151 Journal of Hainan Medical University 

2017; 23(12): 151-154 

Journal of Hainan Medical University 

http://www.hnykdxxb.com 

Effects  of  bifidobacterium-containing  enteral  nutrition  intervention 

on  the  nutritional  status  and  intestinal  flora  disturbance  in  patients 
with the severe cerebral infarction 
Yi Zhang✉, Jun Wang, Hai-Long Zhu, Yi Liang, Juan Wu 
ICU, Deyang Second People’s Hospital in Sichuan Province, Deyang City, Sichuan Province, 618000 
ARTICLE INFO ABSTRACT 
Article history: Received 5 Jun 2017 Received in revised form 12 Jun 2017 Accepted 16 Jun 2017 Available online 28 Jun 2017 
Keywords: Severe cerebral infarction Enteral nutrition Bifidobacterium Nutritional status Intestinal flora disturbance 
✉Corresponding author: Yi Zhang, ICU, Deyang Second People’s Hospital in Sichuan Province, Deyang City, Sichuan 
Province, 618000. 
Tel: 0838-2236712; 13548258964 Fund Project: Fund of Deyang Science and Technology Branch Intellectual Property Office 
No: 2014SZ037 
Objective:  To  study  the  effects of bifidobacterium-containing enteral nutrition intervention on the nutritional status and intestinal 
flora  disturbance  in  patients  with  the  severe  cerebral  infarction.  Methods:  88  patients  with  severe  cerebral  infarction  who  were 
treated  in  Deyang  Second  People’s  Hospital  between  March  2014  and  October  2016  were  collected  and  divided  into  control 
group  and  observation  group  according to the random number table, control group received routine enteral nutrition intervention, 
and  the  observation  group  received  bifidobacterium-containing  enteral  nutrition  intervention.  The  nutritional  status,  intestinal 
mucosa  function  and  intestinal  flora  distribution  before and after nutritional intervention were compared between the two groups 
of  patients.  Results:  Before  intervention,  differences  in  the  nutritional  status,  intestinal  mucosa  function  and  intestinal  flora 
distribution  were  not  statistically  significant  between  two  groups  of  patients.  After  intervention,  peripheral  blood  levels  of 
nutritional  status  indexes  Hb, TP, ALB, PA and TF in observation group were higher than those in control group; serum levels of 
intestinal  mucosal  barrier  function  indexes  DAO  and  D-lactate  were  lower  than  those  in  control  group;  the  number  of 
bifidobacterium  and  lactobacillus  in  feces  were  larger  than  those  in  control  group  while  the  number  of  enterobacteria  and 
enterococcus  were  smaller  than those in control group. Conclusion: Bifidobacterium-containing enteral nutrition intervention can 
enhance  the  nutritional  status,  optimize  the  intestinal  mucosa function and reduce the intestinal flora disturbance in patients with 
severe cerebral infarction. 
gastrointestinal tract[3,4]. Probiotics combined with 
enteral nutrition 1. Introduction 
is considered to be the reliable way to optimize gastrointestinal function and improve the efficiency of nutrient absorption, and it 
Cerebral infarction is the most common brain disorder in the 
has been successfully applied in the treatment of patients 
with a elderly, severe patients are mostly associated with swallowing, 
variety of chronic gastrointestinal dysfunction[5,6]. Given 
the current chewing and other function obstacles that affect normal feeding 
plight of severe pneumonia nutrition intervention, 
bifidobacterium function, and therefore, enteral nutrition is the most common 
was added to enteral nutrition preparations, and the effect 
of the way method to maintain basic energy and nutrient supply[1,2]. Current 
on nutritional status and intestinal flora disturbance was 
explored, study has pointed out that the gastrointestinal function in patients 
now reported as follows. with severe cerebral infarction is 
also affected by different degree, and therefore, enteral nutrition alone cannot make patients absorb nutrients in time, and will 
also increase the burden on 

2. Information and methods 

2.1 Case information 
88 patients with severe cerebral infarction who were treated in our hospital between March 2014 and October 2016 were 
collected 
 
Yi 152 Zhang et al./ Journal of Hainan Medical University 2017; 23(12): 151-154 and the patients' families signed informed 
consent forms. Random number table was used to divide the enrolled patients into control group and observation group, 44 cases 
in each group. Control group included 23 male cases and 21 female cases that were 56-78 years old; observation group included 
24 male cases and 20 female cases that were 54-79 years old. The gender and age distribution of the two groups were not 
significantly different (P >0.05), and the study was approved by the hospital ethics committee. 
Inclusion  criteria:  (1)  diagnosed  with  severe  cerebral  infarction  by  head  CT/MRI;  (2)  the  interval  between  the  onset  and  the 
admission  <6 h; (3) without history of cerebral infarction. Exclusion criteria: (1) dead in hospital; (2) associated with basic severe 
malnutrition; (3) associated with acute and chronic intestinal inflammatory disease. 

2.2 Nutrition intervention 

Control  group  received  conventional  enteral nutrition intervention, Enteral nutritional suspension (Nutricia Pharmaceutical Co., 
Ltd.,  approved  by  H20010285)  was  used  for  gastric  tube  feeding  at  dripping  speed  of  50-100  mL/h,  and  starting  dose  was 500 
mL/  d  and  gradually  increased  to  1  500-2  500  mL/d,  for  2  consecutive  weeks.  On  the  basis  of  conventional  enteral  nutrition, 
observation  group  of  patients  received  Bifidobacterium  tetravaccine  tablets (Inner Mongolia Shuangqi Pharmaceutical Co., Ltd., 
approved  by  S19980004),  and  1.5  g  was  grinded,  hydrated  and  injected  from  the  stomach  tube,  3  times/d,  for  2  consecutive 
weeks. 

2.3 Nutritional status 

Before  and  after  nutrition  intervention,  2.0  mL  fasting  peripheral  venous blood was extracted from two groups of patients, and 
automatic  biochemical  analyzer  (Hitachi  Co.,  LTD.,  model  7600)  was  used  to  detect  hemoglobin  (Hb),  total  protein  (TP), 
albumin (ALB, prealbumin (PA) and transferrin (TF) contents. 

2.4 Intestinal mucosal barrier function 

Before  and  after  nutrition  intervention, 2.0 mL fasting peripheral venous blood was extracted from two groups of patients, anti- 
coagulated  at low speed to get upper serum, spectrophotometry was used to detect the content of diamine oxidase (DAO), and the 
modified enzymatic spectrophotometry was used to determine the content of D-lactate. 

2.5 Intestinal flora distribution 

Before and after nutritional intervention, the wet faeces samples 
were collected from two groups of patients to determine the distribution of intestinal flora by live bacteria plate count. 
Bifidobacterium  and  lactobacillus  medium  were  placed  in  anaerobic  tank  and  closed  at  first,  then  put  in  37  °C  constant- 
temperature  incubator  for  48-72  h  of  incubation;  enterobacterium and enterococcus medium were directly put in 37 °C constant- 
temperature incubator for 24-48 h of incubation. 

2.6 Statistical processing 

All data in the study were processed by the professionals with statistical qualification. Nutritional status indexes, intestinal 
mucosal 
barrier  function indexes, intestinal flora distribution and other measurement data were in terms of mean ± standard deviation (x依
s), and the comparison was by t test. Statistics P<0.05 was the standard of statistical significance in differences. 

3. Results 
3.1 Nutritional status 
Comparison of peripheral blood nutritional status indexes Hb (g/ L), TP (g/L), ALB (g/L), PA (mg/L) and TF (g/L) contents 
between 
two groups of patients before and after intervention was as follows: before intervention, differences in peripheral blood Hb, TP, 
ALB, PA 
and  TF  levels  were  not  statistically  significant  between  two  groups of patients (P>0.05); after intervention, peripheral blood Hb, 
TP,  ALB,  PA  and  TF  levels  in  both  groups  were  significantly  higher  than  those  before  intervention,  peripheral  blood  Hb,  TP, 
ALB, PA and TF levels 
in observation group were higher than those in control group, and differences were statistically significant (P<0.05), shown in 
Table 1. 

3.2 Intestinal mucosal barrier function 

Comparison of serum intestinal mucosal barrier function indexes DAO (U/mL) and D-lactate (mmol/L) levels between two 
groups 
Table 1. 
Comparison of peripheral blood protein content before and after nutritional intervention. Groups n Time Hb TP ALB PA TF 
Control group 44 
Before intervention 113.28±14.09 60.47±7.05 32.18±3.94 301.26±34.58 2.53±0.31 
After intervention 125.47±14.23* 63.87±7.15* 38.76±4.11* 339.75±40.18* 3.11±0.37* 
Observation group 44 
Before intervention 113.19±13.64 60.38±7.11 32.42±3.89 302.74±33.61 2.51±0.34 
After intervention 138.66±14.83*# 69.63±7.94*# 43.58±5.62*# 398.62±44.51*# 3.98±0.45*# 
Note: compared with same group before intervention, *P<0.05; compared with control group after intervention, #P<0.05. 
 
Yi Zhang et al./ Journal of Hainan Medical University 2017; 23(12): 151-154 153 
of  patients  before  and  after intervention was as follows: before intervention, differences in serum DAO and D-lactate levels were 
not  statistically  significant  between  two  groups  of  patients  (P>0.05);  after  intervention, serum DAO and D-lactate levels in both 
groups  were  significantly  lower than those before intervention, serum DAO and D-lactate levels in observation group were lower 
than those in control group, and differences were statistically significant (P<0.05), shown in Table 2. 
Table 2. 
Comparison of serum intestinal mucosal barrier function index levels before 
and after nutritional intervention. Groups n Time DAO D-lactate 
Control group 44 
function  and  intestinal  mucosa  absorption  function  disorders,  which  weaken  the  biological  effect  of  enteral  nutrition alone, and 
affect  both  nutritional  status  and  immune  function[7,8].  Bifidobacterium  tetravaccine  tablet  is  a  new  type  of  compound 
tetravaccine  probiotic,  which  is  colonize  in  the  intestinal  tract  after oral administration, can effectively supplement the intestinal 
probiotics  and  prompt  them  to  multiply  abundantly,  competitively  inhibit  intestinal  pathogenic  bacteria  and  form  a  biological 
intestinal  flora  barrier  so  as  to  protect  patients’  gastrointestinal  function  and  promote  the  absorption of nutrition preparation[9]. 
Choice  of  nutritional  intervention  modes  for  patients  with  severe  cerebral  infarction  has  been  the  focus  of the clinical research, 
Bifidobacterium was added in enteral nutrition in 
Before intervention 4.93±0.56 0.32±0.05 
After intervention 3.78±0.42* 0.23±0.03* 
the study, and the effect of this new way of nutrition intervention on patients' nutrition state, etc was judged so as to provide 
practical 
Observation group 44 
Before  After  intervention  intervention  4.92±0.54  3.04±0.35*#  reference  for  the  nutrition  intervention  of  subsequent  similar 
patients.  The  supply  of  basic  nutrients  is  the  material  basis  of  the  body's  survival  transformation  and  metabolism, studies show 
that the protein malnutrition in patients with chronic disease is mainly characterized by protein malnutrition, namely the synthesis 
rates  of  a  variety  of  proteins  decrease,  and  a  variety  of  biological  functions  involving  proteins  are  abnormal[10,11].  Hb,  TP, 
ALB,  PA  and  TF  are  the  main  protein  compositions in the blood, the above protein contents decrease significantly in circulating 
blood  when  severe  malnutrition  affects  the  protein  synthesis,  and  the  specific  extent  of decrease is consistent with the degree of 
malnutrition[12,13].  In  the  study,  peripheral  blood  protein  contents  were  first  compared  between  two  groups  of  patients  before 
and  after  nutritional  intervention,  and  it  was  found  that  after  two  groups  of patients received enteral nutritional intervention, the 
peripheral  blood  Hb,  TP,  ALB,  PA  and  TF  contents  were  higher  than  those  before  intervention,  indicating  that  patients  can  all 
absorb  part  of  the  nutrients  after  different  enteral  nutrition  intervention;  but  Hb,  TP,  ALB,  PA  and  TF  contents  of  observation 
group  were  higher  after  the  intervention,  indicating  that  adding  bifidobacterium  in  enteral  nutrition  preparations can effectively 
promote the gastrointestinal tract to absorb nutrients and accelerate the production of proteins. 
The  intestinal  mucosal  dysfunction  is  the  core  cause  of  the  nutrient  absorption  dysfunction,  and  the  intestinal  mucosa 
dysfunction  is  prevalent  in  patients  with  poor  nutrition[14].  DAO  and  D-lactate  are  regarded  as  the  serological  indexes  of 
intestinal  mucosal  barrier  function,  they  are  massively  released  into  the  blood  in  the  case  of  mucosa  function  damage,  so  the 
abnormal rise in serum DAO and D-lactate contents is a sign of abnormal function of intestinal 
Table 3. 
Comparison of intestinal flora distribution in feces before and after nutritional intervention (logCFU/g wet feces). Groups n Time 
Bifidobacterium Lactobacillus Enterobacteria Enterococcus 
Control group 44 
0.34±0.04 0.12±0.02*# Note: compared with same group before intervention, *P<0.05; compared 
with control group after intervention,#P<0.05. 
3.3 Intestinal flora distribution 
Comparison  of  the  intestinal  flora  bifidobacterium,  lactobacillus, enterobacteria and enterococcus distribution in feces between 
two  groups  of  patients  before  and  after  intervention  was  as  follows:  before  intervention,  differences  in  bifidobacterium, 
lactobacillus,  enterobacteria  and  enterococcus  distribution  in  feces  were  not  statistically  significant  between  two  groups  of 
patients  (P>0.05);  after  intervention,  the  number  of  bifidobacterium  and  lactobacillus  in  feces  in  both  groups  were  larger  than 
those  before  intervention  while  the  number  of  enterobacteria  and  enterococcus  were  smaller  than  those  before  intervention, the 
number  of  bifidobacterium  and  lactobacillus  in  feces  in  observation  group  were  larger  than  those  in  control  group  while  the 
number  of  enterobacteria  and enterococcus were smaller than those in control group, and differences were statistically significant 
(P<0.05), shown in Table 3. 

4. Discussion 
Enteral  nutrition  is the main method to provided heat and nutrition for patients that cannot eat through the mouth, the nutritional 
intervention  has also been widely used for patients with cerebral infarction, but some severe patients are also with gastrointestinal 
tract 
Before intervention 9.13±0.96 8.45±0.98 10.32±0.97 8.91±0.85 
After intervention 10.14±1.25* 9.11±0.97* 9.14±0.98* 7.86±0.82* 
Observation group 44 
Before intervention 9.12±0.98 8.47±0.92 After intervention 12.87±1.69*# 11.26±1.15*# 10.35±0.93 8.89±0.84 
7.59±0.97*# 
6.12±0.75*# Note: compared with same group before intervention, *P<0.05; compared with control group after intervention, 
#P<0.05. 
 
Yi 154 Zhang et al./ Journal of Hainan Medical University 2017; 23(12): 151-154 mucosa, and the increase of DAO and 
D-lactate contents is closely related to the intestinal function status[15]. In the study, serum DAO and D-lactate contents were 
compared between two groups of patients before and after nutritional intervention, and it was found that serum DAO and 
D-lactate contents decreased in both groups after enteral nutrition intervention, but the decrease in serum DAO and D-lactate 
contents was more significant in observation group, it explains that adding bifidobacterium can be more effective to repair the 
function of intestinal mucosa, and this is also one of the internal causes of the enhanced protein synthesis ability after absorption 
of nutrients. 
There  are  pathogenic  bacteria,  probiotics,  opportunistic  pathogen  and  other  bacteria  in  normal  human  intestinal  tract,  they 
inhibit  and  rely  on  each  other  in  human  intestinal  digestion  environment  under  physiological  condition,  and  the  stable  and 
balanced  relationship  is  beneficial  to  the  body[16].  There  is  intestinal  flora  imbalance  in  the  majority  of  patients  with  severe 
cerebral  infarction,  the  specific  performance  is  that  the  bifidobacterium,  lactobacillus  and  other  predominant  bacteria  count 
decrease  while  the  enterobacter, enterococcus and other opportunistic pathogen count increase, it eventually leads to the decrease 
of  the  intestinal  mucosal  barrier  function  and  the  damage  to  immune  mechanism,  and  local  intestinal  canal  inflammation  can 
appear  and  further  increase  nutrition  absorption  barriers[17].  Adding  Bifidobacterium  to  enteric  nutrition  preparations  can 
increase  the  predominant  flora  count  and inhibit the opportunistic pathogen reproduction so as to optimize the bowel function. In 
the  study,  the  probiotics  and  opportunistic  pathogen  count  were  compared between two groups of patients, and it was found that 
the  number  of  probiotics  bifidobacterium  and  lactobacillus  in  both  groups  of  patients  after  intervention  were  more  than  those 
before  intervention,  the  number  of  opportunistic  pathogens  enterobacter  and  enterococcus  were  less  than  those  before 
intervention,  and  the  changes  in  above  flora  in  feces  in  observation  group  were  greater  than  those  in  control group, confirming 
that  adding  bifidobacterium  can  optimize  the  intestinal  flora  distribution,  then  optimize  intestinal  function  and  promote  the 
absorption of enteral nutrition preparations. 
Bifidobacterium-containing  enteral  nutritional  intervention  can  effectively  optimize  the  nutritional  status  and  reverse  the 
intestinal  flora  disorder  in  patients  with  severe  cerebral  infarction,  is  helpful  for  the  recovery  of  patients,  and  is  worthy  of 
popularization and application in clinical practice in the future. 

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