Koch, Jana Larissa and Lew, Charles Chin Han and Kork, Felix and Koch, Alexander and Stoppe, Christian and Heyland, Daren K. and Dresen, Ellen and Lee, Zheng-Yii and Hill, Aileen (2024) The efficacy of fiber-supplemented enteral nutrition in critically ill patients: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. Critical Care, 28 (1). p. 359. ISSN 1364-8535, DOI https://doi.org/10.1186/s13054-024-05128-2.
Full text not available from this repository.Abstract
BackgroundEvidence on the benefits of fiber-supplemented enteral nutrition (EN) in critically ill patients is inconsistent, and critical care nutrition guidelines lack recommendations based on high-quality evidence. This systematic review and meta-analysis (SRMA) aims to provide a current synthesis of the literature on this topic.MethodsFor this SRMA of randomized controlled trials (RCT), electronic databases (MEDLINE, EMBASE, CENTRAL) were searched systematically from inception to January 2024 and updated in June 2024. Trials investigating clinical effects of fiber-supplemented EN versus placebo or usual care in adult critically ill patients were selected. Two independent reviewers extracted data and assessed the risk of bias of the included studies. Random-effect meta-analysis and trial sequential analysis (TSA) were conducted. The primary outcome was overall mortality, and one of the secondary outcomes was diarrhea incidence. Subgroup analyses were also performed for both outcomes.ResultsTwenty studies with 1405 critically ill patients were included. In conventional meta-analysis, fiber-supplemented EN was associated with a significant reduction of overall mortality (RR 0.66, 95% CI 0.47, 0.92, p = 0.01, I2 = 0%; 12 studies) and diarrhea incidence (RR 0.70, 95% CI 0.51, 0.96, p = 0.03, I2 = 51%; 11 studies). However, both outcomes were assessed to have very serious risk of bias, and, according to TSA, a type-1 error cannot be ruled out. No subgroup differences were found for the primary outcome.ConclusionVery low-certainty evidence suggests that fiber-supplemented EN has clinical benefits. High-quality multicenter RCTs with large sample sizes are needed to substantiate any firm recommendation for its routine use in this group of patients.PROSPERO registration number: CRD42023492829.ConclusionVery low-certainty evidence suggests that fiber-supplemented EN has clinical benefits. High-quality multicenter RCTs with large sample sizes are needed to substantiate any firm recommendation for its routine use in this group of patients.PROSPERO registration number: CRD42023492829.
| Item Type: | Article |
|---|---|
| Funders: | Projekt DEAL |
| Uncontrolled Keywords: | Medical nutrition therapy; Fiber; Enteral nutrition; Critical care; Systematic review; Meta-analysis; Trial sequential analysis |
| Subjects: | R Medicine > R Medicine (General) |
| Divisions: | Faculty of Medicine > Anaesthesiology Department |
| Depositing User: | Ms. Juhaida Abd Rahim |
| Date Deposited: | 20 Feb 2025 05:00 |
| Last Modified: | 20 Feb 2025 05:00 |
| URI: | http://eprints.um.edu.my/id/eprint/47328 |
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