Epidemiology of Constipation in Elderly People in Parts of China: A Multicenter Study

The impact of sugar-sweetened beverages consumption on constipation: evidence from NHANES

BACKGROUND

The consumption of sugar-sweetened beverages (SSBs) has increased substantially over recent decades, raising concerns about its various physiological effects on bodily function. However, the relationship between SSBs intake and constipation remains insufficiently understood.

METHODS

Data from 7,979 participants sourced from the National Health and Nutrition Examination Survey (NHANES) were analyzed in this study. Dietary intake of SSBs was assessed using two 24-hour dietary recall interviews, and constipation was defined according to the Bristol Stool Form Scale (BSFS) Cards. We employed weighted logistic regression analysis to examine the relationship between SSBs consumption (quantified in grams and kilocalories) and the risk of constipation, while stratified and restricted cubic spline (RCS) analyses explored population variability.

RESULTS

After adjusting for all relevant variables, SSBs quantified in grams (SSBs-grams) (ORQ3 vs. Q1 = 1.419, 95% CI: 1.064-1.893, p = 0.019; p for trend = 0.02) and SSBs quantified in kilocalories (SSBs-kcal) (ORQ4 vs. Q1 = 1.567, 95% CI: 1.100-2.234, p = 0.015; p for trend = 0.016) showed a significant positive association with constipation. Furthermore, the weighted RCS and stratified analyses indicated that the association varied among subgroups, with a non-linear relationship between SSBs-kcal and constipation (SSBs-grams: p non-linear = 0.100, SSBs-kcal: p non-linear = 0.026).

CONCLUSIONS

Our findings indicated that increased SSBs consumption is associated with a higher risk of constipation. The results underscore the need for public health interventions aimed at reducing the intake of SSBs and promoting healthier alternatives.

Physical activity and constipation: A systematic review of cohort studies

Background

Constipation significantly impacts quality of life and is a common public health issue. For affected individuals, especially those who are inactive and experience constipation symptoms, it is recommended to engage in physical activity (PA) to improve their condition. However, the relationship between PA and improvement in constipation remains unclear. We performed this systematic review of cohort studies to evaluate this potential association.

Methods

We systematically searched the Embase, Cochrane Library, PubMed, and CINAHL databases for all cohort studies examining the relationship between PA and constipation from the inception of the databases up to 5 November 2023. We calculated the reported risk ratios (RRs) and 95% confidence intervals (CIs), conducted a random effects model, and performed a subgroup analysis based on factors such as gender, geographic region, and PA intensity to comprehensively explore the link between PA and constipation. Furthermore, we used the Newcastle-Ottawa Scale to evaluate the quality of the studies included in our analysis.

Results

The analysis included 13 studies with 119 426 participants and 63 713 cases. The results indicated that higher levels of PA were associated with a decreased risk of constipation compared with lower levels of PA (RR = 0.69; 95% CI = 0.88-0.83) and moderate levels of PA (RR = 0.87; 95% CI = 0.79-0.95). Furthermore, adherence to international PA guidelines was correlated with a significantly reduced risk of constipation (RR = 0.87; 95% CI = 0.81-0.93). Notably, the risk of constipation was lowered among Asian populations (RR = 0.67; 95% CI = 0.56-0.79) and Oceanian populations (RR = 0.72; 95% CI = 0.63-0.83) who engaged in regular PA. Moreover, when comparing the risk of constipation between men and women collectively, PA was associated with a 34% lower risk (RR = 0.66; 95% CI = 0.55-0.80).

Conclusions

The study findings indicated that moderate to high levels of PA significantly reduced the risk of constipation, showing a negative correlation between PA and constipation.

Registration

PROSPERO: CRD42023479653.

Improving the nursing quality of non-pharmacological interventions for elderly constipation patients in the hospital: a best practice implementation project

INTRODUCTION

Non-pharmacological interventions are the preferred treatment for constipation; however, health care professionals in clinical settings tend to focus more on pharmacological treatments.

OBJECTIVES

This best practice implementation project aimed to integrate the best evidence on non-pharmacological interventions for elderly patients with constipation in clinical care practice and to promote the use of non-pharmacological interventions for such patients in the hospital setting.

METHODS

This project is based on the JBI Evidence Implementation Framework, which follows three stages. The first stage involved a baseline audit using two audit criteria derived from the best available evidence. This audit evaluated current clinical scenarios, guided by the i-PARIHS framework. The second stage involved analyzing the results of the baseline audit, identifying barriers to compliance, and developing and implementing strategies to overcome those barriers. Strategies included nursing education, development of constipation information booklets for nurses and patients, establishment of a nursing workflow, and modification of the department environment. In the third stage, a follow-up audit was conducted to evaluate the implementation, using the same data collection indicators and methods as in the baseline audit. Sixty patients participated in the project.

RESULTS

Compliance for Criterion 1 (patient education) increased from 0% to 60% ( p  < 0.001), while compliance for Criterion 2 (monitoring patients' bowel health) increased from 0% to 100% ( p  < 0.001).

CONCLUSIONS

The results indicate that this evidence-based implementation project facilitated the application of non-pharmacological interventions for elderly patients with constipation. Nurses played a significant role in developing regular defecation habits in patients and monitoring their defecation.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A284.

Diminished representation of vitamin-B12-producing bacteria in constipated elders with frailty

Constipation and frailty are associated with intestinal dysbiosis. This study aims to identify intestinal microbial signatures that can differentiate between constipated elders accompanied by frailty and those without frailty. We collected stool samples from 61 participants and conducted 16S rRNA gene sequencing. Constipated patients with frailty (Constipation_F) exhibited reduced gut microbial diversities compared to constipated patients without frailty (Constipation_NF) and healthy individuals (C). From differential genera, random forest models identified 14, 8, and 5 biomarkers for distinguishing Constipation_F from Constipation_NF, Constipation_F from C, and Constipation_NF from C, respectively. Functional analysis revealed that pathways (P381-PWY and PWY-5507) related to vitamin B12 synthesis were reduced in Constipation_F, which aligns with the decreased abundances of vitamin-B12-producing Actinomyces and Akkermansia in this group. Our study unveils substantial differences in gut microbiota between constipated elders with frailty and those without, underscoring the diagnostic and therapeutic potential of genera involved in vitamin B12 synthesis.

Association of habitual sleep duration with abnormal bowel symptoms: a cross-sectional study of the 2005-2010 national health and nutrition examination survey

OBJECTIVES

Nowadays, few studies have examined the relationships between sleep duration and abnormal gut health. In this study, we used data from the National Health and Nutrition Examination Survey (NHANES) to investigate the correlations between habitual sleep duration and abnormal bowel symptoms in adults.

METHODS

This study included 11,533 participants aged ≥ 20 years from the NHANES conducted during 2005-2010. Chronic constipation and chronic diarrhea were defined based on the Bristol Stool Form Scale (BSFS) and frequency of bowel movements. Sleep duration was assessed based on the self-report questionnaire and classified into three groups: short sleep duration (< 7 h), normal sleep duration (7-9 h), and long sleep duration (> 9 h). Weighted data were calculated according to analytical guidelines. Logistic regression models and restricted cubic spline curves (RCS) were used to assess and describe the association between sleep duration and chronic diarrhea and constipation. Univariate and stratified analyses were also performed.

RESULTS

There were 949 (7.27%) adults aged 20 years and older with chronic diarrhea and 1120 (8.94%) adults with constipation among the 11,533 individuals. A positive association was found between short sleep duration and chronic constipation, with a multivariate-adjusted OR of 1.32 (95% CI: 1.05-1.66). Additionally, long sleep duration was significantly associated with an increased risk of chronic diarrhea (OR: 1.75, 95% CI: 1.08-2.84, P = 0.026). The RCS models revealed a statistically significant nonlinear association (P for non-linearity < 0.05) between sleep duration and chronic diarrhea. Furthermore, obesity was found to modify the association between sleep duration and chronic diarrhea and constipation (p for interaction = 0.044).

CONCLUSIONS

This study suggests that both long and short sleep durations are associated with a higher risk of chronic diarrhea and constipation in the general population. Furthermore, a non-linear association between sleep duration and these conditions persists even after adjusting for case complexities.

Association between sleep disorders and constipation Risk: A systematic review and Meta-Analysis

OBJECTIVES

The objective of this study was to evaluate the potential relationship between sleep disturbances and various types of constipation in patients.

METHODS

We conducted systematic searches in the research databases PubMed, EMBASE, Web of Science, and Cochrane Library to identify qualifying studies. Using Stata software version 14.0, we calculated the Odds Ratio (OR) and 95 % confidence interval (CI) for constipation in patients with sleep disorders. If P > 0.1 and I2 ≤ 50 %, we employed a fixed-effects model; otherwise, we applied a random-effects model. We assessed publication bias using funnel plots and Egger's test.

RESULT

The pooled analysis demonstrated that individuals with sleep disorders were associated with an increased risk of all-cause constipation (OR = 1.47; 95 %CI: 1.31-1.64; I2 = 88.8 %, P＜0.001). Specifically, both children (OR = 1.29; 95 %CI: 1.16-1.42; I2 = 63.8 %, P＜0.001) and adults (OR = 1.65; 95 %CI: 1.39-1.97; I2 = 92.4 %, P＜0.001) with a history of sleep disorders exhibited an increased risk of all-cause constipation.. Furthermore, patients with a history of insufficient sleep were also associated with an increased risk of constipation (OR = 1.33; 95 %CI: 1.20-1.46; I2 = 6.7 %, P＜0.001). Additionally, patients with poor sleep quality were found to have an increased risk of constipation (OR = 1.56; 95 %CI: 1.0-2.45; I2 = 90.9 %, P = 0.05). Lastly, patients with insomnia were found to have the highest risk of constipation (OR = 1.94; 95 %CI: 1.37-2.76; I2 = 97.8 %, P＜0.001).

CONCLUSION

This meta-analysis indicates that sleep disorders are associated with an elevated risk of constipation. Insomnia, poor sleep quality, and insufficient sleep duration all contribute to elevating the risk of constipation. These findings emphasize the significance of recognizing sleep disorders as an independent risk factor for constipation in both children and adults.

Living with constipation and communication taboos surrounding constipation among older adults: An interpretive phenomenology analysis study

Chronic constipation is a prevalent problem that significantly impacts older adults' well-being. This study aimed to explore how older adults describe constipation symptoms and impacts and understand the perceived taboo surrounding discussions on related issues. Twenty older adults with constipation were interviewed using a semi-structured format in Taiwan. The Interpretive Phenomenology Analysis approach was utilized for data analysis. Five techniques recommended by Lincoln and Guba (1985) were implemented to ensure the study's trustworthiness. The primary themes encompassed comprehensive portrayals of fecal characteristics, the discomfort symphony of constipation, emotional turbulence in the struggle against constipation, daily activities shadowed by constipation, and underlying factors contributing to communication taboos. Most participants considered the discussion of constipation taboo due to its association with an embarrassing secret, an unacceptable social norm and stigma, and apprehensions of potential gossip. Geriatric caregivers need to consider individual perspectives, communication taboos, and sociocultural contexts when addressing older adults' constipation.

The human colon: Evidence for degenerative changes during aging and the physiological consequences

BACKGROUND

The incidence of constipation increases among the elderly (>65 years), while abdominal pain decreases. Causes include changes in lifestyle (e.g., diet and reduced exercise), disease and medications affecting gastrointestinal functions. Degenerative changes may also occur within the colo-rectum. However, most evidence is from rodents, animals with relatively high rates of metabolism and accelerated aging, with considerable variation in time course. In humans, cellular and non-cellular changes in the aging intestine are poorly investigated.

PURPOSE

To examine all available studies which reported the effects of aging on cellular and tissue functions of human isolated colon, noting the region studied, sex and age of tissue donors and study size. The focus on human colon reflects the ability to access full-thickness tissue over a wide age range, compared with other gastrointestinal regions. Details are important because of natural human variability. We found age-related changes within the muscle, in the enteric and nociceptor innervation, and in the submucosa. Some involve all regions of colon, but the ascending colon appears more vulnerable. Changes can be cell- and sublayer-dependent. Mechanisms are unclear but may include development of "senescent-like" and associated inflammaging, perhaps associated with increased mucosal permeability to harmful luminal contents. In summary, reduced nociceptor innervation can explain diminished abdominal pain among the elderly. Degenerative changes within the colon wall may have little impact on symptoms and colonic functions, because of high "functional reserve," but are likely to facilitate the development of constipation during age-related challenges (e.g., lifestyle, disease, and medications), now operating against a reduced functional reserve.

Enhancing Colonoscopy Preparation in Elderly Constipation Patients: A Personalized Approach with PEG and Exercise - A Case Study

This study aimed to optimize bowel preparation efficacy for colonoscopy in elderly constipation patients. A 71-year-old patient with chronic constipation and a history of poor bowel preparation. To address these challenges, we implemented a personalized strategy combining of PEG administration and walking exercise. The PEG was administered according to a protocol, with intermittent exercise breaks of 10 minute. Bowel cleanliness was assessed using the Boston Bowel Preparation Scale (BBPS). Adverse reactions and tolerance were closely monitored throughout the intervention. The patient's BBPS score improved from 3 to 8 post-intervention. The exercise intervention was well-tolerated (rating I), and mild nausea was observed only after the first PEG dose. No severe adverse reactions occurred. Subsequent Follow-up revealed symptom relief. The personalized approach combining (PEG and exercise intervention) successfully improved bowel preparation quality in the elderly constipation patient undergoing colonoscopy. This approach considers age-related changes in gastrointestinal function and activity level, offering an effective strategy to improve patient tolerance and reduce adverse reactions during bowel preparation. The findings underscore the importance of tailoring interventions for elderly constipation patients to optimize the colonoscopy experience.

Prevalence and associated factors of chronic constipation among Japanese university students

Background

Chronic constipation (CC) is one of the most frequently reported gastrointestinal disorders in the general population and a prominent problem among university students. The study aimed to evaluate the prevalence and the associated factors of CC among Japanese university students.

Methods

This cross-sectional study was conducted among university students at Hiroshima University, Japan. Students answered the web questionnaire when making a web reservation for the health checkup (April 1 to May 31, 2023). The web questionnaire consisted of four sections, including baseline characteristics, lifestyle factors, family history of CC, and three scales to assess depression and eating disorders: the Beck Depression Inventory (BDI), Eating Attitudes Test (EAT)-26 and Bulimic Investigatory Test (BITE). CC was diagnosed using Rome IV criteria. The multivariate logistic regression model was used to determine CC-related factors.

Results

Out of 10,500 individuals who participated in the annual health checkup, 7,496 participants answered the web questionnaire, of whom 5,386 answered all the survey questions. The mean age of the students was 21.1 ± 4.1 years. The male-to-female ratio was 1:1.17. The prevalence of CC was 13.7%. Factors significantly associated with CC in the multivariate model were first-degree family members with CC [Odd ratio (OR): 2.77, 95% confidence interval (CI): 2.31-3.31], severe depression according to BDI scale (OR: 2.59, 95% CI: 1.96-3.43), female sex (OR: 2.00, 95% CI: 1.69-2.36), and short sleep duration of 6 hours or less per day (OR: 1.28, 95% CI: 1.09-1.50). Lack of physical exercise tended to be associated with CC (OR: 1.19, 95% CI: 1.00-1.40).

Conclusions

CC is prevalent among Japanese university students. Significant risk factors for CC included the first-degree family history of CC, severe depression, female sex, and short sleep duration. Lack of physical exercise tended to be associated with CC. This may contribute to implementing suitable education health programs, health care professionals, and public health policies to identify individuals at risk for CC to prevent and treat CC effectively.

Associations Between Plasma Orexin-A Level and Constipation in Cognitive Impairment

BACKGROUND

Constipation is a common symptom in dementia, and the cause is controversial. Rare clinical studies focused on plasma orexin-A levels and constipation in dementia.

OBJECTIVE

To evaluate the associations between orexin-A and constipation in patients with cognitive impairment.

METHODS

A total of 21 patients with mild cognitive impairment (MCI), 142 with Alzheimer's disease (AD), and 57 with Lewy body dementia (LBD) were conducted. Besides informant-based history, neurological examinations or neuropsychological assessments, plasma levels of orexin-A, and constipation were assessed. The associations between orexin-A and constipation were evaluated by logistic regression models.

RESULTS

There were 47/220 (21.36%) cognitive impairment patients having constipation, and the proportion of constipation in LBD (61.40%) was significantly higher than AD (5.63%) and MCI (19.05%). No significant age or sex differences in the prevalence of constipation were found in the MCI, AD, and LBD groups. We found the cognitive impairment patients with constipation had lower levels of plasma orexin-A [1.00 (0.86, 1.28) versus 1.29 (1.01, 1.50) ng/ml, p < 0.001] than those without. And the plasma levels of orexin-A were significantly associated with the occurrence of constipation after adjusting for all variables in all patients with cognitive impairment (OR = 0.151, 95% CI: 0.042-0.537, p = 0.003). And the same finding was more prominent in the LBD group (p = 0.048).

CONCLUSIONS

The decrease of plasma level of orexin-A is closely associated with the occurrence of constipation. Orexin-A has an intestinal protective effect and is involved in the gastrointestinal symptoms of patients with cognitive impairment.

Association between frailty and chronic constipation and chronic diarrhea among American older adults: National Health and Nutrition Examination Survey

BACKGROUND

This study was to explore the relationship between chronic constipation, chronic diarrhea, and frailty in older Americans.

METHODS

This cross-sectional study selected a total of 4241 community-dwelling individuals aged 60 years and older from the 2005-2010 National Health and Nutrition Examination Survey. Frailty was measured using a 49-item frailty index, and a frailty index > 0.21 was defined as a frail status. Chronic constipation and chronic diarrhea were defined as the "usual or most common type of stool" by the Bristol Stool Form Scale (BSFS) Types 1 and 2 and BSFS Types 6 and 7, respectively. Weighted logistic regression analysis was used to examine the relationship between gut health and frailty status. Restricted cubic spline (RCS) curves were built to assess the association between frailty index and stool frequency.

RESULTS

Frailty status was associated with higher odds of constipation in an unadjusted model; however, after further adjusting for confounding variables, the relationship between frailty status and constipation was not statistically significant. We discovered a positive correlation between the frailty status and diarrhea after adjustment for all variables. The frailty index showed a U-shaped relationship with stool frequency, and the frailty index was the smallest at a frequency of 10 stools/week.

CONCLUSION

Negative associations were observed between frailty status and chronic constipation and diarrhea among older adults. Older adults who have a bowel movement frequency of about 10 times per week are the least frail. Future studies are warranted to confirm the causal relationship in this association.