Control of diarrhea by fiber-enriched diet in ICU patients on enteral nutrition: a prospective randomized controlled trial

Background & aims: Enteral fiber-free diets alter intestinal transit and produce diarrhea or constipation. This prospective double blind, controlled study evaluates the use of guar gum, a soluble fiber and a candidate prebiotic in enteral feeds, to prevent diarrhea and potential health benefits in intensive care unit patients. Methods: Twenty patients on enteral nutrition with persistent diarrhea were randomized to receive a new enteral feed either enriched with 2% soluble guar gum (study group, n=10) or fiber-free (control group, n=10) for 4 successive days. Results: The number of liquid stools in response to a soluble fiber-enriched diet was 2.0±0.9 (first day) vs. 1.0±0.7 (fourth day) (P<0.01), and in the control group 1.2±0.7 (first day) vs. 2.1±0.8 (fourth day) (P<0.05). In the fiber-enriched feed group, plasma glucose and cholesterol levels at termination of the study, respectively, reached 126±81 and 164±71 mg dl−1, as compared to 333±108 and 378±26 mg dl−1 on Day first (P<0.01). In the control group, these values on the fourth day were, respectively, 267±94 and 263±79 vs. 247±115 and 315±78 on Day first (P>0.05). Conclusions: Guar gum-enriched enteral nutrition was related to a decrease of diarrheal episodes in ICU patients with preexisting diarrhea; and to a trend for lower plasma glucose and cholesterol levels.