Relationship between nutritional therapy and beneficial bacteria ratio in severe disease

Abstract

Objective: To evaluate relationship between changes in the beneficial bacteria in intensive care unit (ICU) patients and nutritional therapy type. Methods: Ten patients aged ≥18 years admitted to the ICU between January and December 2020, were included. Good enteral nutrition was defined as early achievement of target calorie intake through enteral feeding. The ratio of beneficial bacteria at the first and second bowel movements after each patient’s admission was calculated and the patients were classified into the increase or decrease group. Among all patients, five each were in the increase and decrease groups. We investigated patient background, changes in sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) II scores, nutritional doses or methods, and clinical outcomes. Results: No relationship was found between changes in the ratio of beneficial bacteria and changes in SOFA/APACHE II scores at the time of admission. The rate of good enteral nutrition was significantly higher in the increase group than in the decrease group (4/5 vs. 0/5, P=0.01). Conclusions: An increase in beneficial bacteria may be significantly related to the early establishment of enteral nutrition. In the future, accumulating cases may make it possible to establish a new nutritional strategy for critically ill patients from an intestinal microbiota perspective.

Keywords

Beneficial bacteria / Enteral nutrition / Parenteral nutrition / Intensive care unit / Good enteral nutrition / Severe disease / Nutritional therapy

References

[1] Saji N, Murotani K, Hisada T, Tsuduki T, Sugimoto T, Kimura A, et al. The relationship between the gut microbiome and mild cognitive impairment in patients without dementia: A cross—sectional study conducted in Japan. Sci Rep 2019; 9(1): 19227.

[2] Wang Z, Klipfell E, Bennett BJ, Koeth R, Levison BS, Dugar B, et al. Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease. Nature 2011; 472(7341): 57-63.

[3] Sato J, Kanazawa A, Ikeda F, Yoshihara T, Goto H, Abe H, et al. Gut dysbiosis and detection of “live gut bacteria” in blood of Japanese patients with type 2 diabetes. Diab Care 2014; 37(8): 2343-2350.

[4] Shimizu K, Ogura H, Hamasaki T, Goto M, Tasaki O, Asahara T, et al. Altered gut flora are associated with septic complications and death in critically ill patients with systemic inflammatory response syndrome. Dig Dis Sci 2011; 56(4): 1171-1177.

[5] Shimizu K, Ogura H, Goto M, Asahara T, Nomoto K, Morotomi M, et al. Synbiotics decrease the incidence of septic complications in patients with severe SIRS: A preliminary report. Dig Dis Sci 2009; 54(5): 1071-1078.

[6] Nagashima K, Hisada T, Sato M, Mochizuki J. Application of new primer—enzyme combinations to terminal restriction fragment length polymorphism profiling of bacterial populations in human feces. Appl Environ Microbiol 2003; 69(2): 1251-1262.

[7] Ojima M, Shimizu K, Motooka D, Ishihara T, Nakamura S, Shintani A, et al. Gut dysbiosis associated with antibiotics and disease relation to mortality in critically ill patients. Dig Dis Sci 2022; 67: 2420-2432.

[8] Hayakawa M, Asahara T, Henzan N, Murakami H, Yamamoto H, Mukai N, et al. Dramatic changes of the gut flora immediately after severe and sudden insults. Dig Dis Sci 2011; 56(8): 2361-2365.

[9] Michalsen A, Riegert M, Lüdtke R, Bäcker M, Langhorst J, Schwickert M, et al. Mediterranean diet or extended fasting’s influence on changing the intestinal microflora, immunoglobulin A secretion and clinical outcome in patients with rheumatoid arthritis and fibromyalgia: An observational study. BMC Complement Altern Med 2005; 5: 22.

[10] Manithody CS, Van Nispen J, Murali V, Jain S, Samaddar A, Armstrong A, et al. Role of bile acids and gut microbiota in parenteral nutrition associated injury. J Hum Nutr (Carson City) 2020; 4(1). DOI: 10.36959/487/286.

[11] Hodin CM, Visschers RG, Rensen SS, Boonen B, Olde Damink SW, Lenaerts K, et al. Total parenteral nutrition induces a shift in the Firmicutes to Bacteroidetes ratio in association with Paneth cell activation in rats. J Nutr 2012; 142(12): 2141-2147.

[12] Miyasaka A, Yongjia F, Nicole R, Falkowski NR, Erb—Downward J, Gillilland MG 3rd, et al. Total parenteral nutrition—associated lamina propria inflammation in mice is mediated by a MyD88—dependent mechanism. J Immunol 2013; 190(12): 6607-66015.