The efficacy of fiber-supplemented enteral nutrition in critically ill patients: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis

Koch JL 1 , Lew CCH 2 , Kork F 3 , Koch A 4 , Stoppe C 5 , Heyland DK 6 Show all authors , Dresen E 5 , Lee ZY 7 , Hill A 8

Affiliations 

  • 1 Medical Faculty, RWTH Aachen University, Aachen, Germany
  • 2 Department of Dietetics and Nutrition, Ng Teng Fong General Hospital, Singapore, Singapore
  • 3 Department of Anaesthesiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
  • 4 Department of Gastroenterology, Metabolic Diseases and Internal Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
  • 5 Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
  • 6 Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
  • 7 Department of Cardiac Anaesthesiology and Intensive Care Medicine, Charité Berlin, Berlin, Germany
  • 8 Department of Anaesthesiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. ahill@ukaachen.de
Crit Care, 2024 Nov 07;28(1):359.
PMID: 39511681 DOI: 10.1186/s13054-024-05128-2

Abstract

BACKGROUND: Evidence on the benefits of fiber-supplemented enteral nutrition (EN) in critically ill patients is inconsistent, and critical care nutrition guidelines lack recommendations based on high-quality evidence. This systematic review and meta-analysis (SRMA) aims to provide a current synthesis of the literature on this topic.

METHODS: For this SRMA of randomized controlled trials (RCT), electronic databases (MEDLINE, EMBASE, CENTRAL) were searched systematically from inception to January 2024 and updated in June 2024. Trials investigating clinical effects of fiber-supplemented EN versus placebo or usual care in adult critically ill patients were selected. Two independent reviewers extracted data and assessed the risk of bias of the included studies. Random-effect meta-analysis and trial sequential analysis (TSA) were conducted. The primary outcome was overall mortality, and one of the secondary outcomes was diarrhea incidence. Subgroup analyses were also performed for both outcomes.

RESULTS: Twenty studies with 1405 critically ill patients were included. In conventional meta-analysis, fiber-supplemented EN was associated with a significant reduction of overall mortality (RR 0.66, 95% CI 0.47, 0.92, p = 0.01, I2 = 0%; 12 studies) and diarrhea incidence (RR 0.70, 95% CI 0.51, 0.96, p = 0.03, I2 = 51%; 11 studies). However, both outcomes were assessed to have very serious risk of bias, and, according to TSA, a type-1 error cannot be ruled out. No subgroup differences were found for the primary outcome.

CONCLUSION: Very low-certainty evidence suggests that fiber-supplemented EN has clinical benefits. High-quality multicenter RCTs with large sample sizes are needed to substantiate any firm recommendation for its routine use in this group of patients. PROSPERO registration number: CRD42023492829.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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