The effect of food, vitamin, or mineral supplements on chronic constipation in adults: A systematic review and meta-analysis of randomized controlled trials

Alice Van Der Schoot; Alice Creedon; Kevin Whelan; Eirini Dimidi

doi:10.1111/nmo.14613

The effect of food, vitamin, or mineral supplements on chronic constipation in adults: A systematic review and meta-analysis of randomized controlled trials

Alice Van Der Schoot, Alice Creedon, Kevin Whelan, Eirini Dimidi^*

^*Corresponding author for this work

Nutritional Sciences

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

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Abstract

Background: Over-the-counter supplements are commonly used to manage chronic constipation; however, their efficacy remains unclear. We aimed to investigate the effect of food, vitamin or mineral supplements on stool output, gut transit time, symptoms, and quality of life in adults with chronic constipation via a systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods: Studies were identified using electronic databases, backward citation, and hand-searching abstracts. RCTs reporting administration of food supplements (e.g., fruit extract supplements), vitamin or mineral supplements in adults with chronic constipation were included. Studies administering whole foods (e.g., fruits) were excluded. Risk of bias (RoB) was assessed with Cochrane RoB 2.0. Relative risks (RR), mean differences (MD), or standardized mean differences (95% confidence intervals [CI]) were calculated using a random-effects model.

Key Results: Eight RCTs (787 participants) were included, investigating kiwifruit (n = 3 RCTs), senna (n = 2), magnesium oxide (n = 2), Ziziphus jujuba (n = 1), and Malva Sylvestris (n = 1) supplements. Kiwifruit supplements did not impact stool frequency (MD 0.24 bowel movements/week [−0.32, 0.80]; p = 0.40) or consistency (MD −0.11 Bristol points [−0.31, 0.09], p = 0.29). Overall, 61% responded to senna and 28% to control; however, this did not reach statistical significance (RR 2.78, [0.93, 8.27]; p = 0.07). Overall, 68% responded to magnesium oxide and 19% to control (RR 3.32 [1.59, 6.92]; p = 0.001). Magnesium oxide improved stool frequency (MD 3.72 bowel movements/week [1.41, 6.03]; p = 0.002) and consistency (MD 1.14 Bristol points [0.48, 1.79]; p = 0.0007).

Conclusions and Inferences: Magnesium oxide supplements are effective at improving cardinal symptoms of chronic constipation. Senna and kiwifruit supplements did not impact symptoms; however, findings were based on a small number of studies. Further research is required to investigate the effect of food supplements (e.g., kiwifruit supplements), as well as their whole food equivalents (e.g., whole kiwifruits) in chronic constipation.

Original language	English
Article number	e14613
Journal	Neurogastroenterology and Motility
Volume	35
Issue number	11
Early online date	27 May 2023
DOIs	https://doi.org/10.1111/nmo.14613
Publication status	Published - Nov 2023

Keywords

constipation
food supplements
magnesium oxide
meta-analysis
senna
systematic review

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The effect of food_VAN DER SCHOOT_Accepted14May2023_GREEN AAMAccepted author manuscript, 721 KB

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@article{2c183eae3c65447981376623a3a12d75,

title = "The effect of food, vitamin, or mineral supplements on chronic constipation in adults: A systematic review and meta-analysis of randomized controlled trials",

abstract = "Background: Over-the-counter supplements are commonly used to manage chronic constipation; however, their efficacy remains unclear. We aimed to investigate the effect of food, vitamin or mineral supplements on stool output, gut transit time, symptoms, and quality of life in adults with chronic constipation via a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: Studies were identified using electronic databases, backward citation, and hand-searching abstracts. RCTs reporting administration of food supplements (e.g., fruit extract supplements), vitamin or mineral supplements in adults with chronic constipation were included. Studies administering whole foods (e.g., fruits) were excluded. Risk of bias (RoB) was assessed with Cochrane RoB 2.0. Relative risks (RR), mean differences (MD), or standardized mean differences (95% confidence intervals [CI]) were calculated using a random-effects model. Key Results: Eight RCTs (787 participants) were included, investigating kiwifruit (n = 3 RCTs), senna (n = 2), magnesium oxide (n = 2), Ziziphus jujuba (n = 1), and Malva Sylvestris (n = 1) supplements. Kiwifruit supplements did not impact stool frequency (MD 0.24 bowel movements/week [−0.32, 0.80]; p = 0.40) or consistency (MD −0.11 Bristol points [−0.31, 0.09], p = 0.29). Overall, 61% responded to senna and 28% to control; however, this did not reach statistical significance (RR 2.78, [0.93, 8.27]; p = 0.07). Overall, 68% responded to magnesium oxide and 19% to control (RR 3.32 [1.59, 6.92]; p = 0.001). Magnesium oxide improved stool frequency (MD 3.72 bowel movements/week [1.41, 6.03]; p = 0.002) and consistency (MD 1.14 Bristol points [0.48, 1.79]; p = 0.0007). Conclusions and Inferences: Magnesium oxide supplements are effective at improving cardinal symptoms of chronic constipation. Senna and kiwifruit supplements did not impact symptoms; however, findings were based on a small number of studies. Further research is required to investigate the effect of food supplements (e.g., kiwifruit supplements), as well as their whole food equivalents (e.g., whole kiwifruits) in chronic constipation.",

keywords = "constipation, food supplements, magnesium oxide, meta-analysis, senna, systematic review",

author = "{Van Der Schoot}, Alice and Alice Creedon and Kevin Whelan and Eirini Dimidi",

note = "Funding Information: AvdS and AC are currently funded by grants from the Almond Board of California. ED has received an education grant from Alpro, research funding from the British Dietetic Association, Almond Board of California, the International Nut and Dried Fruit Council and Nestec Ltd and has served as a consultant for Puratos. KW has received research funding from government bodies including National Institute of Health Research and Medical Research Council, charities including Crohn's and ColitisUK, ForCrohns, The Leona M. and Harry B. Helmsley Charitable Trust, Kenneth Rainin Foundation, as well as from industrial sources including Almond Board of California, Clasado Biosciences, Danone, and the International Dried Fruit and Nut Council. KW is the coinventor of biomarkers to detect IBS and markers of response. This systematic review was part of a project funded by the General and Education Trust Fund, British Dietetic Association (grant ID: 19/14). Funders had no role in the design, conduct, or publishment of this review. Publisher Copyright: {\textcopyright} 2023 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd.",

year = "2023",

month = nov,

doi = "10.1111/nmo.14613",

language = "English",

volume = "35",

journal = "Neurogastroenterology and Motility",

issn = "1350-1925",

publisher = "Wiley",

number = "11",

}

TY - JOUR

T1 - The effect of food, vitamin, or mineral supplements on chronic constipation in adults

T2 - A systematic review and meta-analysis of randomized controlled trials

AU - Van Der Schoot, Alice

AU - Creedon, Alice

AU - Whelan, Kevin

AU - Dimidi, Eirini

N1 - Funding Information: AvdS and AC are currently funded by grants from the Almond Board of California. ED has received an education grant from Alpro, research funding from the British Dietetic Association, Almond Board of California, the International Nut and Dried Fruit Council and Nestec Ltd and has served as a consultant for Puratos. KW has received research funding from government bodies including National Institute of Health Research and Medical Research Council, charities including Crohn's and ColitisUK, ForCrohns, The Leona M. and Harry B. Helmsley Charitable Trust, Kenneth Rainin Foundation, as well as from industrial sources including Almond Board of California, Clasado Biosciences, Danone, and the International Dried Fruit and Nut Council. KW is the coinventor of biomarkers to detect IBS and markers of response. This systematic review was part of a project funded by the General and Education Trust Fund, British Dietetic Association (grant ID: 19/14). Funders had no role in the design, conduct, or publishment of this review. Publisher Copyright: © 2023 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd.

PY - 2023/11

Y1 - 2023/11

N2 - Background: Over-the-counter supplements are commonly used to manage chronic constipation; however, their efficacy remains unclear. We aimed to investigate the effect of food, vitamin or mineral supplements on stool output, gut transit time, symptoms, and quality of life in adults with chronic constipation via a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: Studies were identified using electronic databases, backward citation, and hand-searching abstracts. RCTs reporting administration of food supplements (e.g., fruit extract supplements), vitamin or mineral supplements in adults with chronic constipation were included. Studies administering whole foods (e.g., fruits) were excluded. Risk of bias (RoB) was assessed with Cochrane RoB 2.0. Relative risks (RR), mean differences (MD), or standardized mean differences (95% confidence intervals [CI]) were calculated using a random-effects model. Key Results: Eight RCTs (787 participants) were included, investigating kiwifruit (n = 3 RCTs), senna (n = 2), magnesium oxide (n = 2), Ziziphus jujuba (n = 1), and Malva Sylvestris (n = 1) supplements. Kiwifruit supplements did not impact stool frequency (MD 0.24 bowel movements/week [−0.32, 0.80]; p = 0.40) or consistency (MD −0.11 Bristol points [−0.31, 0.09], p = 0.29). Overall, 61% responded to senna and 28% to control; however, this did not reach statistical significance (RR 2.78, [0.93, 8.27]; p = 0.07). Overall, 68% responded to magnesium oxide and 19% to control (RR 3.32 [1.59, 6.92]; p = 0.001). Magnesium oxide improved stool frequency (MD 3.72 bowel movements/week [1.41, 6.03]; p = 0.002) and consistency (MD 1.14 Bristol points [0.48, 1.79]; p = 0.0007). Conclusions and Inferences: Magnesium oxide supplements are effective at improving cardinal symptoms of chronic constipation. Senna and kiwifruit supplements did not impact symptoms; however, findings were based on a small number of studies. Further research is required to investigate the effect of food supplements (e.g., kiwifruit supplements), as well as their whole food equivalents (e.g., whole kiwifruits) in chronic constipation.

AB - Background: Over-the-counter supplements are commonly used to manage chronic constipation; however, their efficacy remains unclear. We aimed to investigate the effect of food, vitamin or mineral supplements on stool output, gut transit time, symptoms, and quality of life in adults with chronic constipation via a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: Studies were identified using electronic databases, backward citation, and hand-searching abstracts. RCTs reporting administration of food supplements (e.g., fruit extract supplements), vitamin or mineral supplements in adults with chronic constipation were included. Studies administering whole foods (e.g., fruits) were excluded. Risk of bias (RoB) was assessed with Cochrane RoB 2.0. Relative risks (RR), mean differences (MD), or standardized mean differences (95% confidence intervals [CI]) were calculated using a random-effects model. Key Results: Eight RCTs (787 participants) were included, investigating kiwifruit (n = 3 RCTs), senna (n = 2), magnesium oxide (n = 2), Ziziphus jujuba (n = 1), and Malva Sylvestris (n = 1) supplements. Kiwifruit supplements did not impact stool frequency (MD 0.24 bowel movements/week [−0.32, 0.80]; p = 0.40) or consistency (MD −0.11 Bristol points [−0.31, 0.09], p = 0.29). Overall, 61% responded to senna and 28% to control; however, this did not reach statistical significance (RR 2.78, [0.93, 8.27]; p = 0.07). Overall, 68% responded to magnesium oxide and 19% to control (RR 3.32 [1.59, 6.92]; p = 0.001). Magnesium oxide improved stool frequency (MD 3.72 bowel movements/week [1.41, 6.03]; p = 0.002) and consistency (MD 1.14 Bristol points [0.48, 1.79]; p = 0.0007). Conclusions and Inferences: Magnesium oxide supplements are effective at improving cardinal symptoms of chronic constipation. Senna and kiwifruit supplements did not impact symptoms; however, findings were based on a small number of studies. Further research is required to investigate the effect of food supplements (e.g., kiwifruit supplements), as well as their whole food equivalents (e.g., whole kiwifruits) in chronic constipation.

KW - constipation

KW - food supplements

KW - magnesium oxide

KW - meta-analysis

KW - senna

KW - systematic review

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U2 - 10.1111/nmo.14613

DO - 10.1111/nmo.14613

M3 - Article

C2 - 37243443

AN - SCOPUS:85160857619

SN - 1350-1925

VL - 35

JO - Neurogastroenterology and Motility

JF - Neurogastroenterology and Motility

IS - 11

M1 - e14613

ER -

The effect of food, vitamin, or mineral supplements on chronic constipation in adults: A systematic review and meta-analysis of randomized controlled trials

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