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Water supplementation enhances the effect of high-fiber diet on stool frequency and laxative consumption in adult patients with functional constipation

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Abstract

The purpose of this study was to determine the effects of a high-fiber diet and fluid supplementation in patients with functional chronic constipation. One hundred and seventeen patients with chronic functional constipation (aged 18-50 years) were randomly divided into two treatment groups. For two months both groups consumed a standard diet providing approximately 25 g fiber per day. Group 1 (58 patients) was allowed ad libitum fluid intake, while Group 2 was instructed to drink 2 liters of mineral water per day. Compliance was monitored throughout the study and results were assessed in terms of bowel-movement frequency and laxative use. Fiber intake was similar in the two groups, while total daily fluid intake in Group 2 (mean 2.1 liters) was significantly greater than that of Group 1 (1.1 liters)(p < 0.001). In both groups, there were statistically significant increases in stool frequency and decreases in laxative use during the two-month trial, but both changes were greater in Group 2 (stool frequency: p < 0.001 vs. Group 1; laxative use: p < 0.001 vs Group 1). A daily fiber intake of 25 g can increase stool frequency in patients with chronic functional constipation, and this effect can be significantly enhanced by increasing fluid intake to 1.5-2.0 liters/day.
... The effects of fibres from diet could also beneficially impact a stool pattern in adults with constipation complaints, but this is not fully researched yet. Anti et al. have shown that a fibre intake of >25 g/d increased stool frequency, which was more pronounced in patients who drank >2 l/day of water after an intervention of 2 months (25) . A high-fibre diet of 28 g/d was also effective in improving constipation in women with pelvic floor disorders after a 42-d intervention (26) . ...
... We aimed to include twenty-five participants in the intervention period to measure an increase in stool frequency of 1·3 (1·8) stools/week with α = 0·05 and 1 − β = 0·80 (25) . We screened participants for a low-fibre intake in two steps: first, a rough screening was done by using our specially developed screening fibre questionnaire (45) . ...
... To our knowledge, only a few studies have used a high-fibre diet instead of fibre supplements to improve symptoms. A study from Anti et al. showed that a fibre intake of ≥25 g/d significantly increased stool frequency (25) , which we did not observe. This discrepancy might be explained by the magnitude of the change in fibre intake: even though our endpoint was similar, their baseline fibre intake was much lower at approximately 13 g/d, therefore having a larger window of opportunity. ...
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Constipation can greatly impact the quality of life (QoL), which can be relieved by dietary fibres; however, preserving a higher fibre intake remains a challenge. We investigated the effects of a personalised dietary advice (PDA) on fibre intake and mild constipation complaints. A total number of twenty-five adults with mild constipation complaints were included in a 4-week observation period followed by a 4-week personalised intervention. The PDA provided high-fibre alternatives via a web tool. In weeks 1, 4 and 8, dietary intake, constipation complaints and QoL were assessed. Furthermore, participants collected a faecal sample at weeks 1, 4 and 8 to determine microbiota diversity and composition, and short-chain fatty acids (SCFA). Participants completed questions daily for 8 weeks regarding abdominal complaints, stool frequency and stool consistency. Fibre intake in week 8 was significantly higher compared to week 1 (Δ = 5·7 ± 6·7 g, P < 0·001) and week 4 (Δ = 5·2 ± 6·4 g, P < 0·001). Constipation severity and QoL significantly improved at week 8 compared to the observation period (P < 0·001). A higher fibre intake significantly reduced constipation severity (β = -0·031 (-0·05; -0·01), P = 0·001) and the QoL (β = -0·022 (-0·04; -0·01), P = 0·009). Stool consistency (P = 0·040) and abdominal pain (P = 0·030) improved significantly during the intervention period (P = 0·040), but stool frequency did not. Average microbial alpha diversity and composition and SCFA concentrations did not change over time, but indicated individual-specific dynamics. Several SCFAs were associated with constipation complaints. To conclude, a PDA effectively increased fibre intake and subsequently reduced constipation complaints, indicating that guided dietary adjustments are important and feasible in the treatment of mild constipation complaints.
... Deshalb wurde insgesamt der Evidenzgrad B gewählt. In einer im Jahr 1998 publizierten Metaanalyse aus 17 Studien zur Wirkung von Ballaststoffen ergab sich eine geringfügige Besserung der gesamten Abdo-minalbeschwerden unter Ballaststoffen [518]. Dieser Effekt war ausgeprägter bei überwiegender Obstipation. ...
... Aufgrund möglicher synergistischer Effekte kann in der Behandlung des Reizdarmsyndroms eine Kombination aus Ballaststoffen und ausgewählten Probiotika versucht werden [523]. Um die positiven Effekte von Ballaststoffen beim Reizdarmsyndrom vom Obstipationstyp zu steigern, sollte auf eine ausreichende Trinkmenge am Tag entsprechend den Empfehlungen der Deutschen Gesellschaft für Ernährung (DGE) geachtet werden [518]. ...
... Deshalb wurde insgesamt der Evidenzgrad B gewählt. In einer im Jahr 1998 publizierten Metaanalyse aus 17 Studien zur Wirkung von Ballaststoffen ergab sich eine geringfügige Besserung der gesamten Abdo-minalbeschwerden unter Ballaststoffen [518]. Dieser Effekt war ausgeprägter bei überwiegender Obstipation. ...
... Aufgrund möglicher synergistischer Effekte kann in der Behandlung des Reizdarmsyndroms eine Kombination aus Ballaststoffen und ausgewählten Probiotika versucht werden [523]. Um die positiven Effekte von Ballaststoffen beim Reizdarmsyndrom vom Obstipationstyp zu steigern, sollte auf eine ausreichende Trinkmenge am Tag entsprechend den Empfehlungen der Deutschen Gesellschaft für Ernährung (DGE) geachtet werden [518]. ...
... In a randomised controlled trial, increasing water intake to two litres per day was shown to increase stool frequency and increasing fibre intake also significantly reduces faecal transit time and increases the stool frequency. 92 ...
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Persons with Intellectual Disabilities (ID) have a higher prevalence of physical health impairments leading to morbidities and premature deaths. The common conditions implicated are epilepsy, gastrointestinal concerns such as constipation and dyspepsia, sensory impairments, musculoskeletal issues, and thyroid disorders. Chronic diseases including hypertension, type 2 diabetes, obesity, and metabolic syndromes occur at an earlier age and nearly half of these conditions are detected only by screening. Annual health checks by primary care teams in the community are being implemented in many countries. Comprehensive health checks using standard questionnaires and preventative health check guidelines specially designed for persons with intellectual disabilities are of great help to primary care physicians in busy clinical settings. Addressing the concerns raised by healthcare professionals on the lack of knowledge and understanding of health needs of persons with ID can be easily addressed by appropriate training programmes. Eliminating communication barriers can be achieved by appropriate training programmes and implementing the use of easy-read materials. Reasonable adjustments must be implemented in practices to facilitate better health experiences for persons with ID and their caregivers.
... In a randomised controlled trial, increasing water intake to two litres per day was shown to increase stool frequency and increasing fibre intake also significantly reduces faecal transit time and increases the stool frequency. 92 ...
Persons with Intellectual Disabilities (ID) have a higher prevalence of physical health impairments leading to morbidities and premature deaths. The common conditions implicated are epilepsy, gastrointestinal concerns such as constipation and dyspepsia, sensory impairments, musculoskeletal issues, and thyroid disorders. Chronic diseases including hypertension, type 2 diabetes, obesity, and metabolic syndromes occur at an earlier age and nearly half of these conditions are detected only by screening. Annual health checks by primary care teams in the community are being implemented in many countries. Comprehensive health checks using standard questionnaires and preventative health check guidelines specially designed for persons with intellectual disabilities are of great help to primary care physicians in busy clinical settings. Addressing the concerns raised by healthcare professionals on the lack of knowledge and understanding of health needs of persons with ID can be easily addressed by appropriate training programmes. Eliminating communication barriers can be achieved by appropriate training programmes and implementing the use of easy-read materials. Reasonable adjustments must be implemented in practices to facilitate better health experiences for persons with ID and their caregivers.
... Participants in the middle lower quartile of water intake had a decreased likelihood of FC compared with participants in the lowest quartile of water intake (Table 3). Some studies reported that low water intake might be an etiological factor for constipation in adults, but the potential beneficial effect of extra water intake is uncertain (45,46). In univariate analysis, low fluid intake was significantly associated with an increased risk of FC, although this significant association disappeared in multivariate analysis (Table 3). ...
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Aim: The objective of this study was to evaluate the relationship between FC and physical activity, dietary intake and malnutrition in the elderly. Method: A cross-sectional study was conducted on 883 adults aged >65 years from nursing homes and community health centers in Turkey. Constipation status was evaluated according to Rome IV criteria and Bristol Stool Form Scale. Dietary intake was assessed using a food consumption record (24-hour food recall). The dietary energy and nutrients were analyzed using the "Nutrition Information Systems Package Program". The nutritional status of participants was evaluated using the Mini-Nutritional Assessment (MNA) test. The International Physical Activity Questionnaire (IPAQ, short form) was used to assess physical activity status. Results: Among the 883 participants, 29.6% were classified into the FC group (32.2% of females, 25.8% of males). The FC group had significantly lower total energy, fluid, water, protein, carbohydrate, magnesium, zinc, phosphorus, potassium, soluble fiber, insoluble fiber, total fiber, and fiber (g)/1000 kcal intake than the non-FC group (p < 0.05). The multivariate logistic regression analysis showed that total dietary fiber intake was significantly associated with a lower prevalence of FC (OR: 0.98, 95% Cl: 0.96-0.99). According to MNA, participants at risk of malnutrition (OR: 5.21, 95% Cl: 3.09-9.77) and malnourished participants (OR: 3.03, 95% Cl: 1.62-5.68) had a greater likelihood of FC compared with normal participants. Participants in the middle lower quartile of water intake (OR: 0.63, 95% CI: 0.42-0.95) had a decreased likelihood of FC compared with participants in the lowest quartile. Conclusion: FC is a common gastrointestinal disorder among the elderly in Turkey. Low dietary fiber intake, low water intake and malnutrition were important risk factors associated with FC in the elderly.
... Moisture intake in our study, however, was similar in both groups. Water supplementation can enhance the effect of a high-fiber diet on stool frequency when sufficient fiber is consumed (at least 25 g/d according to a study by Anti et al. [76]). Notably, this was not the case in our cohort. ...
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... This included all moisture present in foods and beverages, including tap and bottled waters consumed as beverages. An adequate intake of fluid is necessary to enhance the effect of fiber in stool frequency regulation [61,62]. The fact that vegetarians in our sample consumed significantly less moisture than non-vegetarians may also explain why we observed no significant intergroup differences. ...
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