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Re-examining chemically defined liquid diets through the lens of the microbiome

Abstract

Trends in nutritional science are rapidly shifting as information regarding the value of eating unprocessed foods and its salutary effect on the human microbiome emerge. Unravelling the evolution and ecology by which humans have harboured a microbiome that participates in every facet of health and disease is daunting. Most strikingly, the host habitat has sought out naturally occurring foodstuff that can fulfil its own metabolic needs and also the needs of its microbiota, each of which remain inexorably connected to one another. With the introduction of modern medicine and complexities of critical care, came the assumption that the best way to feed a critically ill patient is by delivering fibre-free chemically defined sterile liquid foods (that is, total enteral nutrition). In this Perspective, we uncover the potential flaws in this assumption and discuss how emerging technology in microbiome sciences might inform the best method of feeding malnourished and critically ill patients.

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Fig. 1: Compositionally defined diets do not recapitulate the complexity and heterogeneity of unprocessed, whole foods.
Fig. 2: The advantages and disadvantages of enteral and parenteral nutrition.
Fig. 3: The dynamic interplay between the gut, the microbiota and delivery of luminal nutrition.
Fig. 4: Numerous clinical stressors effect the composition of the gut microbiota.
Fig. 5: Future investigations have the potential to elucidate the links between the microbiota, nutrition and a web of everyday interactions.

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V.G. and J.A. were responsible for conception and design, including substantial contribution to discussion of content. V.G., T.T., and J.A. were responsible for researching data for the article, drafting the manuscript, reviewing and editing manuscript before submission.

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Correspondence to Victoria Gershuni.

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Nature Reviews Gastroenterology & Hepatology thanks Gail Cresci and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Toni, T., Alverdy, J. & Gershuni, V. Re-examining chemically defined liquid diets through the lens of the microbiome. Nat Rev Gastroenterol Hepatol 18, 903–911 (2021). https://doi.org/10.1038/s41575-021-00519-0

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