1Clinical Nutrition Department， Daping Hospital， Army Medical University， Chongqing 400042， China；2General Surgery Department， Daping Hospital， Army Medical University， Chongqing 400042， China
Abstract：Objective To explore the effects of combined lifestyle guidance and early dietary fiber intervention on slow transit constipation. Methods 82 patients diagnosed with slow transit constipation at out-patient department of Daping Hospital， Army Medical University were prospectively included from October 2015 to November 2016. Dietary， exercise and constipation status were investigated. Lifestyle guidance was given via one-to-one interview. Oral intervention of dietary fiber complex was continuously given to each subject for 10days. Daily dietary intake and exercise amount of subjects were monitored by monthly telephone interview. One and six month after intervention beginning， follow-up was performed to evaluate constipation improvement， dietary intake， water consumption， exercise change， weekly stool frequency， stool consistency (Bristol Stool Score)， Patient Assessment of Constipation Symptoms score (PAC-SYM score). Results Among 82 patients， 7 subjects were lost to follow-up. Finally， data from 75 patients diagnosed with slow transit constipation was analyzed. The results showed that proportions of the following patient groups were elevated， including patients with balanced meat and vegetables， patients with combined whole grains and refined grains as their staple food， patients with 100-150g daily animal food consumption， patients with one share of daily fruit consumption， patients with 1，500-2，000ml daily water consumption and patients with regular exercise. Compared with baseline， the patient’s stool frequency increased significantly［(1.40±0.77) vs (3.67±1.20) vs (3.62±1.17)， both P<0.05］ at 1-mo and 6-mo. Meanwhile the defecate feeling demonstrated a significant reduction［(1.48±1.26) vs (1.13±1.24) vs (0.89±1.10) both P<0.05］ and Bristol scores increased remarkably［(1.99±1.34) vs (3.89±0.95) vs (3.87±0.99) both P<0.05］. The PAC-SYM scores had s significant reduction［(2.21±0.42) vs (1.43±0.57) vs (1.51±0.46) both P<0.05］. The clinical improvement rates reached 88.00% and 86.67%， respectively. Self-satisfaction rates were 85.33% and 80.00%， respectively. Conclusion As an integrative clinical measure， combined treatment with lifestyle guidance and early dietary fiber supplementation is effective to improve symptoms and satisfaction degree of patients with slow transit constipation.
张玲，刘高磊，张梦媛，刘洁，郭静，林欣，许红霞，李春穴. 生活方式指导联合早期膳食纤维补充改善慢传输型便秘的自身对照研究[J]. 肿瘤代谢与营养电子杂志, 2019, 6(2): 190-195.
ZHANG Ling， LIU Gao-lei， ZHANG Meng-yuan， LIU Jie，1UO Jing， LIN Xin， XU Hong-xia， LI Chun-xue. Combined life style guidance and early dietary fiber supplementation to improve slow transit constipation: a self-controlled study. Electron J Metab Nutr Cancer, 2019, 6(2): 190-195.
1.陈亭， 许红霞， 孙海岚， 等. 膳食纤维对肠动力障碍改善作用的研究进展. 肠外与肠内营养. 2017；24(2):122-126.
2.Bharucha AE， Pemberton JH， Locke GR. American Gastroentero-logical Association technical review on constipation. Gastroenterology， 2013；144(1):218-238.
3.Higgin PD， Johanson JF. Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol. 2004；99(4):750-759.
4.Belsey J， Greenfield S， Candy D， et al. Systematic review: impact of constipation on quality of life in adults and children. Aliment Pharmacol Ther. 2010；31(9):938-949.
5.Choung RS， Locke GR 3rd， Schleck CD， et al. Cumulative incidence of chronic constipation: a population-based study 1988-2003. Aliment Pharmacol Ther. 2007；26(11-12):1521-1528.
6.Sajid MS， Hebbar M， Baig MK， et al. Use of prucalopride for chronic constipation: a systematic review and meta-analysis of published randomized， controlled trials. J Neurogastroenterol Motil. 2016；22(3):412-422.
7.Clayden GS， Adeyinka T， Kufeji D， et al. Surgical management of severe chronic constipation. Arch Dis Child. 2010；95(11):859-860.
8.刘宝华， 付涛. 慢传输型便秘外科治疗进展. 第三军医大学学报. 2013；35(21):2255-2258.
9.Horvath A， Szajewska H. Probiotics， prebiotics， and dietary fiber in the management of functional gastrointestinal disorders. World Rev Nutr Diet. 2013；108:40-48.
10. 张媛媛. 膳食纤维制剂对老年便秘患者疗效及生活质量的影响. 中国现代医生. 2016；54(23):59-61.
11.Rome Foundation. Guidelines-Rome III diagnostic criteria for functional gastrointestinal disorders. J Gastrointestin Liver Dis. 2006；15(3):307-312.
12.焦广宇， 蒋卓勤.《临床营养学》第3版.北京：科学出版社.
13.Chumpitazi BP， Self MM， Czyzewski DI， et al. Bristol stool form scale reliability and agreement decreases when determining Rome III stool form designations. Neurogastroenterol Motil. 2016；28(3):443-448.
14.Yiannakou Y， Piessevaux H， Bouchoucha M. A randomized， double-blind， placebo-controlled， phase 3 trial to evaluate the efficacy， safety， and tolerability of prucalopride in men with chronic constipation. Am J Gastroenterol. 2015；110(5):741-748.
15.Eswaran S， Muir J， Chey WD. Fiber and functional gastrointestinal disorders. Am J Gastroenterol. 2013；108(5):718-727.
16.Meyer KA， Kushi LH， Jacobs DR Jr， et al. Carbohydrates， dietary fiber， and incident type 2 diabetes in older women. Am J Clin Nutr. 2000；71(4):921-930.
17.Wen W， Shu XO， Li H， Yang G， et al. Dietary carbohydrates， fiber， and breast cancer risk in Chinese women. Am J Clin Nutr. 2009；89(1):283-289.
18.Hijová E， Szabadosova V， tofilová J， et al. Chemopreventive and metabolic effects of inulin on colon cancer development. J Vet Sci. 2013；14(4):387-393.
19.龙连园， 刘薇群， 葛津津， 等. 功能性便秘患者自我效能与生活质量的关系研究. 上海医药. 2013；34(8):3-6.
20.Ladi-Seyedian SS， Sharifi-Rad L， Manouchehri N， et al. A comparative study of transcutaneous interferential electrical stimulation plus behavioral therapy and behavioral therapy alone on constipation in postoperative Hirschsprung disease children. J Pediatr Surg. 2017；52(1):177-183.
21.Tabbers MM， Boluyt N， Berger MY， et al. Nonpharmacologic treatments for childhood constipation: systematic review. Pediatrics. 2011；128(4):753-761.
22.Loening-Baucke V， Miel E， Staiano A. Fiber (glucomannan) is beneficial in the treatment of childhood constipation. Pediatrics. 2004；113(3 Pt 1):e259-264.
23.Yang J， Wang HP， Zhou L， et al. Effect of dietary fiber on constipation: a meta analysis. World J Gastroenterol. 2012；18(48):7378-7383.
24.范杨， 黎娜， 廖淑梅， 等. 复合膳食纤维对骨科住院病人便秘的防治效果观察. 肠外肠内营养. 2016；23(6):336-338.
25.Markland AD， Palsson O， Goode PS， et al. Association of low dietary intake of fiber and liquids with constipation: evidence from the national health and nutrition examination survey. Am J Gastroentero.2013；108(5):796-803.
26.Chmielewska A， Horvath A， Dziechciarz P， et al. Glucomannan is not effective for the treatment of functional constipation in children: a double-blind， placebo-controlled， randomized trial. Clin Nutr. 2011；30(4):462-468.
