Abstract
Background
Low microbial diversity or altered microbiota composition is associated with many
disease states. In the treatment of many conditions, enteral (EN) or parenteral (PN)
nutrition is frequently required.
Objective
This systematic review aimed to identify and evaluate the evidence of the effect of
EN vs PN on the gastrointestinal microbiota.
Method
A comprehensive systematic literature search of 5 databases was completed to review
studies published until February 2020. The Preferred Reporting Items for Systematic
Reviews and Meta-Analyses guidelines were utilized in completion of the review with
the Academy of Nutrition and Dietetics quality criteria checklist and Grading of Recommendations
Assessment, Development and Evaluation to evaluate the included studies. The review
was registered on PROSPERO (CRD42018091328). Studies were eligible for inclusion if
participants were older than 3 years, patients received either EN, PN or both, with
some patients receiving each mode of nutrition support. The main outcome was any assessment
of the gastrointestinal microbiota, including diversity or taxa abundance.
Results
Eleven articles (n = 367 patients) met the inclusion criteria and were evaluated.
Seven studies (n = 237) reported greater abundance of Proteobacteria with the provision
of PN compared to EN; 6 studies (n = 172) reported lower Firmicutes and 5 studies
(n = 155) lower Bacteroidetes. In 7 studies (n = 282), microbial diversity was lower
with provision of PN than EN. The Grading of Recommendations Assessment, Development
and Evaluation certainty of evidence was very low.
Conclusions
Provision of PN may lead to greater abundance of Proteobacteria and reduced microbial
diversity; however, there is limited literature on this topic and additional research
is warranted to improve understanding of the impact of EN vs PN on the microbiota.
Keywords
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Biography
S. Andersen is a senior dietitian, Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia, and a PhD candidate, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia.
Biography
M. Banks is director, Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia; and an adjunct associate professor, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia.
Biography
J. Bauer is an associate professor, Nutrition and Dietetics, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia.
Article info
Publication history
Published online: July 16, 2020
Accepted:
April 27,
2020
Received:
November 21,
2019
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This review was funded by the Royal Brisbane & Women's Hospital Postgraduate Research Scholarship.
AUTHOR CONTRIBUTIONS All authors contributed to the study design, S. Andersen and J. Bauer screened, reviewed, and analyzed the studies for risk of bias and quality. S. Andersen wrote the first manuscript draft and all authors contributed to data interpretation, manuscript revision, and have approved the final version.
Identification
Copyright
© 2020 by the Academy of Nutrition and Dietetics.
