The addition of fiber and the use of continuous infusion decrease the incidence of diarrhea in elderly tube-fed patients in medical wards of a general regional hospital: a controlled clinical trial.
OBJECTIVE
To determine if feeds high in fiber continuously administered might minimize diarrhea.


BACKGROUND
The addition of soluble fiber to enteral feedings has not consistently decreased diarrhea in controlled clinical trials, and the effect of the use of intermittent or continuous infusions on the rate of diarrhea is similarly controversial.


METHODS
We studied 148 of 160 selected elderly well-nourished patients with acute disease prohibiting oral intake in a controlled clinical trial in the setting of an internal medicine departments in a regional hospital who were divided into 4 groups and fed according to combinations of intermittent or continuous systems, with fiber-free or fiber rich formulas. The 5-day rate of diarrhea was defined as 2 liquid stools or 3 or more semisolid or liquid bowel movements during a 24-hour period. Other outcome variables included mortality, hospital days, prolonged hospitalization (over 20 d), fever, and stools positive for Clostridium difficile cytotoxin A/B.


RESULTS
The increased relative risk of the continuous/fiber-free, intermittent/fiber, and intermittent/fiber-free groups compared with the continuous/fiber group was 2.8 [95% confidence interval (CI)=1.0-8.1], 2.5 (95% CI=0.9-7.1), and 5.0 (95% CI=1.9-13.2), respectively. These findings were independent of age (>80 y), female sex, being treated with antibiotics for respiratory or urinary infections, receiving respiratory support, or being fully conscious. There were no significant differences in the other outcomes.


CONCLUSIONS
We conclude that in elderly well-nourished hospitalized patients with acute diseases prohibiting oral intake, continuous and closed enteral feedings with the addition of fiber is effective in reducing the rate of diarrhea.
Shimoni
Zvi
Z
Internal Medicine B, Tel Aviv University, Ramat Aviv, Israel.
Averbuch
Yael
Y
Shir
Esther
E
Gottshalk
Tzippi
T
Kfir
Dalia
D
Niven
Mark
M
Moshkowitz
Menachem
M
Froom
Paul
P
D000368:Aged; D000369:Aged, 80 and over; D003967:Diarrhea / Q000453:epidemiology* / Q000517:prevention & control; D004043:Dietary Fiber / Q000008:administration & dosage*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005526:Food, Formulated; D006760:Hospitalization; D006769:Hospitals, General; D006801:Humans; D015994:Incidence; D007260:Infusion Pumps / Q000706:statistics & numerical data*; D007441:Intubation, Gastrointestinal / Q000379:methods* / Q000706:statistics & numerical data*; D008297:Male; D016896:Treatment Outcome