title: The effect of fibers on coagulation of casein-based enteral nutrition in an artificial gastric digestion model.
abstract: A serious complication seen in critically ill patients is the solidification of enteral nutrition causing gastrointestinal obstruction. It has been suggested that enteral nutrition enriched with insoluble fibers may increase the risk of this complication. Therefore, we investigate the effect of soluble and insoluble dietary fibers on the coagulation of a casein-based enteral nutrition in an artificial gastric digestion model. A 100% casein-based enteral nutrition was enriched with increasing concentrations of soluble fibers (acacia fiber, oligofructose and inulin) and insoluble fibers (soy polysaccharide, resistant starch and alpha cellulose). After digestion in an artificial gastric model, the chyme was poured over sequentially placed sieves, separating the coagulate into size fractions of larger than 2 mm, between 1 and 2 mm, and between 0.25 and 1 mm. Of these fractions we measured wet weight, dry weight and protein content. A significant effect on the fraction larger than 2 mm was considered to be clinically relevant. Addition of high concentrations soy polysaccharide and resistant starch to a casein-based enteral nutrition, did not alter the wet weight, whereas dry weight and protein content of the coagulate was significantly reduced. When high concentrations of soy polysaccharide and resistant starch are added to a 100% casein-based enteral nutrition, the coagulate consist of more water and less proteins, which may lead to an increased protein digestion and absorption in a clinical setting. The suggestion that insoluble fibers increase the risk of gastrointestinal obstruction in critically ill patients is not supported by these data.
authors.affiliation: Department of Surgery, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. j.luttikhold@vumc.nl.
authors.forename: Joanna
authors.initials: J
authors.lastname: Luttikhold
authors.forename: Klaske
authors.initials: K
authors.lastname: van Norren
authors.forename: Marcel
authors.initials: M
authors.lastname: Minor
authors.forename: Nikki
authors.initials: N
authors.lastname: Buijs
authors.forename: Claudia C M
authors.initials: CC
authors.lastname: van den Braak
authors.forename: Thomas
authors.initials: T
authors.lastname: Ludwig
authors.forename: Evan
authors.initials: E
authors.lastname: Abrahamse
authors.forename: Herman
authors.initials: H
authors.lastname: Rijna
authors.forename: Paul A M
authors.initials: PA
authors.lastname: van Leeuwen
mesh_terms: D002364:Caseins / Q000737:chemistry*; D002482:Cellulose / Q000494:pharmacology; D004040:Dietary Carbohydrates / Q000494:pharmacology; D004043:Dietary Fiber / Q000494:pharmacology*; D004063:Digestion; D004750:Enteral Nutrition; D005753:Gastric Mucosa / Q000378:metabolism; D005766:Gastrointestinal Contents; D007444:Inulin / Q000494:pharmacology; D008954:Models, Biological; D013270:Stomach / Q000187:drug effects*
chemical_list: D002364:Caseins; D004040:Dietary Carbohydrates; D004043:Dietary Fiber; D002482:Cellulose; D007444:Inulin