Relationship Between Dietary Fiber Intake and Short‐Chain Fatty Acid–Producing Bacteria During Critical Illness: A Prospective Cohort Study

Abstract

Background Dietary fiber increases short‐chain fatty acid (SCFA)‐producing bacteria yet is often withheld in the intensive care unit (ICU). This study evaluated the safety and effect of fiber in ICU patients with gut microbiome sampling. Methods This was a retrospective study nested within a prospective cohort. Adults were included if newly admitted to the ICU and could receive oral nutrition, enteral feedings, or no nutrition. Rectal swabs were performed at admission and 72 hours later. The primary exposure was fiber intake over 72 hours, classified in tertiles and adjusted for energy intake. The primary outcome was the relative abundance (RA) of SCFA producers via 16S RNA sequencing and the tolerability of fiber. Results In 129 patients, median fiber intake was 13.4 g (interquartile range 0–35.4 g) over 72 hours. The high‐fiber group had less abdominal distension (11% high fiber vs 28% no fiber, P < .01) and no increase in diarrhea (15% high fiber vs 13% no fiber, P = .94) or other adverse events. The median RA of SCFA producers after 72 hours was 0.40%, 0.50%, and 1.8% for the no‐, low‐, and high‐fiber groups (P = .05 for trend). After correcting for energy intake, the median RA of SCFA producers was 0.41%, 0.32%, and 2.35% in the no‐, low‐, and high‐corrected‐fiber categories (P < .01). These associations remained significant after adjusting for clinical factors including antibiotics. Conclusions During the 72 hours after ICU admission, fiber was well tolerated, and higher fiber intake was associated with more SCFA‐producers.

Long‐term changes in the gut microbiota after 14‐day bismuth quadruple therapy in penicillin‐allergic children

“…In general, the group of gut microbes associated with a good health outcome are identified as “potential beneficial bacteria,” 33 such as short‐chain fatty acid (SCFA)‐producing bacteria ( Bacteroides, Faecalibacterium, Phascolarctobacterium, Roseburia, Bifidobacterium, Blautia, etc) 34‐36 . Those could potentially lead to development or progression of noncommunicable diseases are identified as “potential detrimental microbes,” 33 such as enteric pathogens and opportunistic pathogens ( Escherichia‐Shigella , Klebsiella , Enterococcus , Streptococcus , etc) 37‐39 …”

The Importance of the Microbiome in Critically Ill Patients: Role of Nutrition

“…Although some prebiotics selectively promote the growth of fecal Bifidobacterium in healthy individuals, this has not been observed in critically ill patients [87]. A recent prospective cohort study on enterally=fed ICU patients who were administered with high soluble fiber reported a relative abundance of SCFA-producing bacteria, including Faecalibacterium prausnitzii, Eubacterium rectale, Ruminococcus, Blautia, Coprococcus, and Roseburia, improved abdominal distension, and showed no increase in diarrhea [88].…”

Impact of microbiome-based interventions on gastrointestinal pathogen colonization in the intensive care unit

“…64 Our own retrospective study of 129 ICU patients demonstrated a similar increase in SCFA producers with higher amounts of fiber. 65 These findings, assuming SCFAs are indeed beneficial, 66 support the value of fiber and other prebiotics in maintaining gut microbial homeostasis. 64 However, other trials, including a study of oligofructose/inulin in ICU patients receiving enteral nutrition, have shown no impact on the microbiome.…”