Prevalence, Symptoms, and Associated Factors of Chronic Constipation Among Older Adults in North-East of Peninsular Malaysia

Exploring the association between cardiovascular health and bowel health

Chronic constipation, diarrhea, and fecal incontinence have high incidence, potential disability, and socioeconomic impact, imposing a heavy burden on the quality of life. We aim to explore the association between cardiovascular health (CVH) and bowel health from National Health and Nutrition Survey 2005-2010. CVH is assessed using Life's Essential 8 (LE8). Chronic constipation, chronic diarrhea, and fecal incontinence are assessed based on Bristol Stool Form Scale classification, bowel movements, and bowel leakage. Better health behaviors (odds ratio [OR]: 0.71, 95% confidence interval [CI] 0.53-0.94, p = 0.02) and worse health factors (OR: 1.45, CI 1.03-2.04, p = 0.04) were associated with less chronic constipation. Less chronic diarrhea is correlated with better CVH (OR: 0.53, 95% CI 0.35-0.79, p = 0.003) and health factors (OR: 0.61, CI 0.46-0.81, p = 0.001). Meanwhile, the proportion of chronic diarrhea significantly decreases when the health behaviors score exceeds 59.42. Lower fecal incontinence was associated with better health behaviors (OR: 0.63, CI 0.44-0.90, p = 0.01) CVH. Better CVH and health behaviors are both linked to lower all-cause mortality in participants with chronic constipation and chronic diarrhea. A higher health behaviors score is also associated with less all-cause mortality in patients with fecal incontinence. Maintaining CVH at the population level contributes to intestinal health, achieving the dual management of both while saving on healthcare costs. However, further prospective research is needed to confirm these associations.

Causal relationship between hypertension and risk of constipation: A 2-way 2-sample Mendelian randomization study

Patients with hypertension have a higher risk of having constipation and vice versa. The causal association between these 2 variables is not proven. We performed a retrospective Mendelian randomization analysis to determine the causal association between constipation and hypertension. Two-sample 2-way Mendelian randomization analysis was used. Genetic variants for constipation were derived from genome-wide association study data of European origin (15,902 cases and 395,721 controls). Corresponding genetic associations for hypertension were derived from European ancestry GWAS data (54,358 cases and 408,652 controls). Genetic susceptibility to hypertension was associated with an increased risk of constipation (OR: 3.459, 95% CI: 1.820-6.573, P < .001). In an inverse Mendelian randomization analysis, no causal effect of constipation on hypertension was found (OR: 0.999, 95% CI: 0.987-1.011, P = .834). In sensitivity analyses, these associations persisted and no multiple effects were found. This study suggests that there is a causal relationship between hypertension and constipation and that hypertension may increase the risk of developing constipation.

Efficacy and mechanism of acupuncture for functional constipation in older adults: study protocol for a randomized controlled trial

Introduction

Functional constipation (FC) is a common functional gastrointestinal disorder in clinical practice, with the prevalence of which increasing with age. With the increasing aging of the population worldwide, this problem is bound to become more prominent. Acupuncture is effective and recommended for the treatment of FC. However, little is known about how acupuncture affects the gut microbiota and inflammatory cytokines and thus improves gut function. Meanwhile, there are few high-quality clinical trials specifically focusing on acupuncture in treating FC in older people. The objective of this study is to assess the efficacy and safety of acupuncture in treating FC in older people. Additionally, the research aims to explore the mechanism of action of acupuncture in treating FC in older people by affecting intestinal microbiota and inflammation cytokines.

Methods and analysis

This study is designed as a single-center, randomized, sham-controlled clinical trial. A total of 98 eligible FC patients will be randomized in a 1:1 ratio into an acupuncture group and a sham acupuncture group. Both groups will receive 24 treatments over 8 weeks with a 12-week follow-up. The primary outcome of the study is the treatment response rate, which is the proportion of participants with ≥3 mean weekly Complete Spontaneous Bowel Movements (CSBMs) over weeks 3-8. The secondary outcomes will include the proportion of participants with ≥3 mean weekly CSBMs during other assessment periods; the percentage of patients with ≥1 increase in mean weekly CSBMs from baseline; the average changes in CSBMs; Patient Assessment of Constipation-Symptoms (PAC-SYM), Bristol Stool Scale, Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) and weekly usage of emergency bowel medications. Adverse events will be recorded throughout the study. Data for the outcomes will be collected at Week 0 (baseline), Week 4 (the intervention period), Week 8 (the post-treatment), Week 12 (the follow-up period) and Week 20 (the follow-up period). In addition, changes in intestinal microbiota will be analyzed using 16S rRNA high-throughput detection, and the concentration of relevant inflammatory cytokines in serum will be measured by ELISA based on blood samples. The intention-to-treat analysis will be performed in this study.Clinical trial registration: [https://www.chictr.org.cn/], identifier [ChiCTR2300070735].

Analysis of Factors Associated with Constipation in the Population with Obesity: Evidence from the National Health and Nutrition Examination Survey

INTRODUCTION

Obesity and constipation are both global problems, but the factors associated with constipation in individuals with obesity are currently understudied. The aim of our study was to explore the factors associated with constipation in people with obesity.

METHODS

From three cycles of the National Health and Nutrition Examination Survey (NHANES) 2005-2010, data from 14,048 persons aged ≥20 years were collected. Variables included demographics, lifestyle, comorbidities, and dietary data. Multiple logistic regression analysis was used to calculate adjusted prevalence odds ratio (OR) and assess the relationship between different variables and constipation in population with obesity.

RESULTS

Using stool consistency definition, multivariate analysis revealed that education ≥12th grade (OR: 0.456; 95% CI: 0.300, 0.694; p = 0.00024), hypertension (OR: 0.505; 95% CI: 0.334, 0.763; p = 0.00119), polypharmacy (OR: 1.669; 95% CI: 1.104, 2.521; p = 0.01507), high cholesterol (OR: 0.400; 95% CI: 0.213, 0.750; p = 0.00430), and high dietary fiber (OR: 0.454; 95% CI: 0.245, 0.841; p = 0.01206) were substantially linked with constipation in the population with obesity. For constipation defined using stool frequency, multivariate regression analysis show constipation in people with obesity had a significant association with the female sex (OR: 2.684; 95% CI: 1.379, 5.223; p = 0.00366 multivariate), Mexican American (OR: 0.142; 95% CI, 0.033, 0.616; p = 0.00914 multivariate), hypertension (OR: 0.569; 95% CI: 0.324, 0.998; p = 0.04916), depression (OR: 2.280; 95% CI: 1.240, 4.195; p = 0.00803), occasional/often milk consumption (OR: 0.473; 95% CI: 0.286, 0.782; p = 0.00356), medium energy (OR: 0.318; 95% CI: 0.118, 0.856; p = 0.02338), polypharmacy (OR: 1.939; 95% CI: 1.115, 3.373; p = 0.01907), and medium moisture (OR: 0.534; 95% CI: 0.285, 0.999; p = 0.04959). In nonobese people, constipation was significantly associated with the female sex and high moisture but not with hypertension and polypharmacy.

CONCLUSION

This study suggests that the population with obesity has many factors that affect constipation such as hypertension, polypharmacy, cholesterol, dietary fiber, depression, and so on, of which hypertension and polypharmacy were significant associated with constipation, regardless of definitions of constipation. Notably, hypertension might be associated with a reduced risk of constipation in people with obesity.

Global prevalence of constipation in older adults: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

Constipation is one of the most common functional disorders of the gastrointestinal tract in older adults. To date, no systematic review or previous meta-analysis has estimated the global prevalence of constipation in older adults. The prevalence of this disorder has been reported differently in different studies; therefore, this study aims to systematically review the publications and to perform a meta-analysis of the prevalence of constipation in older adults.

METHODS

The electronic databases PubMed, Google Scholar, Scopus, Web of Science, and ScienceDirect were systematically searched for studies reporting the prevalence of constipation in older adults up to February 2022. To perform the analysis, the random effects model was used, and heterogeneity was assessed by Cochran's Q test and expressed as I2.

RESULTS

Out of 5341 evaluated publications, 36 met the eligibility criteria. These studies included 58,405 older adults aged 60-93 years. The overall prevalence of constipation in older adults was 18.9% (95% confidence interval [95% CI]: 14.7-23.9%). The prevalence of constipation in older adults according to Rome II criteria was 16.2% (95% CI: 6.8-33.7), based on Rome III criteria was 19.2% (95% CI: 12.6-28.1), and based on Rome IV criteria was 10.3% (95% CI: 5.8-17.7). The highest prevalence of constipation was found in older adults in Africa at 32.3% (95% CI: 21.5-45.4), and the lowest in Asia at 13.6% (95% CI: 9.1-19.9). Concerning diagnostic tools, the highest prevalence of constipation was found if a self-reporting tool was applied with a value of 19.7% (95% CI: 15.8-24.3).

CONCLUSION

The results suggest that health policymakers should pay more attention to the prevention of constipation in older adults, including raising public awareness to the importance of nutrition and diet and physical activity in older adults.

Serum Metabolic Profile in Schizophrenia Patients With Antipsychotic-Induced Constipation and Its relationship With Gut Microbiome

BACKGROUND AND HYPOTHESIS

Antipsychotics (APs), the cornerstone of schizophrenia treatment, confer a relatively high risk of constipation. However, the mechanisms underpinning AP-induced constipation are poorly understood. Thus, we hypothesized that (1) schizophrenia patients with AP-induced constipation have distinct metabolic patterns; (2) there is more than one mechanism at play in producing this adverse drug effect; and (3) AP-associated changes in the gut microbiome are related to the altered metabolic profiles.

STUDY DESIGN

Eighty-eight schizophrenia patients, including 44 with constipation (C) and 44 matched patients without constipation (NC), were enrolled in this study. Constipation was diagnosed by Rome IV criteria for constipation and colonic transit time using radiopaque markers (ROMs) while severity was evaluated with the Bristol Stool Form Scale (BSS) and Constipation Assessment Scale (CAS). Fasting blood samples were drawn from all participants and were subjected to non-targeted liquid chromatography-mass spectrometry (LC-MS) metabolomic analysis.

STUDY RESULTS

Eleven metabolites were significantly altered in AP-induced constipation which primarily disturbed sphingolipid metabolism, choline metabolism, and sphingolipid signaling pathway (P value < .05, FDR < 0.05). In the C group, changes in the gut bacteria showed a certain degree of correlation with 2 of the significantly altered serum metabolites and were associated with alterations in choline metabolism.

CONCLUSIONS

Our findings indicated that there were disturbances in distinct metabolic pathways that were associated with AP-induced constipation. In addition, this study presents evidence of a link between alterations in the gut microbiome and host metabolism which provides additional mechanistic insights on AP-induced constipation.

Alteration of the faecal microbiota composition in patients with constipation: evidence of American Gut Project

There is limited information is known about the composition difference of the gut microbiota in patients with constipation and healthy controls. Here, the faecal 16S rRNA fastq sequence data of microbiota from the publicly available American Gut Project (AGP) were analysed. The tendency score matching (PSM) method was used to match in a 1:1 manner to control for confounding factors age, gender, body mass index (BMI), and country. A total of 524 participants including 262 patients with constipation and 262 healthy controls were included in this analysis. The richness and evenness of the gut microbiota in the constipation group were significantly lower than those in the control group. The dominant genera in the constipation group include Escherichia_Shigella, Pseudomonas, and Citrobacter. The dominant genera in the control group include Faecalibacterium, Prevotella, Roseburia, Clostridium_XlVa, and Blautia. The abundance of three butyrate production-related pathways were significantly higher in the constipation group than in the control groups. There was no significant difference in the diversity and gut microbiota composition in patients with constipation at different ages. In conclusion, patients with constipation showed gut microbiota and butyrate metabolism dysbiosis. This dysbiosis might provide a reference for the diagnosis and clinical therapy of diseases.

The quality of life and comfort levels of hemodialysis patients with constipation: A descriptive and cross-sectional study

INTRODUCTION

This study was conducted to determine the constipation-related quality of life, bowel habits, and comfort levels of constipated hemodialysis patients. It is known that the prevalence of constipation is high in hemodialysis patients.

METHODS

This was a cross-sectional and correlational study. The study included 164 hemodialysis patients who were determined to have constipation by examining the constipation statuses of 385 patients based on the Rome-IV criteria. The study was reported according to the STrengthening the Reporting of OBservational studies in Epidemiology Declaration.

FINDINGS

It was determined that as the constipation-related quality of life of the patients increased, their comfort levels also increased. Constipation-related quality of life increased in parallel with an increasing Bristol Stool Scale (BSS) score and an increasing number of bowel movements. The BSS scores of the patients were found to have a significant positive correlation with the patients' bowel movement frequencies and a significant negative correlation with their constipation frequencies. There was a negative correlation between years of dialysis and bowel movement frequencies. The presence of a previous gastrointestinal system complaint, the presence of an impact of constipation on the patient's dialysis session, and comfort levels were determined to be significant predictors of constipation-related quality of life that explained 26.3% of the total variance in constipation-related quality of life.

DISCUSSION

In patients receiving hemodialysis treatment, constipation is an important and frequently encountered problem. Constipation leads to a reduction in quality of life and hemodialysis-related comfort.