The Role of Dietary Fibre in Enteral Nutrition in Sepsis Prevention and Therapy: A Narrative Review

Abstract

Objective: This narrative review summarises the current evidence on the role of dietary fibre in enteral nutrition in the prevention and therapy of sepsis, with a focus on critically ill patients. The aim is to discuss the implications for clinical practice and identify future directions for policy and research.

Resources: We searched MEDLINE and Google Scholar for records on sepsis, critically ill, enteral nutrition, and dietary fibre. We included all types of articles such as meta-analyses, reviews, clinical trials, preclinical studies, and in vitro studies. Data were evaluated for significance and clinical relevance. Synopsis of Review: Despite the ongoing debate, enteral nutrition containing dietary fibres showed great potential in attenuating sepsis-related outcomes and preventing the incidence of sepsis in critically ill patients on enteral nutrition. Dietary fibres target different underlying mechanisms such as microbiota, mucosal barrier integrity, local cellular immune response, and systemic inflammation. We discuss the clinical potential and concerns that currently exist with the standard implementation of dietary fibre in enterally fed intensive care patients. Additionally, we identified research gaps that should be addressed to determine effectiveness and the role of dietary fibres in sepsis itself and its associated outcomes.

Keywords: dietary fibre; enteral nutrition; infection; microbiome; sepsis.

Figure 1

Putative mechanism of dietary fibre in preventing and treating sepsis. Key modes of action are indicated by the numbers 1 to 4. 1. Increase in microbiome diversity and SCFA production, 2. support of intestinal integrity via tight junction expression, 3. improvement of cellular immune responses, 4. regulation of inflammation. DC = dendritic cell, IgA = immunoglobulin A, IL = interleukin, iNKT = invariant natural killer T cell, PAMP = pathogen-associated molecular pattern, SCFA = short-chain fatty acid, Th = T helper cell, TJ = tight junction, TLR = toll-like receptor, TNF-a = tumor necrosis factor alpha, Treg = regulatory T cell. Created with BioRender.com.