Fiber Content

Another distinguishing factor of enteral formulas is whether or not they contain fiber. Both soluble and insoluble fibers may be included in the formula, with insoluble fiber exerting more effect on gut motility by drawing water into the intestine and decreasing transit time, thus preventing constipation. Soluble fiber can help to lower blood cholesterol levels, regulate blood sugar, and prolong gastric emptying. Cellulose gum is an example source of insoluble fiber. Oat fiber and guar gum provide primarily soluble fiber. Soy fiber provides primarily insoluble fiber but also some soluble fiber and is the most commonly used fiber source in tube feeding products. Fiber has been useful for regulating gut motility in some but not all clinical studies; it certainly can be useful in selected patients.18 Some patients may experience GI discomfort secondary to gas production with introduction of fiber-containing formulas.

Fructooligosaccharides (FOSs) are a form of fiber receiving increasing attention. These pass through the stomach and small bowel undigested and are fermented by colonic bacteria to the SCFAs butyrate, propionate, and acetate. The SCFAs serve as a major fuel source for colonocytes and facilitate water and sodium reabsorption in the colon.19 The FOSs fit in the category called prebiotics that serve as fermentable substrates for the normal flora of the colon. The SCFAs are not added directly to EN products because they would be absorbed completely before reaching the colon; rather FOSs are added, allowing bacterial degradation to form SCFAs.

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