Abstract
Objectives
To assess the effectiveness of partially hydrolyzed guar gum (PHGG) in improving constipation and reducing the use of laxatives among long term care facility (LTCF) residents.
Design
A single-center, prospective, randomized, placebo-controlled, single-blinded parallel-group trial from September 2021 to November 2021.
Setting
Four LTCF in Hong Kong.
Participants
Fifty-two LTCF residents with chronic constipation (mean age: 83.9±7.6 years, male 38%).
Intervention
5g PHGG mixed with 200ml water per day for 4 weeks was given to intervention group participants. Control group received 200ml water for 4 weeks. Participants continued their usual as-needed laxative (lactulose, senna or dulcolax) on their own initiative.
Measurements
Baseline measurements included age, gender, Charlson comorbidity index, Roackwood’s Clinical Frailty Scale, body mass index and daily dietary fiber intake. Outcome measures were fecal characteristics assessed by Bristol Stool Form Scale, bowel opening frequency and laxative use frequency at baseline, first, second, third and fourth week of trial. Adverse events were measured. The study was registered on ClinicalTrial.gov; identifier: NCT 05037565.
Results
There was no significant difference in bowel frequency and stool characteristics between the treatment group and control group. However, there was a significantly lower frequency of lactulose, senna, and total laxative use in the treatment group compared with controls in the third and fourth week. There was no significant difference in adverse effects between the two groups.
Conclusion
This study showed that daily dietary fibre supplementation by using PHGG for 4 weeks in LTCF residents results in significantly less laxative use than placebo. It may be an effective way to reduce laxative dependence among older people living in LTCFs.
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References
Gustafsson M, Lamas K, Isaksson U, et al. Constipation and laxative use among people living in nursing homes in 2007 and 2013. BMC Geriatrics; 2019: 19:38, DOI: https://doi.org/10.1186/s12877-019-1054-x
Komiya H, Umegaki H, Asai A, et al. Prevalence and risk factors of constipation and pollakisuria among older home-care patients. Geriatr Gerontol Int 2019;19: 277–281, DOI: https://doi.org/10.1111/ggi.13610
Tariq SH, Morley JE, Prather CM. Health issues in the elderly: Fecal incontinence: Importance, clinical evaulation and treatment. Am J Med 2003;115: 217–227, DOI: https://doi.org/10.1016/s0002-9343(03)00327-9
Musa MK, Saga S, Blekken LE, Harris R, et al. The prevalence, incidence and correlates of fecal incontinence among older people residing in care homes: a systematic review. Journal of American Medical Directors Association 2019;20: 956–962, DOI: https://doi.org/10.1016/j.jamda.2019.03.033
Tariq SH. Constipation in long-term care. Journal of the American Medical Directors Association 2007;8: 209–218, DOI: https://doi.org/10.1016/j.jamda.2007.02.009
Bug S, Brinckman J, Cicconetti G, Valentine B. Efficacy of a herbal dietary supplement (Smooth Move) in the management of constipation in nursing home residents. Journal of the American Medical Directors Association 2006;7: 556–561, DOI: https://doi.org/10.1016/j.jamda.2006.06.001
Dahl WJ, Mendoza DR. Is fibre an effective strategy to improve laxation in long term care residents?. Canadian Journal of Dietetic Practice and Research 2018; 79: 35–41, DOI: https://doi.org/10.3148/cjdpr-2017-028
McRorie JW, Fahey GC, Gibb RD, Chey WD. Laxative effects of wheat bran and psyllium: Resolving enduring misconceptions about fiber in treatment guidelines for chronic idiopathic constipation. Journal of American Association of Nurse Practitioners 2020;32: 15–23, DOI: https://doi.org/10.1097/JXX.0000000000000346
Giannini EG, Mansi C, Dulbecco P, et al. Role of partially hydrolyzed guar gum in the treatment of irritable bowel syndrome. Nutrition 2006;22: 334–342, DOI: https://doi.org/10.1016/j.nut.2005.10.003
Quaratone G. Role of PHGG as a dietary fiber: a review article. Minerva Gastroenterol Dietol 2013;59: 329–340, PMID: 24212352
Niv E, Halak A, Tiommny E, et al. Randomized clinical study: Partially hydrolyzed guar gum (PHGG) versus placebo in the treatment of patients with irritable bowel syndrome. Nutrition & Metabolism 2016;13: 10, DOI: https://doi.org/10.1186/s12986-016-0070-5
Polymeros D, Beintaris I, Gaglia A, et al. Partially hydrolyzed guar gum accelerates colonic transit time and improves symptoms in adults with chronic constipation. Dig Dis Sci 2014;59: 2207–2214, DOI: https://doi.org/10.1007/s10620-014-3135-1
Ustundag G, Kuloglu Z, Kirbas N, et al. Can partially hydrolyzed guar gum be an alternative to lactulose in treatment of childhood constipation. Turk J Gastroenterol 2010;21: 360–364, DOI: https://doi.org/10.4318/tjg.2010.0121
Patrick PG, Gohman SM, Marx SC, et al. Effect of supplements of partially hydrolyzed guar gum on the occurrence of constipation and use of laxative agents. Journal of the American Dietetic Association 1998;98: 912–914, DOI: https://doi.org/10.1016/S0002-8223(98)00210-7
Finley JW, Soto-Vaca A, Heimbach J, et al. Safety Assessment and Caloric value of partially hydrolyzed guar gum. Journal of Agricultural and food chemistry 2013;61: 1756–1771, DOI: https://doi.org/10.1021/jf304910k
Takahashi H, Yang SI, Hayashi CH, et al. Effect of partially hydrolyzed guar gum on fecal output in human volunteers. Nutr Res 1993;13: 649–657, https://doi.org/10.1016/S0271-5317(05)80557-3
Daniels G, Schmelzer M. Giving laxatives safely and effectively. Nursing Pharmacology 2013; 22; 291–296, PMID: 24358569
Vincent C, Miller MA, Edens TJ, et al. Bloom and bust: intestinal microbiota dynamics in response to hospital exposures and Clostridium difficile colonization or infection. Microbiome 2016;4: 12, DOI: https://doi.org/10.1186/s40168-016-0156-3
Jump RL, Donskey CJ. Clostridium difficile in the long term care facility: prevention and management. Curr Geriatr Rep 2015;4: 60–69, DOI: https://doi.org/10.1007/s13670-014-0108-3
Yasukawa Z, Inoue R, Ozeki M, et al. Effect of repeated consumption of partially hydrolyzed guar gum on fecal characteristics and gut microbiota: A randomized, double blind, placebo-controlled, and parallel-group clinical trial. Nutrients 2019;11: 2170; doi: https://doi.org/10.3390/nu11092170, DOI: https://doi.org/10.3390/nu11092170
Takahashi C, Kozawa M. The effect of partially hydrolyzed guar gum on preventing influenza infection. Clinical Nutrition ESPEN 2021;42: 148–152, DOI: https://doi.org/10.1053/j.gastro.2005.11.061
Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gastroenterology 2006;130: 1480–1491, DOI: https://doi.org/10.1053/j.gastro.2005.11.061
Chan TC, Luk JK, Chu LW, et al. Validation study of Charlson Comorbidity Index in predicting mortality in Chinese older adults. Geriatrics and Gerontology International 2014;14: 452–457, DOI: https://doi.org/10.1111/ggi.12129
Rockwood K, Abeysundera J, Mitniski A. How should we grade frailty in nursing home patients? Journal of the American Medical Directors Association 2007; 8: 595–603, DOI: https://doi.org/10.1016/j.jamda.2007.07.012
ESHA’s Food Processor® Nutrition Analysis Software. ESHA Research website: https://esha.com/products/food-processor/
Riegler G, Esposito I. Bristol scale stool form. A still valid help in medical practice and clinical research. Tech Coloprotocol 2001;5: 163–164, DOI: https://doi.org/10.1007/s101510100019
Trumbo P, Schlicker S, Yates AA, Poos M. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. J Am Diet Assoc 2002;102: 1621–1630, DOI: https://doi.org/10.1016/s0002-8223(02)90346-9
Nowson CA, Sherwin AJ, McPhee JG, et al. Energy, protein, calcium, vitamin D and fiber intakes from meals in residential care establishments in Australia. Asia Pac J Clin Nutr 2003;12: 172–177, PMID: 12810407
Kyle S, Brooks C. Myths and misconceptions about constipation: a new view for the 2020s. Am J Gastroenterol 2020;115: 1741–1745, DOI: https://doi.org/10.14309/ajg.0000000000000947
Rodríguez RAI, Ruiz LMD, Malafarina V, et al. Menus offered in long-term care homes: quality of meal service and nutritional analysis. Nutr Hosp. 2017 Jun 5;34(3):584–592, DOI: https://doi.org/10.20960/nh.941
Acknowledgements and funding
The authors gratefully acknowledge the Research Matching Grant Scheme of the University Grants Committee from the government of Hong Kong Special Administrative Region [Grant ID: 207300993], which partially supported the study financially.
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Study concept, design and participant recruitments: TC Chan, JKY Yuen, JKH Luk, FHW Chan. Data collection: TC Chan, VMW Yu. Analysis and interpretation of data: TC Chan, LW Chu, VMV Yu. Preparation of paper: TC Chan, JKH Luk, LW Chu, FHW Chan.
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The research was approved by the Institutional Review Board of The University of Hong Kong. The study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice.
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The authors declare no conflict of interest.
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Chan, TC., Yu, V.M.W., Luk, J.K.H. et al. Effectiveness of Partially Hydrolyzed Guar Gum in Reducing Constipation in Long Term Care Facility Residents: A Randomized Single-Blinded Placebo-Controlled Trial. J Nutr Health Aging 26, 247–251 (2022). https://doi.org/10.1007/s12603-022-1747-2
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DOI: https://doi.org/10.1007/s12603-022-1747-2