Exploring choices of early nutritional support for patients with sepsis based on changes in intestinal microecology

BACKGROUND Sepsis exacerbates intestinal microecological disorders leading to poor prognosis.Proper modalities of nutritional support can improve nutrition,immunity,and intestinal microecology.AIM To identify the optimal modality of early nutritional support for patients with sepsis from the perspective of intestinal microecology.METHODS Thirty patients with sepsis admitted to the intensive care unit of the General Hospital of Ningxia Medical University,China,between 2019 and 2021 with indications for nutritional support,were randomly assigned to one of three different modalities of nutritional support for a total of 5 d:Total enteral nutrition(TEN group),total parenteral nutrition(TPN group),and supplemental parenteral nutrition(SPN group).Blood and stool specimens were collected before and after nutritional support,and changes in gut microbiota,short-chain fatty acids(SCFAs),and immune and nutritional indicators were detected and compared among the three groups.RESULTS In comparison with before nutritional support,the three groups after nutritional support presented:(1)Differences in the gut bacteria(Enterococcus increased in the TEN group,Campylobacter decreased in the TPN group,and Dialister decreased in the SPN group;all P<0.05);(2)different trends in SCFAs(the TEN group showed improvement except for Caproic acid,the TPN group showed improvement only for acetic and propionic acid,and the SPN group showed a decreasing trend);(3)significant improvement of the nutritional and immunological indicators in the TEN and SPN groups,while only immunoglobulin G improved in the TPN group(all P<0.05);and(4)a significant correlation was found between the gut bacteria,SCFAs,and nutritional and immunological indicators(all P<0.05).CONCLUSION TEN is recommended as the preferred mode of early nutritional support in sepsis based on clinical nutritional and immunological indicators,as well as changes in intestinal microecology.

Rewiring host–microbe interactions and barrier function during gastrointestinal inflammation

Organismal survival depends on a well-balanced immune system and maintenance of host–microbe mutualism.The finetuned relationship between the gut microbiota and host immunity is constantly challenged by opportunistic bacteria testing the integrity of gastrointestinal(GI)barrier defenses.Barrier dysfunction reduces immunological tolerance towards otherwise innocuous microbes;it is a process that may instigate chronic inflammation.Paradoxically,sustained inflammation further diminishes barrier function,enabling bacterial translocation to extra-intestinal tissues.Once translocated,these bacteria stimulate systemic inflammation,thereby compromising organ function.While genetic risk alleles associate with barrier dysfunction,environmental stressors are key triggers of GI inflammation and associated breakdown in immune tolerance towards resident gut microbes.As dietary components dictate substrate availability,they also orchestrate microbiota composition and function,including migratory and pro-inflammatory potential,thus holding the capacity to fuel both GI and extra-intestinal inflammation.Additionally,Western diet consumption may weaken barrier defenses via curbed Paneth cell function and diminished host-defense peptide secretion.This review focuses on intervenable niches of host–microbe interactions and mucosal immunity with the ambition to provide a framework of plausible strategies to improve barrier function and regain tolerance in the inflamed mucosa via nutritional intervention.