A high-fibre personalised dietary advice given via a web tool reduces constipation complaints in adults

Iris Rijnaarts, Nicole M de Roos, Taojun Wang, Erwin G Zoetendal, Jan Top, Marielle Timmer, Koen Hogenelst, Emily P Bouwman, Ben Witteman, Nicole de Wit, Iris Rijnaarts, Nicole M de Roos, Taojun Wang, Erwin G Zoetendal, Jan Top, Marielle Timmer, Koen Hogenelst, Emily P Bouwman, Ben Witteman, Nicole de Wit

Abstract

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.

Keywords: BMI, body mass index; Constipation; Dietary fibre; EMA, ecological momentary assessment; FFQ, food frequency questionnaire; Functional bowel disorders; IBS-C, Irritable Bowel Syndrome constipation predominant; MET, metabolic equivalent task; PAC-QoL, Patient Assessment of Constipation Quality of Life; PAC-SYM, Patient Assessment of Constipation Symptoms; PDA, personalised dietary advice; Personalised nutrition; QoL, quality of life; Quality of life; SQUASH, short questionnaire to assess health-enhancing physical activity; VAS, visual analogue scale.

© The Author(s) 2022.

Figures

Fig. 1.
Fig. 1.
Study design.
Fig. 2.
Fig. 2.
Study flowchart.
Fig. 3.
Fig. 3.
Changes in constipation severity over time. Legend: measured by the PAC-SYM questionnaire. Scores range from 0 to 4, a higher score indicating more severe constipation. Differences over time were tested with linear mixed models. Weeks 1 and 4 were observational, and week 8 is after the intervention.
Fig. 4.
Fig. 4.
Changes in the constipation-related QoL over time. lLegend: measured by the PAC-QoL questionnaire. Scores range from 0 to 4, a lower score indicating a better QoL. Differences over time were tested with linear mixed models. Weeks 1 and 4 were observational, and week 8 is after the intervention.
Fig. 5.
Fig. 5.
Analysis of daily measurements of stool pattern and complaints over time Legend: data were collected daily using the EMA application on a participants’ mobile phone. The dotted line represents the group average, the solid line represents the regression line. (a) Stool frequency per day, 0 indicating no stool that day. (b) Stool consistency, assessed by the Bristol stool chart per day, ranging from 1 ‘hard pellets’ to 7 ‘loose stools’. (c) Abdominal complaints assessed on a 100-point VAS from 0 ‘no complaints’ to 100 ‘very severe’.
Fig. 6.
Fig. 6.
Analysis of short-chain fatty acids and faecal microbiota composition over time. Legend: Values were presented as interquartile with the boxplot. Samples taken at different timepoints are connected by solid lines per subject. Weeks 1 and 4 were observational, and week 8 is after the intervention. No differences were observed in faecal acetate (a), propionate (b) and butyrate (c), microbiota ASV richness (d) and Shannon diversity (e) between the time points before and after intervention. A trend was observed for the comparison of microbiota composition stability based on weighted Unifrac distances between week 1 v. week 4, and week 4 v. week 8 (f). PCoA of microbiota composition based on weighted Unifrac distances (g) and unweighted Unifrac distances (h), stratification based on sampling timepoints.

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