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Diarrhea in enterally fed patients: blame the diet?

Chang, Sue-Joana; Huang, Hsiu-Huaa,b

Current Opinion in Clinical Nutrition & Metabolic Care: September 2013 - Volume 16 - Issue 5 - p 588–594
doi: 10.1097/MCO.0b013e328363bcaf
NUTRITION AND THE GASTROINTESTINAL TRACT: Edited by M. Isabel T.D. Correia and Miquel A. Gassull

Purpose of review: Diarrhea has great impact on enteral nutrition. The purpose of this review is to identify the factors leading to diarrhea during enteral nutrition and to provide the published updates on diarrhea prevention through nutritional intervention.

Recent findings: Diarrhea in enteral fed patients is attributed to multiple factors, including medications (major contributor), infections, bacterial contamination, underlying disease, and enteral feeding. Diet management can alleviate diarrhea in enteral feeding. High content of fermentable oligosaccharides, disaccharides, and monosaccharides and polyols (FODMAPs) in enteral formula is postulated to induce diarrhea and lower FODMAPs formula may reduce the likelihood of diarrhea in enterally fed patients. Fiber-enriched formula can reduce the incidence of diarrhea and produce short-chain fatty acids for colonocytes. Ingesting prebiotics, nonviable probiotics or probiotic derivatives, and human lactoferrin may provide alternatives for reducing/preventing diarrhea.

Summary: Enteral feeding is not generally considered the primary cause of diarrhea, which is frequently linked to prescribed medications. When diarrhea is apparent, healthcare members should evaluate the possible risk factors and systematically attempt to eliminate the underlying causes of diarrhea before reducing or suspending enteral feeding. Lower FODMAPs formula, prebiotics, probiotic derivatives, and lactoferrin may be used to manage enteral feeding-related diarrhea.

aDepartment of Life Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan

bDepartment of Food and Nutrition, Taipei Veterans General Hospital, Taipei, Taiwan

Correspondence to Sue-Joan Chang, Department of Life Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, No.1, University Road, Tainan City 701, Taiwan. Tel: +886 6 2757575x65542; fax: +886 6 2742583; e-mail: sjchang@mail.ncku.edu.tw

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins