Early Dietary Fiber Intake in ICU Patients and Its Associations with Acute Gastrointestinal Injury: A Prospective Observational Study

Ting Liu,1,* Hai-fang Wang,2,* Xiao-song Jiang,1 Yu-yu Wang,1 Can Wang,1 Jian-zheng Cai2 1Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People’s Republic of China; 2Nursing Department, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People’s Republic of China*These authors contributed equally to this workCorrespondence: Can Wang, Email wangcan@suda.edu.cn Jian-zheng Cai, Email 15106205726@163.comBackground: Insufficient early dietary fiber (DF) supplement may be closely associated with adverse clinical outcomes in critically ill patients.Objective: We evaluated the association between the early intake of dietary fiber (DF) and the development of acute gastrointestinal injury (AGI) in ICU patients.Methods: A prospective observational study was conducted at the First Affiliated Hospital of Soochow University from April 2021 to March 2023. DF intake was quantified using dietary records, and AGI severity was assessed on day 3 (D3) and day 5 (D5) after ICU admission based on the 2012 ESICM recommendations.Results: A total of 184 ICU patients were enrolled. The mean daily DF intake over the first five days was 5.44 ± 4.33 g/day. The cumulative intake reached 11.07 ± 11.60 g by day 3 and 27.21 ± 21.65 g by day 5. The incidence of AGI was 95.6%, 77.7%, and 51.1% on days 1, 3, and 5, respectively. Ordered logistic regression revealed that higher average DF intake in the first three days was independently associated with reduced AGI severity on D3 (OR 0.863, 95% CI: 0.771– 0.967, P < 0.05) and D5 (OR 0.823, 95% CI: 0.712– 0.952, P < 0.05).Conclusion: Higher average DF intake during the first three days following ICU admission may be associated with reduced AGI severity on D3 and D5. Future multi-center, large-sample, randomized controlled studies are needed to confirm the relationship between early DF intake and the severity of AGI.Keywords: dietary fiber, acute gastrointestinal injury, critically ill patients