Effect of fiber supplementation on the microbiota in critically ill patients

作     者：Stephen JD O'Keefe Junhai Ou James P DeLany Scott Curry Erwin Zoetendal H Rex Gaskins Scott Gunn 

作者机构：Division of GastroenterologyDepartment of MedicineUniversity of PittsburghPittsburghPA 15213United States Division of EndocrinologyDepartment of MedicineUniversity of PittsburghPittsburghPA 15261United States Division of Infectious DiseaseDepartment of MedicineUniversity of PittsburghPittsburghPA 15261United States Laboratory of MicrobiologyWageningen UniversityWageningen 6703HBThe Netherlands Department of Animal Sciences and PathobiologyDivision of Nutritional SciencesInstitute for Genomic BiologyUniversity of Illinois at Urbana-ChampaignUrbanaIL 61801United States Division of Critical Care MedicineDepartment of MedicineUniversity of PittsburghPittsburghPA 15261United States 

出 版 物：《World Journal of Gastrointestinal Pathophysiology》 (世界胃肠病理生理学杂志（英文版）（电子版）)

年 卷 期：2011年第2卷第6期

页      面：138-145页

学科分类：100218[医学-急诊医学] 1002[医学-临床医学] 1010[医学-医学技术（可授医学、理学学位）] 10[医学] 

基　　金：Supported by NIH NCI R01 CA135379 for O'Keefe and Gas-kins Laboratories 

主　　题：Critical illness Acute pancreatitis Microbiota Enteral nutrition Fiber 

摘      要：AIM:To determine tolerance to fiber supplementation of semi-elemental tube feeds in critically ill patients and measure its effect on colonic microbiota and ***:Thirteen intensive care unit patients receiving jejunal feeding with a semi-elemental diet for predominantly necrotizing pancreatitis were *** study was divided into 2 parts:first,short-term (3-9 d)clinical tolerance and colonic fermentation as assessed by fecal short chain fatty acid(SCFA)concentrations and breath hydrogen and methane was measured in response to progressive fiber supplementation increasing from 4 g tid up to normal requirement levels of 8 g tid;second,4 patients with diarrhea were studied for 2-5 wk with maximal supplementation to additionally assess its influence on fecal microbiota quantitated by quantitative polymerase chain reaction (qPCR)of microbial 16S rRNA genes and Human Intestinal Tract Chip(HITChip)microarray *** all patients were receiving antibiotics(10/13)and acid suppressants(11/13)at some stage during the ***:In group 1,tolerance to progressive fiber supplementation was good with breath hydrogen and methane evidence(P=0.008 and P0.0001,respectively)of increased fermentation with no exacerbation of abdominal symptoms and resolution of diarrhea in 2 of 4 *** group 2 before supplementation,fecal microbiota mass and their metabolites,SCFA,were dramatically lower in patients compared to healthy *** qPCR and HITChip analyses we calculated that there was a 97%reduction in the predominant potential butyrate producers and starch *** 2-5 wk of fiber supplementation there was a significant increase in fecal SCFA(acetate 28.4±4.1μmol/g to 42.5±3.1μmol/g dry weight,P=0.01;propionate 1.6±0.5 vs 6.22±1.1,P=0.006 and butyrate 2.5±0.6 vs 5.9±1.1,P=0.04)and microbial counts of specific butyrate producers,with resolution of diarrhea in 3 of 4 ***:Conventional management of critically ill patie