# Efficacy of Fiber-Enriched Versus Fiber-Free Enteral Feeds on Bowel Function of Non-Critically Ill Tube-Fed Adult Patients in Saudi Arabia—A Prospective Cohort Study

## TL;DR

This study found that fiber-enriched tube feeding reduced diarrhea and weight loss in non-critically ill hospitalized patients compared to fiber-free formulas.

## Contribution

The study provides evidence supporting fiber-enriched enteral feeding in reducing bowel intolerance in non-critically ill patients in the Middle East.

## Key findings

- Fiber-enriched feeding reduced diarrhea rates by 46% compared to fiber-free formulas.
- Fiber enrichment also reduced significant weight loss by 41%.
- Fiber-free formulas were a significant predictor of both diarrhea and weight loss.

## Abstract

Background: There is controversy regarding whether using fiber-enriched formula affects the incidence of diarrhea among enterally fed patients in our setting. Also, there is a lack of clinical studies about enterally fed patients’ tolerance for feeding and the incidence of diarrhea among patients in the Middle East. This study aimed to assess fiber enrichment’s efficacy in reducing post-enteral feeding bowel intolerance in non-critically ill patients. Methods: This was a prospective cohort study of 55 fiber-free (FF) and 119 fiber-enriched (FE) tube-fed adult patients admitted for five or more days with medical or surgical conditions. Data on patients’ demographics, antibiotics and laxative medications, and gastrointestinal complications were collected. Absolute risk reduction (ARR), relative risk reduction (RRR), and relative risks (RR) were calculated to assess the efficacy of fiber enrichment in reducing post-enteral feeding bowel intolerance. Statistical significance was set at p ≤ 0.05. Results: The rate of diarrhea dropped from 54.5% for FF to 29% for FE groups, with an ARR of 25.1% (95% CI 24.6–25.6, p < 0.001) and an RRR of 64.1%, and RR was 0.54, reflecting a reduction in the rate of diarrhea by 46% after fiber enrichment. The rate of significant weight loss dropped from 45.5% without enrichment to only 26.9% with enrichment, with an ARR of 18.6% (95% CI: 18.0–19.2, p < 0.001) and RRR of 40.9%, and RR was 0.59, reflecting a 41% reduction in significant weight loss after fiber enrichment. After adjusting for some potential confounders, FF formula was a significant predictor of diarrhea (OR = 3.04, 95% CI 1.49–6.19, p = 0.002) and significant weight loss (OR = 2.37, 95% CI 1.16–4.84, p = 0.018) in tube feeding, while antibiotic intake was also a significant predictor of only diarrhea (OR = 2.68, 95% CI 1.12–6.38, p = 0.026). Conclusions: This study demonstrated the beneficial effect of fiber supplementation in minimizing diarrhea in hospitalized patients receiving tube feeding. Antibiotic usage must be scrutinized and stopped if possible. Overall, the study provides compelling evidence supporting fiber-enriched enteral feeding, though further discussion on potential confounders and clinical applications would enhance its impact. Further, well-designed RCTs are needed to prove the efficacy of fiber-enriched feeds used in enteral tube feeding in non-critically ill patients.