Effect of fiber supplementation on the microbiota in critically ill patients.
Effect of fiber supplementation on the microbiota in critically ill patients.
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DOI：
10.4291/wjgp.v2.i6.138
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发表时间：
2011-12-15
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影响因子：
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通讯作者：
Gunn, Scott
中科院分区：
文献类型：
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作者：
O'Keefe, Stephen J D;Ou, Junhai;Gunn, Scott
目的：为了确定对危重患者的半元素管饲纤维补充的耐受性，并测量其对结肠微生物群和发酵的影响。方法：对13名重症监护病房患者进行了研究，这些患者接受空肠喂养，主要是坏死性胰腺炎的半元素饮食。本研究分为两部分：第一部分，通过粪便短链脂肪酸（SCFA）浓度和呼吸氢和甲烷来评估对渐进式纤维补充从4g tid增加到8 g tid的正常需要水平的短期（3- 9d）临床耐受性和结肠发酵的响应;第二，对4名腹泻患者进行了2-5周的研究，最大限度地补充，以额外评估其对粪便微生物群的影响，所述粪便微生物群通过微生物16 S rRNA基因的定量聚合酶链反应（qPCR）和人类肠道芯片（HITChip）定量。微阵列分析。几乎所有的患者在研究的某个阶段都接受了抗生素（10/13）和抑酸剂（11/13）。在第1组中，对渐进式纤维补充的耐受性良好，呼吸氢和甲烷证据（分别为P = 0.008和P < 0.0001），4名患者中有2名患者的发酵增加，腹部症状未加重，腹泻消退。在补充前的第2组中，与健康志愿者相比，患者的粪便微生物群质量及其代谢产物SCFA显着降低。根据qPCR和HITChip分析，我们计算出主要的潜在丁酸生产者和淀粉降解者减少了97%。补充纤维2-5周后，粪便SCFA显著增加，（醋酸盐28.4 ± 4.1 μ mol/g至42.5 ± 3.1 μ mol/g干重，P = 0.01;丙酸1.6 ± 0.5 vs 6.22 ± 1.1，P = 0.006和丁酸2.5 ± 0.6 vs 5.9 ± 1.1，P = 0.04）和特定丁酸生产者的微生物计数，4例患者中有3例腹泻消退。重症患者的常规管理，包括使用元素饮食和广谱抗生素，与结肠微生物群及其必需结肠燃料的产生的总体抑制相关，即，SCFA。我们的研究表明，饲料中的纤维补充剂有可能改善微生物群的质量和功能，从而降低因生态失调而导致腹泻的风险。
AIM: To determine tolerance to fiber supplementation of semi-elemental tube feeds in critically ill patients and measure its effect on colonic microbiota and fermentation.METHODS: Thirteen intensive care unit patients receiving jejunal feeding with a semi-elemental diet for predominantly necrotizing pancreatitis were studied. The 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 analysis. Nearly all patients were receiving antibiotics (10/13) and acid suppressants (11/13) at some stage during the studies.RESULTS: In group 1, tolerance to progressive fiber supplementation was good with breath hydrogen and methane evidence (P = 0.008 and P < 0.0001, respectively) of increased fermentation with no exacerbation of abdominal symptoms and resolution of diarrhea in 2 of 4 patients. In group 2 before supplementation, fecal microbiota mass and their metabolites, SCFA, were dramatically lower in patients compared to healthy volunteers. From qPCR and HITChip analyses we calculated that there was a 97% reduction in the predominant potential butyrate producers and starch degraders. Following 2-5 wk of fiber supplementation there was a significant increase in fecal SCFA (acetate 28.4 ± 4.1 mumol/g to 42.5 ± 3.1 mumol/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 patients.CONCLUSION: Conventional management of critically ill patients, which includes the use of elemental diets and broad-spectrum antibiotics, was associated with gross suppression of the colonic microbiota and their production of essential colonic fuels, i.e., SCFA. Our investigations show that fiber supplementation of the feeds has the potential to improve microbiota mass and function, thereby reducing the risks of diarrhea due to dysbiosis.