1 Nutrition & Dietetics, UNIVERSITI TEKNOLOGI MARA, SELANGOR, Malaysia THE EFFECT OF ENTERAL NUTRITION SUPPLEMENTED WITH PREBIOTICS ON FAECAL OUTPUT& MICROBIOTA IN THE CRITICALLY ILL PATIENTS PR121 Mazuin Kamarul Zaman 1, Vineya Rai* 2, Mohd Shahnaz Hasan2, Hazreen Abdul Majid 3 1 Nutrition & Dietetics, UNIVERSITI TEKNOLOGI MARA, SELANGOR, Malaysia 2 Anesthesiology, 3 Social and Preventive Medicine, UNIVERSITY OF MALAYA, KUALA LUMPUR, Malaysia INTRODUCTION RESULTS CONCLUSIONS Fibre (including prebiotics) supplementation in enteral formula reduces diarrhoea incidence in non-critically ill patients receiving enteral nutrition (EN). Prebiotics will be fermented to short chain fatty acid (SCFA) and stimulate the growth of bifidobacteria which helps in minimising diarrhoea. OBJECTIVES: Evaluate the incidence of diarrhoea and faecal microbiota concentrations (total bacteria, bifidobacteria, lactobacilli, bacteroides, clostridia and Faecalibacterium prausnitzii) between critically ill patients who receive enteral formula with and without fibre/prebiotics during EN. At the end of the intervention, 7 were receiving fibre-free formula (FF) and 8 were receiving fibre/prebiotics formula (N=15). Patients in the fibre/prebiotics group had a trend of lower stool frequency (1.2±0.6) compared to patients receiving the fibre-free enteral formula (1.8±0.9), p=0.092. No difference in incidence of diarrhoea between the groups. No significant differences in the concentrations of bifidobacteria between the groups (fibre/prebiotics 8.2±1.9 vs. FF 5.7±2.7 log10 copy number/g faeces, p= 0.07) . No significant changes in total bacteria, lactobacilli, bacteroides, clostridia concentrations after two week of the use of prebiotics supplemented EN Significantly lower concentrations of F. prausnitzii (4.5±2.0 vs. 6.9±1.7 log10 copy number/g faeces, p=0.03) in patients receiving fibre/prebiotics. The RCT demonstrated a trend of reduced stool frequency in patients receiving FOS-supplemented EN. However, the provision of 10 g/L of FOS in EN did not improve diarrhoea. The formula that patients were receiving did not appear to influence concentrations of the major bacterial genera. Low concentrations of bifidobacteria were identified in patients receiving EN in this study. As FOS has been shown to increase bifidobacteria in healthy subjects, the absence of an effect here may be due to the patients’ disease state, antibiotic prescription or perhaps the low dose of FOS delivered. Conclusions: Provision of prebiotics as the sole source of fibre in EN may not increase faecal bifidobacteria concentrations of critically ill patients. However, the provision of prebiotics may be useful in alleviating diarrhoea by reducing the stool frequency. METHODS Study Design: Randomised Controlled Trial (RCT), open labelled Conducted in the Intensive Care Unit (ICU), University Malaya Medical Centre (UMMC) Consecutive sampling Study Population: Inclusion criteria Exclusion criteria Patients receiving exclusive EN, nasogastric, continuous infusion. Adult patients, 18 years old and above. Critically ill patients. Expected to require EN more than five days [1]. Patients with gastrointestinal disease [2] or GIT surgery [3] or GIT radiation therapy [4]. Patients receiving lactulose as it is a prebiotics [5]. Currently under chemotherapy treatment [6]. Patients who had received prebiotics and probiotics supplements within the previous one month. Patients who have diarrhoea, 3 consecutive days [7]. REFERENCES 1. Bleichner, G., et al., Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients. A multicenter, randomized, double-blind placebo-controlled trial. Intensive Care Med, 1997. 23(5): p. 517-23. 2. Sokol, H., et al., Specificities of the fecal microbiota in inflammatory bowel disease. Inflammatory Bowel Diseases, 2006. 12(2): p. 106-111. 3. Scheppach, W., et al., Faecal short-chain fatty acids after colonic surgery. Eur J Clin Nutr, 1989. 43(1): p. 21-5. 4. Kapkac, M., et al., Fiber enriched diets and radiation induced injury of the gut. Nutrition research (New York, N.Y.), 2003. 23(1): p. 77-83. 5. Bouhnik, Y., et al., Lactulose ingestion increases faecal bifidobacterial counts: a randomised double-blind study in healthy humans. Eur J Clin Nutr, 2004. 58(3): p. 462-6. 6. Ratnaike, R.N. and T.E. Jones, Mechanisms of drug-induced diarrhoea in the elderly. Drugs Aging, 1998. 13(3): p. 245-53. 7. Majid, H.A., et al., Additional oligofructose/inulin does not increase faecal bifidobacteria in critically ill patients receiving enteral nutrition: A randomised controlled trial. Clinical Nutrition, 2014. 33(6): p. 966-972. Adult patients in the intensive care unit who were starting EN were randomly allocated to receive either a fibre-free (FF) formula or fibre/prebiotic-supplemented enteral formula (10g/L FOS) for up to 14 days. Nutritional delivery and faecal output were recorded daily. Fresh faecal samples were collected at baseline, 1 week and 2 weeks. Faecal output was recorded using King’s stool chart and faecal microbiotas were analysed using real-time polymerase chain reaction. Figure : Faecal microbiota concentrations at baseline , post 1-week, post 2-weeks for patients receiving fibre-free EN (n= 7) DISCLOSURE This research was supported by University of Malaya PPP Research Grant, PG127-2013A and SLAB, UiTM Scholarship. Ethics’s approval was obtained from University of Malaya Medical Centre (UMMC) Ethics Committee: Reference number 989.31 prior to the study commencement. ClinicalTrials.gov identifier number: NCT02144168 Figure : Faecal microbiota concentrations at baseline , post 1-week, post 2-weeks for patients receiving fibre/prebiotics supplemented EN (n = 8)