What dietary modifications should I recommend for a patient with short bowel syndrome to improve nutrient absorption?

For a patient with short bowel syndrome (SBS), dietary modifications should focus on optimizing nutrient absorption by tailoring the diet to the reduced absorptive capacity of the remaining intestine. Small, frequent meals are recommended to enhance nutrient uptake and reduce gastrointestinal symptoms. The diet should be high in complex carbohydrates and protein to provide adequate energy and support tissue repair, while fat intake may need to be adjusted depending on the presence of fat malabsorption, often requiring medium-chain triglycerides which are more easily absorbed. Oral nutrition support including fortified foods and oral nutritional supplements can be used to improve overall nutrient intake, ensuring a balanced mixture of protein, energy, fibre, electrolytes, vitamins, and minerals to prevent deficiencies NICE CG32.

Micronutrient supplementation, particularly of vitamins and trace elements, should be considered due to the risk of malabsorption, with a complete oral multivitamin and mineral supplement providing reference nutrient intake recommended when dietary intake is inadequate NICE CG32. Additionally, fluid and electrolyte management is crucial because SBS patients are prone to dehydration and electrolyte imbalances due to reduced absorptive surface area Goulet et al. 2013. Pancreatic enzyme replacement therapy may be necessary if exocrine pancreatic insufficiency coexists, to improve fat digestion and absorption NICE NG78.

Enteral feeding should be introduced cautiously and progressively to meet energy and protein needs without overwhelming the compromised gut, starting at lower levels and increasing as tolerated NICE CG32. The use of altered meal patterns and dietary advice tailored by healthcare professionals skilled in nutrition support is essential to optimize absorption and maintain nutritional status NICE CG32. Overall, the dietary approach in SBS aims to maximize the absorptive capacity of the remaining bowel, prevent malnutrition, and manage symptoms such as diarrhea and steatorrhea Goulet et al. 2013.