[Intake of dietary fiber and other nutrients by children with and without functional chronic constipation]
de Morais MB; Vitolo MR; Aguirre AN; Medeiros EH; Antoneli EM; Fagundes-Neto U
Departamento de Pediatrica da Universidade Federal de Sao-Paulo-Escola Paulista de Medicina (UNIFESP-EPM).
Arq Gastroenterol (Brazil) Apr-Jun 1996, 33 (2) p93-101
The aim of this study was to evaluate the dietary fiber intake and the dietary habits of children with and without functional chronic constipation. We enrolled 58 children with functional chronic constipation and 58 controls without constipation matched for sex and age. Food and fiber intake were evaluated by 24 hour dietary recall and a complete clinical history was performed. The age of onset of constipation occurred during the first year of life in 55.4% of the patients while the median age of evaluation was 78 months. Soiling was found in 41.7% of patients. The median period of exclusive breast feeding was shorter (P = 0.002) in the constipation group (one month) than in the control group (three month). The proportion of constipation was similar for mothers of children of both groups as well as for siblings in both groups. The fathers of children with constipation presented higher frequency of constipation (12.3%) than the fathers of children in control group (1.8%), but the difference did not reach statistical significance (P = 0.06). The amount of food measured by 24 hour recall was similar in both groups. The calorie intake of constipated children (1526 +/- 585 calories/day) was lower (P = 0.07) than in the control group (1712 +/- 513 calories/day) but the difference did not reach statistical significance. The intake of protein, fat and iron was lower in the constipation group than in the control group. The volume of cow's milk intake was similar in both groups. The median of total dietary fiber intake in the constipation group (13.5 g/day) was statistically (P = 0.009) lower than in the control group (16.8 g/day). The daily intake of insoluble dietary fiber was also statistically lower (P = 0.001) in the constipation group (6.3 g) than in the control group (9.4 g). The intake of soluble dietary fiber was similar in both groups. The intake of dietary fiber per 1,000 calories of diet was 10.3 g in the constipation group and 10.4 in the control group (P = 0.41). There was a considerable intersection of individual values in fiber intake of the constipation and control groups, suggesting that low fiber intake acts in association with others factors on the genesis of constipation in children. However, the low intake of insoluble fiber, suggests that it plays an important role on the pathogenesis of chronic constipation in children.
The treatment of chronic constipation in adults. A systematic review
Tramonte SM; Brand MB; Mulrow CD; Amato MG; O'Keefe ME; Ramirez G
Metropolitan Methodist Hospital, University of Texas Health Science Center at San Antonio, USA.
J Gen Intern Med (United States) Jan 1997, 12 (1) p15-24
OBJECTIVE: To evaluate whether laxatives and fiber therapies improve symptoms and bowel movement frequency in adults with chronic constipation.
DATA SOURCES: English language studies were identified from computerized MEDLINE (1966-1995). Biological Abstracts (1990-1995), and Micromedex searches; bibliographies; textbooks; laxative manufactures; and experts.
STUDY SELECTION: Randomized trials of laxative or fiber therapies lasting more than 1 week that evaluated clinical outcomes in adults with chronic constipation.
MEASUREMENTS AND MAIN RESULTS: Two independent reviewers appraised each trial's characteristics including methodologic quality. There were 36 trials involving 1,815 persons from a variety of settings including clinics, hospitals and nursing homes. Twenty-three trials were 1 month or less in duration. Several laxative and fiber preparations were evaluated. Twenty trials had a placebo, usual care, or discontinuation of laxative control group, and 16 directly compared different agents. Laxatives and fiber increased bowel movement frequency by an overall weighted average of 1.4 (95% confidence interval [CI] 1.1-1.8) bowel movements per week. Fiber and bulk laxatives decreased abdominal pain and improved stool consistency compared with placebo. Most nonbulk laxative data concerning abdominal pain and stool consistency were inconclusive, though cisapride, lactulose, and lactitol improved consistency. Data concerning superiority of various treatments were inconclusive. No severe side effects for any of the therapies were reported.
CONCLUSIONS: Both fiber and laxatives modestly improved bowel movement frequency in adults with chronic constipation. There was inadequate evidence to establish whether fiber was superior to laxatives or one laxative class was superior to another.
Health help. Fluid + fiber = frequency.
Home Care Provid (United States) Jan-Feb 1996, 1 (1) p30
Fecal incontinence in children.
Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City 52242-1083, USA.
Am Fam Physician (United States) May 1 1997, 55 (6) p2229-38
Functional constipation is the cause of fecal incontinence in 95 percent of affected children, and anatomic or neurologic causes account for up to 5 percent of cases. The history and the physical examination (with emphasis on abdominal, rectal and neurologic examinations) are most helpful in identifying organic disease. In some children, anorectal manometry, a barium enema radiographic examination and a rectal biopsy are necessary to determine the etiology. Most children with fecal incontinence benefit from a strict treatment plan that includes defecation trials, a fiber-rich diet and laxative medications. Surgery followed by medical treatment is required in patients with Hirschsprung's disease and in some patients with anal stenosis or a history of surgical repair of an anorectal malformation.
Chronic constipation--is the work-up worth the cost?
Rantis PC Jr; Vernava AM 3rd; Daniel GL; Longo WE
Department of Surgery, Saint Louis University School of Medicine, MO 63110-0250, USA.
Dis Colon Rectum (United States) Mar 1997, 40 (3) p280-6
BACKGROUND: Chronic constipation can be a disabling condition that may require colectomy. Evaluation has been included as a way to select appropriate patients for colectomy and may also be extensive, unrevealing, and costly.
AIMS: This study was undertaken to determine the cost and use of evaluation and outcome of patients with chronic constipation.
METHODS: Patients with chronic constipation were reviewed for severity of symptoms, diagnostic studies performed, treatment, and outcome. The costs of the diagnostic studies were determined at our institution. Fifty-one patients were identified with chronic constipation; all were referred by other physicians. Mean age was 54 (range, 21-81) years; 59 percent were females. Average number of bowel movements per week was two (range, 0-4), and average duration of symptoms was five years (range, 1-20). Forty-three of 51 (84 percent) colonoscopies or barium enemas were normal. Thirteen of 51 (25 percent) colonic transit studies were abnormal. Twenty-six of 51 (51 percent) patients underwent defecography; 12 (46 percent) were abnormal. Thirty-seven of 51 (74 percent) underwent anal manometry; 5 (14 percent) were abnormal. One of 18 (6 percent) rectal biopsies demonstrated Hirschsprung's disease. Overall, 8 patients (16 percent) were diagnosed with outlet obstruction, 12 (24 percent) with colonic inertia, and 31 (61 percent) with constipation of unclear etiology. Overall mean cost of diagnosis was $2,752 (range, $1,150-$4,792). Fiber, cathartics, or biofeedback therapy was successful in 33 of 51 (65 percent) patients. Among the remaining 18 patients, 12 underwent surgery, of which 10 were successful. The remaining eight patients were constipated, despite treatment.
CONCLUSION: A cost of $140,369 was expended on extensive diagnostic tests, from which 12 of 51 (23 percent) patients benefited. Exhaustive diagnostic evaluation of constipation is costly, and its benefits are unclear.
Changing bowel hygiene practice successfully: a program to reduce laxative use in a chronic care hospital.
Benton JM; O'Hara PA; Chen H; Harper DW; Johnston SF
Sisters of Charity of Ottawa (SCO) Hospital, Ontario, Canada.
Geriatr Nurs (United States) Jan-Feb 1997, 18 (1) p12-7
Laxative use was significantly reduced in our long-term care facility when an interdisciplinary program based on a philosophy of prevention and health promotion was implemented. Specifically, increased fluid and fiber intake, timely toileting habits, and regular activity/exercise led to a halving of the number of patients receiving laxatives as required, relative to pre-program levels and relative to a control unit not receiving the program.
[A clinical study of the use of a combination of glucomannan with lactulose in the constipation of pregnancy]
Signorelli P; Croce P; Dede A
Divisione di Ostetricia e Ginecologia, Ospedale di Codogno, Regione Lombardia, USL n. 25, Lodi.
Minerva Ginecol (Italy) Dec 1996, 48 (12) p577-82
RATIONAL: Constipation is a problem frequently encountered during pregnancy as is excessive weight gain. Treatments of common use to control constipation are endowed with some drawbacks and they are not active in controlling weight increase. A preparation of lactulose and glucomannan in previous studies proved very effective and well tolerated in patients affected by stypsis and evidentiated also activity both in controlling excessive food intake and in correcting some metabolic imbalances regarding lipids and urea.
MATERIAL AND METHODS: 50 pregnant females affected by constipation were treated with sachets containing a preparation of glucomannan (1.45 g) and lactulose (4.2 g) in a posology of 2 (1-4) sachets a day for 1-3 months.
RESULTS: Treatment induced a return to normal frequency of weekly number of evacuations (4.9-5.8/week) and a parallel control of weight gain (within 20% of initial body weight). The latter finding seems to be related to hunger control induced by glucomannan at the gastric level which prevents an excessive food intake.
Clinical response to dietary fiber treatment of chronic constipation.
Voderholzer WA; Schatke W; Muhldorfer BE; Klauser AG; Birkner B; Muller-Lissner SA
Medizinische Klinik, Klinikum Innenstadt, University of Munich, Germany.
Am J Gastroenterol (United States) Jan 1997, 92 (1) p95-8
OBJECTIVES: To determine the clinical outcome of dietary fiber therapy in patients with chronic constipation.
METHODS: One hundred, forty-nine patients with chronic constipation (age 53 yr, range 18-81 yr, 84% women) at two gastroenterology departments in Munich, Germany, were treated with Plantago ovata seeds, 15-30 g/day, for a period of at least 6 wk. Repeated symptom evaluation, oroanal transit time measurement (radiopaque markers), and functional rectoanal evaluation (proctoscopy, manometry, defecography) were performed. Patients were classified on the basis of the result of dietary fiber treatment: no effect, n = 84; improved, n = 33; and symptom free, n = 32.
RESULTS: Eighty percent of patients with slow transit and 63% of patients with a disorder of defecation did not respond to dietary fiber treatment, whereas 85% of patients without a pathological finding improved or became symptom free.
CONCLUSION: Slow GI transit and/or a disorder of defecation may explain a poor outcome of dietary fiber therapy in patients with chronic constipation. A dietary fiber trial should be conducted before technical investigations, which are indicated only if the dietary fiber trial fails.
Lack of influence of intestinal transit on oxidative status in premenopausal women.
Lewis S; Bolton C; Heaton K
University Department of Medicine, Bristol Royal Infirmary.
Eur J Clin Nutr (England) Aug 1996, 50 (8) p565-8
OBJECTIVE: There are reasons for believing that diet can alter the risk of malignancy by alteration of the body's oxidative status. Intestinal contents and enterohepatically recirculated substances are influenced by intestinal transit rate. A low fibre diet has been linked to the increase in constipation seen in countries consuming a westernized diet, as well as to the aetiology of many diseases. We studied the effects of altering intestinal transit rates and of wheat bran on oxidative status.
DESIGN: 40 premenopausal women were randomized to receive dietary supplements of wheat bran, senna or loperamide for the length of two menstrual cycles. Dietary records, whole gut transit time (WGTT) and plasma lipid peroxides, measured as TBARS (specifically malondialdehyde) were determined at the beginning and end of each intervention.
SETTING: University department of Medicine, Bristol Royal Infirmary.
RESULTS: 36 volunteers completed the study. WGTT increased in those receiving loperamide and decreased in those receiving senna. The decrease in WGTT was not significant in those receiving wheat bran. Diets did not change. There were no changes in TBARS, cholesterol, triglyceride or TBARS adjusted for cholesterol and triglyceride, during any intervention.
CONCLUSIONS: Dietary supplementation with wheat bran and pharmacological alteration of intestinal transit had no influence on oxidative status or on plasma cholesterol or triglycerides.
Dietary fiber and laxation in postop orthopedic patients.
Ouellet LL; Turner TR; Pond S; McLaughlin H; Knorr S
Clin Nurs Res (United States) Nov 1996, 5 (4) p428-40
The addition of wheat fiber in the diet of post-surgical orthopedic patients as a means of preventing constipation was studied using a quasi-experimental design. It was hypothesized that a 20 gm supplement of All Bran and natural bran would promote spontaneous bowel movements, reduce the incidence of constipation, and thus decrease the need for elimination interventions. The results show that the study group had more spontaneous bowel movements and required fewer elimination interventions than did the control group.
[The relationship between intake of dietary fiber and chronic constipation in children]
Mooren GC; van der Plas RN; Bossuyt PM; Taminiau JA; Buller HA
Academisch Medisch Centrum-Het Kinder AMC, afd Kindergastroenterologie en Voeding, Amsterdam.
Ned Tijdschr Geneeskd (Netherlands) Oct 12 1996, 140 (41) p2036-9
OBJECTIVE: Evaluation of the feeding patterns of children with chronic constipation, in particular dietary fibres, energy and fluid intake and their influence on colonic transit time. In addition, the effect of dietary recommendations regarding fibres was assessed.
DESIGN: Prospective randomized study.
SETTING: Department of Paediatric Gastroenterology and Nutrition, Academic Medical Centre, Amsterdam, the Netherlands.
METHOD: Children with at least 2 months of complaints related to constipation were enrolled and both dietary intake and colonic transit time were evaluated. After dietary and laxative treatment, in some combined with biofeedback training, and a follow-up of 6 months, a randomized sample were again evaluated regarding their transit times and dietary patterns.
RESULTS: In 73 consecutive children mean fibre intake was the same as in healthy controls, although energy and fluid intake were lower. Colonic transit time was increased compared with healthy controls and no relationship was established between fibre intake and transit time. At 6 months no significant increase in mean fibre intake was observed and no relationship was found between either transit time and change in fibre intake or cure and change in fibre intake. In the cured patients no increase of their mean fibre intake could be observed.
CONCLUSION: The amount of dietary fibres played no pathogenic part in chronic constipation. Dietary advice did not change the mean fibre content of the diet. In addition, changes in fibre intake had no effect on colonic transit time or cure.
Assessment of the effect of increased dietary fibre intake on bowel function in patients with spinal cord injury.
Cameron KJ; Nyulasi IB; Collier GR; Brown DJ
Spinal Injuries Unit, Austin Hospital, Heidelberg, Victoria, Australia.
Spinal Cord (England) May 1996, 34 (5) p277-83
It is common for constipation to occur following severe spinal cord injury (SCI). Although a bowel management program including a high fibre diet is an integral part of rehabilitation, the effect of a high fibre diet on large bowel function in SCI has not been examined. The aims of this study were to assess the nutrient intake of SCI patients, to determine baseline transit time, stool weight and evacuation time and to assess the effect of addition of bran on large bowel function. Eleven subjects, aged 32 +/- 10.5 years participated in the study. The level of injury ranged from C4 to T12; only one patient had an incomplete injury. Baseline mean energy intake was 7823 +/- 1443 kJ/d, protein intake 93 +/- 21 g/d, carbohydrate intake 209 +/- 39 g/d and mean dietary fibre intake 25 +/- 8 g/d. Mean baseline stool weight was 128 +/- 55 g/d and bowel evacuation time was 13 +/- 7.4 min/d. Three subjects who consumed < 18 g dietary fibre/d had low stool weights of 60-70 g/d and two had very delayed transit times that were too slow to enable quantitation. Mean mouth to anus transit time was 51.3 +/- 31.2 h, mean colonic transit time 28.2 +/- 3.5 h, right colonic transit time 5.9 +/- 4.5 h, left colonic transit time 14.5 +/- 5.2 h and rectosigmoid colonic transit time 7.9 +/- 5.6 h. Following the addition of bran, dietary fibre intake significantly increased from 25 g/d to 31 g/d (P < 0.001). However, the mean colonic transit time increased from 28.2 h to 42.2 h (P < 0.05) and rectosigmoid colon transit time increased from 7.9 to 23.3 h (P < 0.02). Stool weight, mouth to anus, left and right colon transit time and evacuation time did not change significantly. Results of this study suggest that increasing dietary fibre in SCI patients does not have the same effect on bowel function as has been previously demonstrated in individuals with 'normally functioning' bowels. Indeed the effect may be the opposite to that desired. This preliminary study highlights the need for further research to examine the optimal level of dietary fibre intake in SCI patients.
Chronic idiopathic constipation: pathophysiology and treatment.
Velio P; Bassotti G
Cattedra di Gastroenterologia, Universita degli Studi di Milano, IRCSS-Ospedale Maggiore di Milano, Italy.
J Clin Gastroenterol (United States) Apr 1996, 22 (3) p190-6
Chronic constipation is common in the general population, especially in women, in its idiopathic form. However, confusion still surrounds its definition, despite recent efforts to standardize it. Constipation can be divided in two large subgroups-normal transit and slow transit. The have different pathophysiological bases still not completely understood. Most patients respond to simple therapeutic measures aimed at correcting dietary fiber intake and lifestyle. Others, however, need more aggressive treatment, including laxatives, psychological therapy, and biofeedback. In a few patients with intractable constipation, surgery might be indicated to give relief.