Alimentazione, fibre, stipsi Annamaria Staiano Dipartimento di Scienze Mediche Traslazionali Università di Napoli “Federico II”

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<ul><li> Slide 1 </li> <li> Alimentazione, fibre, stipsi Annamaria Staiano Dipartimento di Scienze Mediche Traslazionali Universit di Napoli Federico II </li> <li> Slide 2 </li> <li> &lt; 5% 5 - 10% 10 - 15% 15 - 20% Canada Finland Saudi Arabia Japan Brazil USA Turkey UK Greece &gt; 20% Italy Hong Kong Prevalence of constipation van den Berg MM et al. Am J Gastroenterol 2006; 101:2401-09 Rajindrajith S. et al. J Pediatr gastr Nutr 2010; 51:472-6 Sri Lanka </li> <li> Slide 3 </li> <li> Health Utilization and Cost Impact of Childhood Constipation in the United States O Liem, J Harman, M Benninga, H Mousa, K Kelleher, C Di Lorenzo J Pediatr 2009; 154: 258-62 Children with constipation impose a significant burden on healthcare utilization and costs Children with constipation $ 3.430/yr vs Children without constipation $ 1.099/yr PREVALENCE AND ECONOMIC BURDEN </li> <li> Slide 4 </li> <li> Journal Pediatr Gastroenterol Nutr 2014;58: 258274 </li> <li> Slide 5 </li> <li> What is the definition of functional constipation? 1. Based on expert opinion, we recommend the ROME III criteria for the definition of functional constipation for all age groups. Rasquin A et al. Gastroenterology. 2006 Apr;130(5):1527-37.Hyman PE et al. Gastroenterology. 2006 Apr;130(5):1519-26. </li> <li> Slide 6 </li> <li> Suzanne M. Mugie et al. Rev. Gastroenterol. Hepatol. 8, 502511 (2011) Causes and risk factors for childhood constipation Functional Constipation (90% - 95%) </li> <li> Slide 7 </li> <li> Most commonly used initial interventions Without FI With FI ? ? ? Yang CH, Punati J. JPGN 2015 </li> <li> Slide 8 </li> <li> Journal of Pediatric Gastroenterology and Nutrition 2003 36:329337 </li> <li> Slide 9 </li> <li> LE FIBRE ALIMENTARI INSOLUBILI CELLULOSA, LIGNINA, EMICELLULOSA si comportano prevalentemente come agenti di rigonfiamento in relazione alla loro CAPACIT DI ASSORBIRE ACQUA </li> <li> Slide 10 </li> <li> PECTINE, GOMME, MUCILLAGINI il parametro responsabile delleffetto funzionale la FERMENTABILIT LE FIBRE ALIMENTARI SOLUBILI </li> <li> Slide 11 </li> <li> CELLULOSAPolimeri non ramificati del glucosio Cereali integrali, verdura legumi, frutta Trattiene acqua Aumenta massa fecale Diminuisce transito intestinale Lega i sali biliari EMI- CELLULOSA Polimeri di esosiCereali integrali, verdura, legumi, frutta Trattiene acqua Aumenta massa fecale Diminuisce transito intestinale Lega i sali biliari LIGNINAPolimeri non saccaridici Cereali integrali, verdura, legumi, frutta Antiossidante Aumenta massa fecale Diminuisce transito intestinale Lega i sali biliari Es. CRUSCA DI FRUMENTO FIBRA INSOLUBILE </li> <li> Slide 12 </li> <li> PECTINA Polimeri di acido galatturonico Frutta, patate, carote, fagioli Aumenta il tempo di svuotamento gastrico e transito intestinale Aumenta SCFA Aumento attivit disaccarasica GOMMEPolisaccaridi di riserva Avena, orzo, legumi Aumenta il tempo di transito intestinale Diminuisce colesterolo Legano i sali biliari Formano sostanze viscose MUCILLAGINIMucopolisaccaridiAvena, orzo, legumi Aumenta il tempo di transito intestinale Diminuisce colesterolo Legano i sali biliari Formano sostanze viscose Es. GOMMA GUAR (Cyamopsis tetragonolubus), PECTINA FIBRA SOLUBILE </li> <li> Slide 13 </li> <li> LA FIBRA SOLUBILE PREBIOTICO (COLONIC FOOD) Alimento NON digeribile (dallorganismo umano) che influenza lospite stimolando selettivamente la crescita e/o lattivit di batteri residenti benefici nel colon producendo diversi metaboliti tra cui acidi grassi a corta catena (SCFA) GIBSON E ROBERFROID, 1995 </li> <li> Slide 14 </li> <li> Journal of Pediatric Gastroenterology and Nutrition 36:329337 </li> <li> Slide 15 </li> <li> Slide 16 </li> <li> Attalauri, et al. Aliment Pharmacol Ther 2011 The laxative effects a combination: sorbitol (14.7g 100g) dietary fiber (6g 100) polyphenols (184 mg 100g) exact mechanism has not been established </li> <li> Slide 17 </li> <li> Prunes (dried plums) are high in fibre and are perceived to promote healthy gastrointestinal (GI) function. In constipation, prunes appear superior to psyllium for improving stool frequency and consistency, however, the evidence for other outcomes and the effects in non- constipated subjects is weak. Although prunes may be a promising intervention for the management of constipation and increasing stool weight, this needs to be confirmed by further rigorous research. Lever E et al. Aliment Pharmacol Ther. 2014 Oct;40(7):750-8. </li> <li> Slide 18 </li> <li> Kivia powder containing Zyactinase is a freeze-dried powder from kiwifruit (Actinidia deliciosa var. Deliciosa) containing the enzyme actinidin, plant polyphenols, dietary fiber, carbohydrates, and oligosaccharides. Pediatrics 1962 Udani JK1, Bloom DW. Nutr J. 2013 Jun 8;12:78 </li> <li> Slide 19 </li> <li> Slide 20 </li> <li> In this randomized, doubleblind, placebo-controlled study, we examined the effects of Actazin and Gold, kiwifruit derived nutritional ingredients, on stool frequency, stool form, and gastrointestinal comfort in healthy and functionally constipated (Rome III criteria for C3 functional constipation) individuals In the healthy cohort the Actazin-H and Gold interventions significantly increased the mean daily bowel movements compared with the washout. In a subgroup analysis of responders in the healthy cohort, Actazin-L, Actazin-H, and Gold consumption significantly increased the number of daily bowel movements by greater than 1 bowel movement per week. This study demonstrated that Actazin and Gold produced clinically meaningful increases in bowel movements in healthy individuals. Ansell J et al. Nutr Res. 2015 Apr 11. </li> <li> Slide 21 </li> <li> Rhei rhizoma-based Japanese herbal medicines (JHMs) including Daiokanzoto and Mashiningan, and Kenchuto-based JHMs including Keishikashakuyakuto and Daikenchuto, which coordinate the motility of the alimentary tract. Shimoyama T, et al. J Gastroenterol Hepatol 2015 </li> <li> Slide 22 </li> <li> Lizuka N &amp; Hamamota Y, Frontiers in Pharmacol 2015 Rhei Rhizoma (rhubarb) Dianthrone glucosides (sennosides A to F) and anthraquinones Daikenchuto Ginger, Ginseng Radix Rubra, Zanthoxyli Fructus and Saccharum Granorum (maltose powder derived from rice) Has been successfully used to treat postoperative ileus since it stimulates peristalsis of the gastrointestinal tract </li> <li> Slide 23 </li> <li> Effect of Vegetables and Whole Grain Powder That Is Rich in Dietary Fibers on Bowel Functions and Defecation in Constipated Young Adults 51 subjects were supplied with rice flakes-powder (RFP) 45 subjects in the VP group (whole grain, chicory (inulin), and broccoli) were provided with 30 g of VP twice daily for 4 weeks Woo H-I, et al. J Cancer Prev 2015 In addition, significant differences between RFP and VP groups in stool hardness, amount, sensation of incomplete evacuation, and straining to defecate at day 14 and 28 of experimental diet </li> <li> Slide 24 </li> <li> A Randomized, Prospective, Comparison Study of a Mixture of Acacia Fiber, Psyllium Fiber and Fructose (AFPFF) versus Polyethylene Glycol 3350 with Electrolytes (PEG+E) for the Treatment of Chronic Functional Constipation in Childhood No significant difference were found between the efficacy of AFPFF and PEG+E in the treatment of children with CFC. Both medications were proved to be safe for CFC treatment, but PEG+E was better accepted by children. Quitadamo P. et al. J Pediatr. 2012 </li> <li> Slide 25 </li> <li> Prospective evaluation of dietary treatment in childhood constipation: high dietary fiber (DF) and wheat bran intake are associated with constipation amelioration High DF and bran intake are feasible in constipated children and contribute to amelioration of constipation BH and dietary data of 28 children with functional constipation defined by the "Boston criteria" were obtained at visit 1 (V1,n = 28) and at 4 follow-up visits (V2- V5, n = 80) At V1, median DF intake was 29.9% below the minimum recommended and at the last visit 49.9% above it At the last visit 21 children presented RECOVERY (REC) (improved, no complications; asymptomatic) (75%); 20 of them were asymptomatic and 18 were off washout/laxatives Maffei HV et al. JPGN 2011 Jan;52(1):55-9 </li> <li> Slide 26 </li> <li> Low fibre intake is associated with constipation. We found insufficient evidence from RCTs showing that extra fibre reduces constipation compared with placebo. We found insufficient evidence on the effects of increased fibre intake compared with lactulose. We found insufficient evidence from RCTs on the effects of probiotics versus placebo or versus osmotic laxatives at improving symptoms of constipation. Overall, many of the studies we found used different definitions and outcomes measures, and the quality of evidence was low. There is a need for further large high-quality RCTs in this condition. Tabbers MM, Benninga MA. BMJ Clin Evid. 2015 Mar 10;2015 </li> <li> Slide 27 </li> <li> Slide 28 </li> <li> What is the additional effect of nonpharmacological treatments in children with functional constipation? We recommend a normal fiber intake in children with constipation. We recommend a normal fluid intake in children with constipation. We recommend a normal physical activity in children with constipation. We do not recommend the routine use of prebiotics or probiotics in the treatment of childhood constipation. Journal Pediatr Gastroenterol Nutr 2014;58: 258274 </li> <li> Slide 29 </li> <li> CONCLUSIONI Si raccomanda una normale assunzione di fibre (5g+anni deta al giorno) Si raccomanda una normale assunzione di fluidi Al momento mancano studi RCT che provino lefficacia terapeutica delle fibre nella stipsi cronica funzionale Alimentazione, fibre, stipsi </li> </ul>

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