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[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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