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The microbiome and nutrition in critical illness

Oami, Takehikoa,b; Chihade, Deena B.a; Coopersmith, Craig M.a

Current Opinion in Critical Care: April 2019 - Volume 25 - Issue 2 - p 145–149
doi: 10.1097/MCC.0000000000000582
GASTROINTESTINAL SYSTEM: Edited by Constantine J. Karvellas
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Purpose of review The present review aims to describe the relationship between nutrition and the gut microbiome in critical illness.

Recent findings Critical illness disrupts not only cells of human origin but also the intestinal microbiome, with a decrease in bacterial diversity and transformation into a pathobiome. Under basal conditions, nutrition profoundly alters microbial composition with significant salutatory effects on human health. In critical illness, enteral nutrition is recommended and has theoretical (but not proven) advantages towards improved inner microbial health and diminution of bacterial translocation. Dietary supplements such as probiotics and fiber have been shown to improve microbial derangements in health. However, their impact on the microbiome in critical illness is unclear and although they may have some beneficial effects on patient-centric outcomes, they do not alter mortality. The precise mechanisms of how nutrition and dietary supplements modulate the gut microbiome remain to be determined.

Summary Nutrition and supplements such as probiotics appear to play a significant role in modulating the microbiome in health, yet the relationship in critical illness is unclear. Further investigation is required to determine the mechanistic determinants of the impact of nutrition on the microbiome in critical illness and the potential clinical implications of this.

aDepartment of Surgery and Emory Critical Care Center, Emory University School of Medicine, Atlanta, Georgia, USA

bDepartment of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan

Correspondence to Craig M. Coopersmith, 101 Woodruff Circle, Suite WMB 5105, Atlanta, GA 30322, USA. Tel: +1 404 727 4273; fax: +1 404 727 3660; e-mail: cmcoop3@emory.edu

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