title: Additional oligofructose/inulin does not increase faecal bifidobacteria in critically ill patients receiving enteral nutrition: a randomised controlled trial.
abstract: OBJECTIVE
  Patients with diarrhoea during enteral nutrition (EN) have been shown to have low faecal bifidobacteria concentrations. Oligofructose/inulin selectively stimulate the growth of bifidobacteria in healthy humans. This study investigates the effect of additional oligofructose/inulin on the gastrointestinal microbiota, short-chain fatty acids (SCFA) and faecal output in patients receiving EN.
  
  
  METHODS
  Adult patients in the intensive care unit (ICU) who were starting EN with a formula containing fibre were randomised to receive 7 g/d of additional oligofructose/inulin or an identically packaged placebo (maltodextrin). A fresh faecal sample was collected at baseline and following at least 7 days of supplementation. Faecal microbiota were analysed using fluorescent in-situ hybridisation and faecal output was monitored daily.
  
  
  RESULTS
  Twenty-two patients (mean age 71 years) completed at least 7 days of intervention (mean 12 days). At the end of the intervention, there were no significant differences in the concentrations of bifidobacteria between the groups, after adjusting for baseline values (oligofructose/inulin 6.9 + 1.4, placebo 7.8 + 1.3 log10 cells/g dry faeces, P > 0.05), but there were significantly lower concentrations of Faecalibacterium prausnitzii (7.0 + 1.0 vs. 8.4 + 1.3 log10 cells/g, P = 0.01) and Bacteroides-Prevotella (9.1 + 1.0 vs. 9.9 + 0.9 log10 cells/g, P = 0.05) in patients receiving additional oligofructose/inulin. There were no differences in faecal concentrations of any SCFA, secretory IgA, daily faecal score or incidence of diarrhoea between the two groups.
  
  
  CONCLUSIONS
  Additional oligofructose/inulin did not increase faecal bifidobacteria in critically ill patients receiving EN, although it did result in lower concentrations of F. prausnitzii and Bacteroides-Prevotella. This trial is registered at http://controlled-trials.com. Identifier: ISRCTN06446184.
authors.affiliation: King's College London, School of Medicine, Diabetes and Nutritional Sciences Division, London, UK; University of Malaya, Department of Social and Preventive Medicine, Kuala Lumpur, Malaysia. Electronic address: hazreen.abdulmajid@gmail.com.
authors.forename: Hazreen A
authors.initials: HA
authors.lastname: Majid
authors.affiliation: King's College London, School of Medicine, Diabetes and Nutritional Sciences Division, London, UK.
authors.forename: Jayne
authors.initials: J
authors.lastname: Cole
authors.affiliation: King's College London, School of Medicine, Diabetes and Nutritional Sciences Division, London, UK.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Emery
authors.affiliation: King's College London, School of Medicine, Diabetes and Nutritional Sciences Division, London, UK.
authors.forename: Kevin
authors.initials: K
authors.lastname: Whelan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000032:analysis; D001427:Bacterial Toxins / Q000032:analysis; D001644:Bifidobacterium / Q000302:isolation & purification*; D016360:Clostridioides difficile / Q000302:isolation & purification; D016638:Critical Illness / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods*; D004768:Enterotoxins / Q000032:analysis; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D007444:Inulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009844:Oligosaccharides / Q000008:administration & dosage*
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; D009844:Oligosaccharides; C120489:oligofructose; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile; D007444:Inulin
keywords: Bifidobacteria; Diarrhoea; Enteral nutrition; Oligofructose/inulin; Prebiotics