A systematic review of the nutritional and medical outcomes of the use of fibre containing enteral feeds vs fibre-free feeds in adults patients receiving enteral feeding

Abstract

Background: Enteral nutrition (EN) involves administering a fully balanced nutritional feed through a tube into the stomach, duodenum, or jejunum but it can lead to complications like diarrhoea, constipation, vomiting, and other gastrointestinal symptoms. Recent studies have investigated how fibre containing formulas impacts GI symptoms and clinical outcomes ; however, the findings have been inconsistent.

Aim: This systematic review aimed to evaluate the outcomes associated with fibre-containing versus fibre-free feeds in adult patients receiving enteral feeding. This includes evaluating gastrointestinal symptoms (diarrhoea, constipation, abdominal distention, vomiting, regurgitation, and other GI symptoms), length of hospital stay, nutritional intake, and infectious complications.

Method: A systematic search across three databases (PubMed, MEDLINE via Ovid, and Web of Science) was conducted for full-text articles published in English between 2014 and 2024, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Randomized controlled trials comparing the effects of fibre formulas versus fibre-free formulas on adult patients receiving enteral feeding were deemed eligible.

Results: Eight studies involved 640 participants aged between 18 and 90 years were identified and evaluated. Six studies demonstrated significant improvements in diarrhoea incidence in the intervention group (p < 0.05), while one study found no significant differences in diarrhoea incidence among the groups. Regarding constipation, two studies reported a significant decrease in the intervention group, whereas two studies found no significant difference in constipation rates across the groups. For secondary outcomes, two studies revealed a significant decrease in the length of hospital stay, while four studies indicated no statistically significant differences among the groups. Additionally, three studies showed an improved volume of nutrient intake (p < 0.05), while three studies reported similar mean daily intake between the groups.

Conclusion: Fibre-containing enteral feeds appear to be beneficial in managing gastrointestinal symptoms, particularly diarrhoea, and may also enhance secondary outcomes, such as nutritional intake, in hospitalised patients receiving enteral feeding. However, further robust, well-designed randomized controlled trials are essential to provide definitive guidance for clinical practice. Keywords: Enteral nutrition, enteral feeding, fibre containing formula, fibre free feeds, GI symptoms, gastrointestinal symptoms