Elsevier

Nutrition

Volume 18, Issue 1, January 2002, Pages 35-39
Nutrition

Applied nutritional investigation
Usefulness of soluble dietary fiber for the treatment of diarrhea during enteral nutrition in elderly patients

https://doi.org/10.1016/S0899-9007(01)00715-8Get rights and content

Abstract

OBJECTIVES: We investigated the clinical usefulness of soluble dietary fiber (SDF) for the treatment of diarrhea during enteral nutrition in elderly patients.

METHODS: This study included 10 men and 10 women (mean age ± standard deviation: 79.3 ± 5.1 y) who had diarrhea during long-term nutrition management. When administering SDF, the initial dose was 7 g and thereafter gradually increased at 1-wk intervals. After 4 wk, the administration was discontinued for 2 wk to confirm the effects of SDF.

RESULTS: After the administration of SDF, serum diamine oxidase activity significantly increased (P < 0.001): The water content of the feces decreased significantly after the administration of fiber (P < 0.01). The frequency of daily bowel movements also decreased significantly (P < 0.05). Simultaneously, the fecal features improved. Concerning intestinal flora, there were no significant changes in the total number of bacteria or the number of anaerobic bacteria. The fecal pH decreased significantly 4 wk after the administration of fiber (P < 0.05). The total level of short-chain fatty acids increased significantly 4 wk after the administration of fiber (P < 0.05). There were no significant changes in the various nutritional indices.

CONCLUSIONS: The administration of SDF is useful for controlling spontaneous, favorable bowel movement by improving symptoms of small intestinal mucosal atrophy and normalizing the intestinal flora.

Introduction

In the geriatric field, long-term parenteral nutrition recently was found to cause mucosal atrophy. In particular, nutritional management with semidigested formula is commonly used.1 However, the administration of semidigested formula has been reported to induce small intestinal mucosal atrophy or the enhancement of intestinal tract permeability, because such a formula has low residue.2, 3 Problems such as diarrhea and loose stools are especially common. In general, strategies to prevent the development of diarrhea after the administration of enteral nutrients have included appropriate nutrient administration methods such as the regulation of the administration rate, concentration, temperature, and medication. In recent years, some studies have reported that the addition of dietary fiber helps normalize digestive function and prevent diarrhea.4, 5, 6 However, the efficacy of such additional dietary fiber has not been examined in detail.

In this study, to improve small intestinal mucosal atrophy, we administered soluble dietary fiber to elderly patients in whom oral ingestion was impossible, and where small intestinal mucosal atrophy had developed during long-term parenteral nutrition so as to cause mucosal atrophy, thus resulting in loose stools or diarrhea.

The clinical usefulness of soluble dietary fiber was examined by measuring the serum diamine oxidase (DAO) activity, which is an index of the morphologic change in small intestinal mucosa, fecal features, the frequency of bowel movements, the water content of feces, fecal pH, and fecal short-chain fatty acid (SCFA) levels; in addition, we examined the intestinal flora. Various serum biochemical parameters and oligodynamic trace minerals were also examined as nutritional indices.

Section snippets

Subjects

This study was based on an investigation of 20 elderly inpatients (10 men and 10 women; mean age ± standard deviation: 79.3 ± 5.1 y) at the Nagoya University Hospital Geriatrics Department who had no organic disorders of the digestive tract, had been bed-ridden for a prolonged period due to cerebral infarction or cerebral hemorrhaging, and demonstrated loose stool or diarrhea. In these patients, semidigested formula (Ensure Liquid, Dainabot Co., Ltd.) was administered with the use of a

Results

In 20 patients, the mean serum DAO activity before administration of the fiber was 8.54 ± 0.16 IU/L, which was significantly lower than in control subjects (10.0 ± 1.5 IU/L). Serum DAO activity increased significantly between 2 and 4 wk after administration (P < 0.001) but decreased significantly 1 and 2 wk after discontinuation compared with DAO activity 4 wk after administration (P < 0.001; Fig. 1).

The water content of the feces decreased serially compared with that before fiber

Discussion

Hosoda et al. conducted an animal experiment and reported that intravenous hyperalimentation and nutritional management with certain kinds of enteral nutrients and non-physiologic component nutrients cause atrophy of the digestive tract mucosa, whereas the administration of dietary fiber prevents atrophy of the mucosal epithelium.10 Because the soluble dietary fiber product used in our clinical study, Healsh Fiber, is liquid, this preparation can be easily and evenly mixed with other enteral

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