Evidence-based Medical Evidence and Clinical Recommendations for Dietary Modification and Dietary Fiber Supplementation in the Treatment of Chronic Constipation

doi:10.12114/j.issn.1007-9572.2022.0112

Abstract

Abstract:

The incidence of chronic constipation is high, and it will seriously affect people's quality of life. There are many treatment methods for chronic constipation, including dietary modification, drug therapy, acupuncture and massage, exercise, surgery, etc. Dietary modification or dietary fiber supplementation therapy is often recommended before or in combination with drug therapy, but its application in clinical practice lacks specific norms. Based on evidence-based medical evidence, this paper analyzed the importance of dietary modification in the prevention and treatment of chronic constipation and the clinical efficacy of dietary fiber supplements, natural fruits or food raw materials in the treatment of chronic constipation, and put forward the application principles and specific methods of dietary modification and dietary fiber supplementation in clinical practice, in order to provide useful assistance to specialists, general practitioners and patients with chronic constipation.

Key words: Constipation, Signs and symptoms, digestive, Diet modification, Dietary therapy, Dietary fiber

摘要：

慢性便秘发病率较高，且严重影响人们的生命质量。慢性便秘的治疗方法众多，包括饮食调整、药物治疗、针灸按摩、运动、手术治疗等，饮食调整或膳食纤维补充治疗常被推荐用于药物治疗之前应用或与药物治疗联合应用，但在临床实践中缺乏具体的应用规范。本文以循证医学证据为基础，分析饮食调整对预防和治疗慢性便秘的重要地位以及膳食纤维补充剂、天然水果或食品原材料治疗慢性便秘的临床疗效，提出在临床实践中饮食调整、膳食纤维补充的应用原则和具体方法，旨在为专科医师、全科医师以及慢性便秘患者在治疗上提供有益的帮助。

关键词: 便秘, 体征和症状, 消化系统, 饮食调整, 饮食疗法, 膳食纤维

Songpeng SUN,Junhong LONG,Hong NI, et al. Evidence-based Medical Evidence and Clinical Recommendations for Dietary Modification and Dietary Fiber Supplementation in the Treatment of Chronic Constipation[J]. Chinese General Practice, 2022, 25(18): 2179-2187. DOI: 10.12114/j.issn.1007-9572.2022.0112.
孙松朋,龙俊红,倪红等. 饮食调整和膳食纤维补充治疗慢性便秘的循证医学证据和临床建议[J]. 中国全科医学, 2022, 25(18): 2179-2187. DOI: 10.12114/j.issn.1007-9572.2022.0112.

Figures/Tables 4

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膳食纤维分类	来源	可溶性	黏性	可发酵性
纤维素	所有绿色植物细胞壁	不溶	无黏性	低
木质素	所有绿色植物细胞壁	不溶	无黏性	低
阿拉伯木聚糖	小麦、车前草	低~中等	中等	低
β-葡聚糖	燕麦、大麦、菌类	低~中等	中~高等	高
半乳糖甘露聚糖	瓜尔胶、葫芦巴	中~高等	中~高等	高
葡甘聚糖	魔芋	高等	高等	高
果胶	水果、蔬菜、豆类	高等	中~高等	高
菊粉	谷类、水果、蔬菜	中~高等	低~高等	高
低聚半乳糖	豆类（大豆、豌豆、扁豆等）	高等	低等	高
糊精	谷物（小麦、淀粉提取物等）	高等	无~低等	高
藻酸盐	海藻	高等	高等	低
甲基纤维素	合成	高等	高等	无发酵
抗性淀粉-1	全谷物、豆类、生冷瓜果、蔬菜	不溶	无黏性	高
抗性淀粉-2	谷物、生豆类、生冷瓜果、蔬菜	低等	无黏性	高
抗性淀粉-3	任何烹饪和冷却的淀粉	低等	无黏性	高
抗性淀粉-4	合成（酰化淀粉等）	低~高等	低~中等	高
抗性淀粉-5	合成（直链淀粉和硬脂酸等）	低等	低等	低

膳食纤维分类	来源	可溶性	黏性	可发酵性
纤维素	所有绿色植物细胞壁	不溶	无黏性	低
木质素	所有绿色植物细胞壁	不溶	无黏性	低
阿拉伯木聚糖	小麦、车前草	低~中等	中等	低
β-葡聚糖	燕麦、大麦、菌类	低~中等	中~高等	高
半乳糖甘露聚糖	瓜尔胶、葫芦巴	中~高等	中~高等	高
葡甘聚糖	魔芋	高等	高等	高
果胶	水果、蔬菜、豆类	高等	中~高等	高
菊粉	谷类、水果、蔬菜	中~高等	低~高等	高
低聚半乳糖	豆类（大豆、豌豆、扁豆等）	高等	低等	高
糊精	谷物（小麦、淀粉提取物等）	高等	无~低等	高
藻酸盐	海藻	高等	高等	低
甲基纤维素	合成	高等	高等	无发酵
抗性淀粉-1	全谷物、豆类、生冷瓜果、蔬菜	不溶	无黏性	高
抗性淀粉-2	谷物、生豆类、生冷瓜果、蔬菜	低等	无黏性	高
抗性淀粉-3	任何烹饪和冷却的淀粉	低等	无黏性	高
抗性淀粉-4	合成（酰化淀粉等）	低~高等	低~中等	高
抗性淀粉-5	合成（直链淀粉和硬脂酸等）	低等	低等	低

类别	食物	膳食纤维含量	类别	食物	膳食纤维含量
水果	红富士苹果	2.1	谷物和杂豆	大麦	9.9
	梨	3.1		玉米面	5.5
	鲜枣	1.9		玉米糁	14.5
	芭蕉	3.1		玉米（爆米花）	14.5
	牛油果	6.7		小米	4.6
	黑莓	5.3		莜麦面	4.6
	猕猴桃（绿）	3.0		黄豆	15.5
蔬菜	大白菜（青口）	1.8		红小豆	7.7
	菠菜	1.7		芸豆	8.3
	油菜	2.0		麦片（即食谷物）	16.9~18.3
	韭菜	3.3		麸皮（即食谷物）	29.3~47.5
	番茄	1.9	干果	花生（油烤）	9.4
	辣椒（青、尖）	2.5		榛子	9.7
	白萝卜	1.8		开心果（干烤）	9.9
	莲藕	2.6		红枣	8.0
	豆角	2.1		葵花籽仁（烘烤）	11.1
	毛豆（青豆）	4.0		南瓜子（烘烤）	18.4
	扁豆	4.4	菌类	蘑菇（干）	21.0
	四季豆	4.7		木耳（干，黑）	29.9
	黄豆芽	3.6		松蘑（干）	47.8
	烤地瓜	3.3		香菇（干）	31.6
	豇豆（熟）	6.5		银耳（干）	30.4
	豌豆（青、熟）	4.1~5.5		紫菜（干）	21.6

类别	食物	膳食纤维含量	类别	食物	膳食纤维含量
水果	红富士苹果	2.1	谷物和杂豆	大麦	9.9
	梨	3.1		玉米面	5.5
	鲜枣	1.9		玉米糁	14.5
	芭蕉	3.1		玉米（爆米花）	14.5
	牛油果	6.7		小米	4.6
	黑莓	5.3		莜麦面	4.6
	猕猴桃（绿）	3.0		黄豆	15.5
蔬菜	大白菜（青口）	1.8		红小豆	7.7
	菠菜	1.7		芸豆	8.3
	油菜	2.0		麦片（即食谷物）	16.9~18.3
	韭菜	3.3		麸皮（即食谷物）	29.3~47.5
	番茄	1.9	干果	花生（油烤）	9.4
	辣椒（青、尖）	2.5		榛子	9.7
	白萝卜	1.8		开心果（干烤）	9.9
	莲藕	2.6		红枣	8.0
	豆角	2.1		葵花籽仁（烘烤）	11.1
	毛豆（青豆）	4.0		南瓜子（烘烤）	18.4
	扁豆	4.4	菌类	蘑菇（干）	21.0
	四季豆	4.7		木耳（干，黑）	29.9
	黄豆芽	3.6		松蘑（干）	47.8
	烤地瓜	3.3		香菇（干）	31.6
	豇豆（熟）	6.5		银耳（干）	30.4
	豌豆（青、熟）	4.1~5.5		紫菜（干）	21.6

膳食纤维	推荐剂量	研究人群	排便量	大便质地	排便次数	肠传输时间	腹部症状	不良反应
车前草^[47,48,49]	12 g/d	健康人、慢性便秘患者	增加	—	增加	无影响	—	无
部分水解的瓜尔胶^{[49,50,51,52,53]}	成年人5 g/d，4~6岁3 g/d，6~12岁4 g/d，12~16岁5 g/d	慢性便秘、IBS-C患者	—	改善	增加	缩短	腹胀缓解、腹痛改善	短暂不良反应或无
菊粉^[54]	3 g/次，3次/d	慢性便秘患者	—	改善	增加	—	—	排气轻度增加、偶发头疼
葡聚糖^{[55,56,57,58]}	8~12 g/d	慢性便秘患者、FC患者、健康者、透析者	增加	—	增加	—	—	少量不良反应或无