Influence of nutrition therapy on the intestinal microbiome

Monika A. Krezalek, Andrew Yeh, John C. Alverdy, Michael Morowitz

Research output: Contribution to journalReview articlepeer-review

29 Scopus citations


Purpose of review This review describes the relationship between nutritional therapies and the intestinal microbiome of critically ill patients. Recent findings The intestinal microbiome of the critically ill displays a near complete loss of health-promoting microbiota with overgrowth of virulent healthcare-associated pathogens. Early enteral nutrition within 24h of admission to the ICU has been advocated in medical and surgical patients to avoid derangements of the intestinal epithelium and the microbiome associated with starvation. Contrary to previous dogma, permissive enteral underfeeding has recently been shown to have similar outcomes to full feeding in the critically ill, whereas overfeeding has been shown to be deleterious in those patients who are not malnourished at baseline. Randomized clinical trials suggest that peripheral nutrition can be used safely either as the sole or supplemental source of nutrition even during the early phases of critical care. The use of probiotics has been associated with a significant reduction in infectious complications in the critically ill without a notable mortality benefit. Summary Focus of research is shifting toward strategies that augment the intestinal environment to facilitate growth of beneficial microorganisms, strengthen colonization resistance, and maintain immune homeostasis.

Original languageEnglish
Pages (from-to)131-137
Number of pages7
JournalCurrent opinion in clinical nutrition and metabolic care
Issue number2
StatePublished - Mar 1 2017


  • diet
  • enteral nutrition
  • intestinal microbiome
  • parenteral nutrition
  • probiotics


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