock should not be considered a contraindication for trophic EN unless the vasopressor dose is being escalated, feeding intolerance is present, or both.8 This statement is derived from more recent research that I review below.Six observational studies before 2000 found a greater incidence than more recent studies of NOBN,9–14 which historically has been the basis for concern with EN when vasopressors are being administered. All 6 studies involved feeding into the jejunum, and 5 of the 6 studies were related to surgically placed jejunostomy tubes. Past management strategies may have differed from current ones, focusing less on fluid resuscitation before starting a vasopressor.More recent research refutes the findings of these earlier studies. In a 2014 article, Marik15(964) stated that EN has been shown to increase blood flow to the gut, which protects against bowel ischemia, as EN prevents In a 2020 review, Patel et al2 found that recent retrospective studies showed patients receiving early EN and vasopressors did not have any incidence of NOBN (Table 2). The largest study included 3 cases of NOMI, but they were associated with vasopressin; patients receiving norepinephrine tolerated EN better than patients receiving dopamine or vasopressin. The more recent studies demonstrate that EN is safe for patients receiving vasopressors, especially at a low dose (Table 2).The benefits of early EN in critically ill patients treated with vasopressors were demonstrated in a multicenter study of 707 patients.20 In that study, among patients who were hemodynamically stable after fluid resuscitation and were receiving at least 1 vasopressor, those who had started EN within 48 hours from admission had lower mortality (34%) than did those who started EN late, after 48 hours (44%; P < .001).20 Khalid et al20 also demonstrated the benefits of early EN were greatest in the sickest patients and those receiving multiple vasopressors. Patel et al17 described similar findings in adult patients with septic shock who received EN and vasopressors in a medical ICU. Trophic EN was defined as less than 600 kcal/d (~20 mL/h). After controlling for confounders, multivariate logistic regression analysis identified a shorter length of stay and shorter mechanical ventilation time in patients receiving trophic EN than in those receiving full EN support or no EN. Ewy et al24 confirmed these findings, stating that early EN delivered during septic shock was not associated with worsening hemodynamic instability.One recent randomized controlled trial, however, raised concerns with potential adverse events with early EN.30 The NUTRIREA-2 (Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study) trial enrolled 2410 adults receiving mechanical ventilation and vasopressors; the patients were randomized to either parenteral nutrition (PN) or EN with the aim of achieving early nutrition goals within 24 hours. The NUTRIREA-2 investigators found no differences between the groups in ICU-acquired infections, organ failure, length of stay, or mortality.30 They did, however, find a higher risk of bowel ischemia in the patients receiving EN. This finding contrasts with those of previous nonrandomized studies, which indicated that early EN was feasible and beneficial in patients with shock.19,20,31 In NUTRIREA-2, the norepinephrine dosage was 0.56 μg/kg/min (range, 0.30–1.20) in the EN group and 0.50 μg/kg/min (range, 0.25–1.03) in the PN group.30 Patients also received full-dose EN, suggesting that introducing full-dose EN while a patient is also receiving a high dose of norepinephrine may incrementally increase the risk of NOMI. The NUTRIREA-2 investigators determined that full feeding with EN should be avoided until patients are hemodynamically stable. This conclusion may not be generalizable to patients receiving lower volumes of EN, smaller doses of vasopressors, or both.2Almost all recent studies show that EN is associated with preserved splanchnic blood flow, is well tolerated, and may be associated with improved clinical outcomes. Therefore, EN can be delivered safely to patients receiving vasopressors, especially at low doses.32,33 Studies point to a higher rate of complications when EN is introduced in patients receiving high or escalating doses of a vasoactive drug. Covello et al34 stated that patients can safely tolerate early EN when they are receiving stable or declining doses of vasopressors. The best feeding strategy seems to be trophic feeding (10–20 mL/h), with slow increases in rate. Careful monitoring is indicated for any signs of intestinal ischemia.On the basis of current evidence, it is appropriate to withhold EN during periods of hypotension, active resuscitation, and use of high or escalating doses of vasopressors; EN should be avoided until hemodynamic stability is achieved. It is also important to ensure the patient has received adequate fluid resuscitation before starting vasopressors, as this, too, may contribute to ischemia. Early studies suggest caution with nasojejunal feeding and use of vasopressors; however, no evidence from the past 2 decades seems to support this idea. Many studies, however, do not mention the route used for feeding, so it is difficult to draw conclusions. Additional research should be completed to address this question.Controversy remains about the use of EN in patients receiving vasopressors, and more research is required to determine what level of hemodynamic support is safe for the initiation of EN. Until more research is completed, clinicians should consider a pragmatic approach for patients with shock or hemodynamic instability. Low-dose vasopressors with trophic EN seem to be safe for such patients. Higher or escalating doses of vasopressors have greater potential to induce complications. When starting EN in a patient receiving a low dose of a vasopressor, recommendations indicate starting with trophic gastric feeding (10–20 mL/h).33 Allen and Hoffman35 found that norepinephrine at dosages of 6 to 25 μg/min, dopamine at 3 to 10 μg/kg/min, and dobutamine at 12 μg/kg/min are safe with EN. The greatest concern for complications arises with full-dose EN and high-dose vasopressors. Patients receiving a low dose of a vasopressor may experience improved tolerance for trophic EN with slow advancement. Avoid starting nutrition when actively escalating vasopressor doses in hemodynamically unstable patients.Because no clear early warning sign exists for NOMI or NOBN, it is also important to monitor closely for signs of intolerance in any patient taking vasopressors and receiving EN. Signs of intolerance include increased gastric residual volume, abdominal distension, nausea or vomiting, abdominal pain, unexplained elevation in lactate upon initiating or escalating feeding, intra-abdominal hypertension, or abdominal compartment syndrome.36 Last, if patients are unable to meet their nutritional goals, clinicians may need to consider supplementation with PN.

Cisapride Use in Pediatric Patients With Intestinal Failure and Its Impact on Progression of Enteral Nutrition.

Gastrointestinal dysmotility is common in patients with pediatric intestinal failure (PIF), leading to delays in advancement of enteral nutrition (EN). Few studies have been published regarding the safety and efficacy of cisapride for improvement of enteral tolerance and ability to wean parenteral nutrition. Our objective was to describe a single center experience on the use of cisapride in patients with PIF. Retrospective chart review of patients was performed. Demographic, intestinal anatomy, and outcome data were collected. Percentage of EN before initiation of cisapride, progression of EN at 3 and 6 months, and ability to wean parenteral nutrition after initiation of cisapride were calculated. Prokinetics were used in 61 of 106 patients (56.6%); 29 of 60 patients (48.3%) failed to progress EN on other prokinetics and started on cisapride. Before cisapride the progress of EN plateaued for a mean of 42.3 (standard deviation [SD] 60.2) days. The rate of feed progression was 0.14% (SD 0.19)/day pre-cisapride and 0.69%/day (SD 0.31) after cisapride initiation (P < 0.001). Percentage of EN improved significantly from baseline to 3 months postinitiation (23.9% vs 79.4%, respectively; P < 0.001). Electrocardiogram was performed on initiation of cisapride and after every dose change. Medication was discontinued in 2 of 29 (6.8%). This retrospective study suggests that cisapride may be beneficial in PIF patients who fail to progress EN on first line prokinetics. The most significant period of improvement occurs within 3 months of cisapride initiation. Cardiac side effects in our cohort were lower than previously reported; however, cardiac monitoring is still recommended.

Effectiveness and Safety of Fast Enteral Advancement in Preterm Infants Between 1000 and 2000 g of Birth Weight.

The advancement of enteral nutrition in premature infants is still controversial. Clinicians must provide adequate caloric intake but avoiding feeding intolerance and necrotizing enterocolitis (NEC). The aim of this study was to establish the safety and effectiveness of fast enteral advancement by comparing it with traditional advancement. This is a controlled randomized clinical trial. Feeding was advanced at 30mL/kg/d vs 20mL/kg/d in premature infants under 34 weeks between 1000 and 1499g birth weight, and at 40mL/kg/d vs 20mL/kg/day in those weighing 1500-1999g. Outcomes included time to reach total enteral nutrition, days of parenteral nutrition (PN) and/or intravenous fluid (IVF), days to recover birth weight, episodes of feeding intolerance, growth and weight gain at 40 weeks, sepsis, hypoglycemia, hyperbilirubinemia, NEC, and mortality. Student t-test or Mann-Whitney U test, Fisher test or χ2 test, and multiple linear regression were used. Differences were found in days to reach total enteral nutrition (slow: 7 [IQR(interquartile range), 6-9], fast: 4 [IQR, 4-6]; P < .001) and days of IVF or PN (slow: 6 [IQR, 4-8], fast: 3 [IQR, 3-5]; P < .001). Fast advancement decreases time to total enteral nutrition by 3 days and PN and/or IVF by up to 5 days. There were no differences in other outcomes. Fast enteral advancement decreases the days to reach total enteral nutrition and the days of PN and/or IVF without causing greater feeding intolerance. Additional studies are required for more evidence.

Blended tube feeding prevalence, efficacy, and safety: What does the literature say?

For most of human history, physicians used blended whole foods for patients who are unable to eat by mouth. However, by the 1960s and 1970s, advances in enteral nutrition resulted in the gradual displacement of blenderized tube feedings (BTFs) with commercial formulas. There are advantages and disadvantages to commercial formulas and BTFs. The purpose of this article was to review the literature for the incidence of blended tube feeding use and its safety, efficacy, and implications for clinical practice. A search of the scientific literature in PubMed, CINAHL, Cochrane, ProQuest, and Ovid was conducted using the keywords "blenderized tube feeding" and "blended tube feeding." Articles were divided into two categories: 1) frequency of use and experiences of BTF in patients or caregivers and health care providers and 2) safety/efficacy studies. The literature review shows a rising interest in BTF, with more research on efficacy indicated. The use of BTF is primarily patient or caregiver driven. Blenderized tube feeding requires oversight by health care providers just as commercial formulas. Health care providers should be aware of the use of BTF and the effect it can have on different patient populations regarding content, cost, safety, and efficacy in the clinical and home settings.

Process-Related Barriers to Optimizing Enteral Nutrition in a Tertiary Medical Intensive Care Unit.

Enteral nutrition (EN) is the preferred route of nutrient delivery in critically ill patients. Research has consistently described an incomplete delivery of EN in critically ill patients. The purpose of this study was to investigate barriers to reach and maintain >90% prescribed EN among critically ill medical intensive care unit (ICU) patients. We performed a retrospective cohort quality improvement study of patients ≥ 18 years of age admitted to a tertiary medical ICU and referred for EN from October 1-December 31, 2013. We excluded patients who received intermittent or bolus feeding. Demographic, clinical, and nutrition data were collected. Potential barriers to EN were categorized a priori. Seventy-eight patients receiving 344 days of EN were included in the study. EN was initiated at a median of 32 hours (interquartile range, 18.5-75 hours) after ICU admission. Initiation and advancement of EN was identified as the most common reason for <90% prescribed intake. The top 5 interruption reasons were extubation, fasting for bedside procedure, loss of enteral access, gastric residual volume (0-499 mL), and radiology suite procedure. Suboptimal EN volume delivery continues to be an issue in critically ill patients. Our study identified initiation and advancement of EN as the most common reason for suboptimal EN volume delivery. Variation in practice was noted within several categories, and multiple reversible barriers to optimal EN delivery were identified. These data can serve as the impetus to modify practice models and workflow to optimize EN delivery among critically ill patients.

Enteral Feedings in Children: Sorting Out Tubes, Buttons, and Formulas.

Enteral nutrition (EN) is the provision of food or nutrients beyond the esophagus via a tube either to the stomach or small intestines. Choosing the route, method, and formula for administration of EN to infants and children is complicated by the increasing options available. Indications and contraindications change as surgical procedures and medical treatments advance. Human milk remains the normative standard for infant formulas; if a safe supply is available, it is recommended as optimal nutrition for infants, including via enteral tube access. For infants without an available supply of human milk and children older than 12 months, a wide variety of formulas are available, including the renewed interest in formulas using cooked table foods. This article presents the different methods of EN access placement, maintenance, formula recommendations, and advancement of EN. It is important for healthcare professionals to be aware of the options and recommendations for EN.

1034

Introduction: Optimal nutrient delivery and the use of uniform feeding protocols have been associated with improved clinical outcomes in pediatric critical illness. We aimed to examine the prevalence of nutrition guidelines and protocols in PICUs across the world and identify variability in key practice parameters. Hypothesis: We hypothesized that feeding protocols are not routinely employed and consist of recommendations that are variable among institutions. Methods: Centers participating in a prospective nutritional study were asked to provide details of the nutrition support guidelines currently implemented in their PICU. Specific recommendations regarding feeding route, rate of advancement, contraindications, definition and management of intolerance and goals for enteral nutrition (EN) were compared between centers. Results: Of the 30 PICUs from academic centers in the international study, 9 (30%) from 3 countries reported using a nutrition guideline. EN was preferred in all the centers and recommended early in a majority of the centers, but contraindicated with ionotrope use or abdominal pathology. Uniform nutritional screening and measurement of energy expenditure were not specified in most guidelines. EN goals were volume-based and stepwise rates for advancement of EN were variable. Criteria for EN intolerance included: increased gastric residual volume (GRV) (7/9), abdominal distension (5/9), vomiting (5/9), and diarrhea (4/9). GRV threshold for stopping EN ranged from 2 to 5mL/kg or 2 to 4 hours of feed volume. A majority of the protocols defined a plan to address EN intolerance, which included reducing feed volume, post-pyloric feeding and use of prokinetics. Conclusions: Uniform nutrition guidelines were used in less than a third of all participating PICUs. A majority of the guidelines prioritize EN, soon after admission, with stepwise advancement to a specified volume goal and a plan to address intolerance. The definitions of EN intolerance are variable. Despite a lack of evidence, centers use variable GRV thresholds for stopping EN, and the indications for post-pyloric feeds and prokinetics are heterogeneous. Nutritional investigations to guide uniform evidence-based best practices in the PICU are urgently needed.

Are there any real differences between enteral feed formulations used in the critically ill?

We know that adequate nutritional support is essential in the treatment of critically ill patients, because it can, if applied appropriately, improve the clinical outcome. Increasing evidence seems to suggest that malnutrition itself is a predictor of poor outcome in intensive care, and significant underfeeding during intensive care stay increases the risk of bloodstream infections. The purpose of this review is to highlight recent advances in enteral nutrition in the critically ill adult patient. Recent studies suggest that tight glycaemic control is associated with improved outcome. Enteral feeding should be encouraged, using simple feeding protocols, and started early if safe to do so. Gastric residual volumes do not correlate with the risk of aspiration, and therefore should be used with caution in feeding protocols. Conflicting evidence exists for supplementation with antioxidant and immunonutrition in the critically ill. Glutamine and fish oil/borage oil should be considered for burns patients and patients with adult respiratory distress syndrome, respectively. This review offers information regarding the latest developments in nutritional support via the enteral route. Further research is needed to clarify the role of enteral supplements such as antioxidants and 'immune modulating substances'.

Migrating motility complexes persist after severe traumatic shock in patients who tolerate enteral nutrition.

Postinjury small bowel ileus is poorly characterized and may be an important factor in intolerance to enteral nutrition (EN). We, therefore, placed jejunal manometry catheters in high-risk trauma patients. Our hypothesis was that the presence of "fasting migrating motility complex (MMC)" activity and conversion to a "fed pattern" at goal rate of EN would be present in those patients who tolerate jejunal feeding. After obtaining baseline fasting manometry pressure tracings, jejunal feeding was advanced stepwise to a set goal while tolerance was monitored and intolerance was treated by a standard approach. Of the 10 study patients, 7 were able to be maintained on EN. Five (50%) had "fasting MMCs" and had good tolerance to early advancement of EN. The remaining five patients did not exhibit "fasting MMCs" and four had poor tolerance to early advancement of EN. Overall, nine patients reached goal rate of EN of which four converted to a "fed pattern." This, however, was not associated with later tolerance to EN. EN is feasible following severe traumatic shock. Surprisingly, half of the patients had fasting MMCs. This requires intact neural and motor function and was associated with good tolerance of early EN.

From TPN to breast feeding--feeding the premature infant--2000: Part I. Parenteral nutrition.

Advancements in medical technology have allowed for the survival of smaller, more premature infants, during the past several years. Infants as immature as 23 weeks gestational age and as small as 500 g, or even less, are now common sights in Neonatal Intensive Care Units throughout the United States. These infants present a unique challenge to neonatologists and registered dietitians, who must provide them with the nutrients needed for normal growth and development. With mounting evidence of a direct link between early nutrition and later outcome, the need for a better understanding of fetal and neonatal nutrition is critical. From admission to discharge, most infants will transition from a dependence on parenteral feeding, to a dependence on tube feeding, and finally, the ability to orally feed. In the early days of postnatal life, decisions must be made about when to initiate TPN, what type of intravenous access will be required, and to what extent and at what rate parenteral nutrients should be advanced. Similar decisions are made about the introduction and advancement of enteral nutrition. The following is a review of the available literature on the parenteral feeding of premature infants, with an emphasis on how our practice in the year 2000 was evolved over time. A similar review of enteral feeding practices will be presented in a future installment.

Enteral feeding techniques.

Major technical advances in enteral nutrition include the use of erythromycin or magnetic guidance for the placement of the feeding tube into the duodenum, the development of new enteral tubes, and bedside methods to control the tube position. Percutaneous endoscopic jejunostomy is becoming a safe procedure with a high success rate. Specialized diets offer little or no clinical advantages when compared with standard polymeric diets.

Invited Review: Dietary Fiber: A Brief Review and Potential Application To Enteral Nutrition

Advances in enteral nutrition include the provision of organ-specific fuels to improve gut structure and function. Examples of these fuels include soluble fiber as a fuel precursor, and the SCFAs acetate, propionate, and butyrate. Butyrate appears to exert its trophic effect primarily in the colon, whereas the combined SCFAs affect the whole gastrointestinal tract. The provision of these fuels may be indicated for selected patients with intestinal dysfunction.