Efficacy of Fiber-Enriched Versus Fiber-Free Enteral Feeds on Bowel Function of Non-Critically Ill Tube-Fed Adult Patients in Saudi Arabia—A Prospective Cohort Study
Abstract
:1. Introduction
2. Methods
2.1. Study Setting
2.2. Study Subjects
2.3. Study Design
2.4. Sample Size and Sampling Technique
2.5. Data Collection
- a
- Type of enteral feeding: Fiber-free formula or fiber-enriched formula.
- b
- Volume ratio (Percent of EN volume ratio): The efficiency of EN was measured daily by volume ratio (%): VR (%) = (administered volume of nutrition/prescribed volume of nutrition) × 100. Energy requirements were calculated using the Harris–Benedict equation [39], and the protein requirement for surgical patients was 1.2–1.5 g/kg. The dietitian calculated the volume of the enteral formula prescribed for each patient based on the patient’s energy requirement.
- c
- Underweight. Underweight was considered for ≥65-year-old patients whose initial BMI was <22 kg/m2, or for <65-year-old patients whose initial BMI was <18.5 kg/m2.
- d
- Antibiotics and laxative medications. Laxatives [Docusate, Glycerin rectal, Magnesium Sulphate, Bisacodyl Suppository, Fleet enema, Movicol, Lactolose, Prune juice, milk of magnesia, senna]. Antibiotics [Tigecycline, Meropenem, Tazocin, Augmentin, Cefepime, Ceftriaxone, Moxifloxacin, Clindamycin, Co-trimoxazole].
- e
- Other medications, e.g., nonsteroidal anti-inflammatory drugs, alpha-glucosidase inhibitors, antineoplastics, magnesium-based antacids, colchicine sorbitol- or -lactose-based drugs, prostaglandins, antiarrhythmic drugs, cholinergic drugs, anthraquinone-related drugs, lipase inhibitors, and cholinesterase inhibitors.
- a
- Gastric residual is considered high if the volume exceeds 500 mL.
- b
- Regurgitation is defined as observing the enteral formula in the oral cavity.
- c
- Vomiting will be defined as the return of the enteral formula from the stomach to the mouth.
- d
- Abdominal distention is the presence of excessive gases in the stomach or intestine. It is diagnosed with tympany, or the absence of bowel sounds during physical examination.
- e
- Constipation is the absence of bowel motion for more than three days.
- f
- Diarrhea is defined as a daily accumulation score of more than or equal to 12, as proposed by Hart and Dobb [41]. This is aligned with our practice at the Ministry of National Guard. The nursing staff and the study investigators collected scores daily. Patients were followed daily for 14 successive days unless discharged or in cases of death.
- g
- Significant weight loss was considered as a loss of ≥2% of the initial body weight over the study period.
2.6. Data Analysis
3. Results
4. Discussion
5. Strengths and Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Nutrition Information | Jevity | Ensure |
---|---|---|
Energy (Calories) | 1060 | 1000 |
Protein (g) | 44 | 40 |
Fat (g) | 35 | 34 |
Carbohydrate (g) | 155 | 137 |
Fiber (g) | 14.4 | 0 |
Osmolality (mOsm/kg) | 300 | 376 |
Fiber-Free (FF) [n = 55] | Fiber-Enriched (FE) [n = 119] | Difference | |
---|---|---|---|
Patient characteristics | |||
Age in years (mean ± SD) | 50.0 ± 25.8 | 57.7 ± 21.9 | t = 1.91, p = 0.059 |
Gender (m/f) (n) | 36/19 | 73/46 | X2 = 0.27, p = 0.60 |
Weight in Kg (mean ± SD) | 59.2 ± 20.1 | 65.1 ± 14.5 | t = 1.97, p = 0.051 |
BMI (mean ± SD) | 22.9 ± 7.1 | 24.7 ± 5.7 | t = 1.75, p = 0.08 |
Underweight (n, %) | 21 (38.2) | 31 (26.1) | X2 = 2.64, p = 0.10 |
CCI score (mean ± SD) | 2.8 ± 2.5 | 3.6 ± 2.8 | t = 1.83, p = 0.07 |
Post ICU admission (n, %) | 8 (14.5) | 16 (13.4) | X2 = 0.04, p = 0.85 |
Volume ratio (%) | 73.1 ± 18.2 | 80.8 ± 17.6 | t = 2.63, p = 0.009 * |
Laxative medication (n, %) | 50 (90.9) | 92 (77.3) | X2 = 4.63, p = 0.031 * |
Antibiotics administration (n, %) | 6 (10.9) | 23 (19.3) | X2 = 1.92, p = 0.17 |
C. difficilis + ve (n, %) | 1 (1.8) | 2 (1.7) | FET, p = 1.0 |
Complications | |||
Diarrhea (n, %) | 30 (54.5) | 35 (29.4) | X2 = 10.15, p = 0.001 * |
Significant weight loss (n, %) | 25 (45.5) | 32 (26.9) | X2 = 5.89, p = 0.015 * |
Constipation (n, %) | 18 (32.7) | 30 (25.2) | X2 = 1.06, p = 0.30 |
Vomiting (n, %) | 4 (7.3) | 9 (7.6) | FET, p = 0.61 |
Gastric residual (n, %) | 2 (3.6) | 2 (1.7) | FET, p = 0.59 |
Abdominal distention (n, %) | 0 (0.0) | 5 (4.2) | FET, p = 0.18 |
Regurgitation (n, %) | 0 (0.0) | 0 (0.0) |
Diarrhea | |
Incidence of D+ in FF group (CER) % | 54.5 |
Incidence of D+ in FE group (EER) % | 29.4 |
ARR on D+ reduction % = (CER − EER) = 54.5 − 29.4 | 25.1 (95% CI 24.6–25.6) |
RRR on D+ % = (CER − EER)/CER = (54.5 − 29.4)/54.5 | 46.1 |
Relative risk (RR) = EER/CER = 29.4/54.5 | 0.54 |
Significant weight loss | |
Incidence of D+ in FF group (CER) % | 45.5 |
Incidence of D+ in FE group (EER) % | 26.9 |
ARR on D+ reduction % = (CER − EER) = 45.5 − 26.9 | 18.6 (95% CI 18.0–19.2) |
RRR on D+ % = (CER − EER)/CER = 45.5 − 26.9)/45.5 | 40.9 |
Relative risk (RR) = EER/CER = 26.9/45.5 | 0.59 |
Diarrhea | Significant Weight Loss | |||||
---|---|---|---|---|---|---|
Predictors | B (SE) | p-Value | OR (95% CI) | B (SE) | p-Value | OR (95% CI) |
Fiber free # versus fiber enrichment | 1.11 (0.36) | 0.002 * | 3.04 (1.49–6.19) * | 0.86 (0.36) | 0.018 * | 2.37 (1.16–4.84) * |
Antibiotic medication (yes # versus no) | 0.98 (0.44) | 0.026 * | 2.68 (1.12–6.38) * | −0.16 (0.48) | 0.74 | 0.85 (0.33–2.19) |
Laxative medication (yes # versus no) | 0.20 (0.48) | 0.68 | 1.22 (0.48–3.11) | −0.42 (0.47) | 0.37 | 0.66 (0.26–1.64) |
Volume ratio (%) | −0.01 (0.01) | 0.50 | 0.99 (0.98–1.01) | −0.02 (0.01) | 0.08 | 0.98 (0.96–1.00) |
Constant | −0.69 (0.92) | 0.45 | 0.50 | 0.64 (0.93) | 0.49 | 1.89 |
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Abolfotouh, M.A.; Alolayan, R.A.; Binhusain, H.; Alsayegh, A.; Al Babtain, I.T. Efficacy of Fiber-Enriched Versus Fiber-Free Enteral Feeds on Bowel Function of Non-Critically Ill Tube-Fed Adult Patients in Saudi Arabia—A Prospective Cohort Study. Nutrients 2025, 17, 676. https://doi.org/10.3390/nu17040676
Abolfotouh MA, Alolayan RA, Binhusain H, Alsayegh A, Al Babtain IT. Efficacy of Fiber-Enriched Versus Fiber-Free Enteral Feeds on Bowel Function of Non-Critically Ill Tube-Fed Adult Patients in Saudi Arabia—A Prospective Cohort Study. Nutrients. 2025; 17(4):676. https://doi.org/10.3390/nu17040676
Chicago/Turabian StyleAbolfotouh, Mostafa A., Rawan A. Alolayan, Heba Binhusain, Abdulrahman Alsayegh, and Ibrahim T. Al Babtain. 2025. "Efficacy of Fiber-Enriched Versus Fiber-Free Enteral Feeds on Bowel Function of Non-Critically Ill Tube-Fed Adult Patients in Saudi Arabia—A Prospective Cohort Study" Nutrients 17, no. 4: 676. https://doi.org/10.3390/nu17040676
APA StyleAbolfotouh, M. A., Alolayan, R. A., Binhusain, H., Alsayegh, A., & Al Babtain, I. T. (2025). Efficacy of Fiber-Enriched Versus Fiber-Free Enteral Feeds on Bowel Function of Non-Critically Ill Tube-Fed Adult Patients in Saudi Arabia—A Prospective Cohort Study. Nutrients, 17(4), 676. https://doi.org/10.3390/nu17040676