Impact of Soluble Fiber in the Microbiome and Outcomes in Critically Ill Patients

Purpose of Review To discuss the controversy over the effect of dietary fiber (DF) on (1) outcomes in critical illness, (2) microbiome and metabolic homeostasis, and (3) current evidence and guidelines regarding supplementation in critically ill patients. Recent Findings In healthy individuals, consumption of DF is widely known as a long-term protecting factor against colon cancer, cardiovascular disease, and other metabolic disorders like obesity, type 2 diabetes, and fatty liver disease; in hospitalized patients, DF may have a beneficial effect in the incidence of diarrhea, infections, and length of stay. But, what does that mean for critically ill patients? What is the recommended DF intake and what are current guidelines? Summary There are many confounding factors that limit the evidence of beneficial effects from fiber supplementation in critically ill patients, including the side effects critical care therapies can have on gut microbiota, but after extrapolating data from healthy and hospitalized non-critical patients and considering that its administration appears to be safe, it may be wise to administer fiber-containing enteral feedings in ICU patients. Analysis of those confounders requires future research.