[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.
Kurgan A
Home Care Provid (United States) Jan-Feb 1996, 1
(1) p30
No abstract.
Fecal
incontinence in children.
Loening-Baucke V
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.
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