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Nutrition and Health (including climate and ecological aspects)

Effect of early enteral nutrition combined with probiotics in patients with stroke: a meta-analysis of randomized controlled trials

Subjects

Abstract

Background/Objectives

Whether to conduct early enteral nutrition combined with probiotics (EEN/probiotics) in stroke patients remains controversial. This study was aimed to systematically explore the efficacy and safety of EEN/probiotics in stroke patients.

Subject/Methods

We performed searches in EMBASE, PubMed, Medline, Cochrane Library, Chinese Biomedicine Literature Database (SinoMed), Chinese Scientific Journal Database (VIP), Chinese National Knowledge Infrastructure (CNKI) and Wanfang database.

Results

A total of 26 randomized controlled trials (2216 patients) were included. Meta-analysis showed a significantly lower incidence of gastrointestinal complications (%) (OR, 0.29; 95% CI,0.24–0.36; P < 0.00001), a lower incidence of infection (%) (OR, 0.27; 95% CI, 0.21–0.36; P < 0.00001), a shorter length of hospital stay (d) (MD, −8.70; 95% CI, −13.24 to −4.16; P = 0.003), and a lower dysbacteriosis rate (%) (OR, 0.17; 95% CI, 0.07–0.41; P < 0.0001) in the EEN/probiotics group than EEN group. Compared with EEN group, EEN/probiotics group had lower levels of diamine oxidase (U/L) (MD, −0.78; 95% CI, −0.93 to −0.63; P < 0.00001), D-lactic acid (mmol/L) (MD, −0.06; 95% CI, −0.07 to −0.05; P < 0.00001) and higher levels of albumin (g/L) (MD, 3.38; 95% CI, 2.74–4.02; P < 0.00001), prealbumin (mg/L) (MD, 32.20; 95% CI, 24.42–39.98; P < 0.00001), total protein (g/L) (MD, 4.91; 95% CI, 3.20–6.62; P < 0.00001), hemoglobin (g/L) (MD, 9.62; 95% CI, 7.92–11.32; P < 0.00001), immunoglobulin A (g/L) (MD, 0.23; 95% CI, 0.12–0.34; P < 0.0001) and immunoglobulin G (g/L) (MD, 0.33; 95% CI, 0.21–0.45; P < 0.00001).

Conclusion

Early enteral nutrition combined with probiotics may effectively improve the nutritional status of stroke patients, regulate the intestinal flora and intestinal mucosal barrier function, improve the immune function, reduce the incidence of infectious complications and gastrointestinal motility disorders.

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Fig. 1
Fig. 2: Risk of bias assessment based on review author’s judgment about a risk of bias item for each eligible study (n = 26).
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Funding

This research was supported by a program of Department of Science and Technology of Sichuan Province (No. 2021YFS0022). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Conceptualization: XC, YH. Data curation: XC, JY. Formal analysis: XC, XY. Project administration: KL. Resources: KL. Software: XC, YH. Supervision: KL, JY. Writing—original draft: XC, YH, XY. Writing—review and editing: KL, JY.

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Correspondence to Ka Li.

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Chen, X., Hu, Y., Yuan, X. et al. Effect of early enteral nutrition combined with probiotics in patients with stroke: a meta-analysis of randomized controlled trials. Eur J Clin Nutr (2021). https://doi.org/10.1038/s41430-021-00986-3

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