Association of low dietary intake of fiber and liquids with constipation: Evidence from the National Health and Nutrition Examination Survey
Open accessAbstract
OBJECTIVES: Epidemiological studies support an association of self-defined constipation with fiber and physical activity, but not liquid intake. The aims of this study were to assess the prevalence and associations of dietary fiber and liquid intake to constipation. METHODS: Analyses were based on data from 10,914 adults (≥20 years) from the 2005-2008 cycles of the National Health and Nutrition Examination Surveys. Constipation was defined as hard or lumpy stools (Bristol Stool Scale type 1 or 2) as the "usual or most common stool type." Dietary fiber and liquid intake from total moisture content were obtained from dietary recall. Co-variables included: age, race, education, poverty income ratio, body mass index, self-reported general health status, chronic illnesses, and physical activity. Prevalence estimates and prevalence odds ratios (POR) were analyzed in adjusted multivariable models using appropriate sampling weights. RESULTS: Overall, 9,373 (85.9%) adults (4,787 women and 4,586 men) had complete stool consistency and dietary data. Constipation rates were 10.2% (95% confidence interval (CI): 9.6, 10.9) for women and 4.0% (95% CI: 3.2, 5.0) for men (P<.001). After multivariable adjustment, low liquid consumption remained a predictor of constipation among women (POR: 1.3, 95% CI: 1.0, 1.6) and men (POR: 2.4, 95% CI: 1.5, 3.9); however, dietary fiber was not a predictor. Among women, African-American race/ethnicity (POR: 1.4, 95% CI: 1.0, 1.9), being obese (POR: 0.7, 95% CI: 0.5,0.9), and having a higher education level (POR: 0.8, 95% CI: 0.7, 0.9) were significantly associated with constipation. CONCLUSIONS: The findings support clinical recommendations to treat constipation with increased liquid, but not fiber or exercise.
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In general, chronically constipated patients and nonconstipated persons drink similar amounts of fluid on a daily basis.
“In general, chronically constipated patients and nonconstipated persons drink similar amounts of fluid on a daily basis.”
From American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation (2023) · cites this paper as [35]
The Results (Univariate tests for risk factors; page unavailable) report significantly higher constipation rates among men and women in the lowest quartile of daily dietary-liquid intake. The Discussion says low intake of total liquids from food and beverages remained associated with constipation after adjustment, contrary to the claimed general similarity. The paper measures total dietary liquid, however, not beverages alone. (LLM, conf=0.81)
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Experimental — accuracy not yet measuredWhen individuals are placed in quartiles based on daily fluid intake, those in the lowest quartile for fluid intake are more likely to be constipated.
“However, when individuals are placed in quartiles based on daily fluid intake, those in the lowest quartile for fluid intake are more likely to be constipated.”
Human observational studies showed mixed associations between dietary fibers and constipation symptoms.
“yet human observational studies showed mixed associations between dietary fibers and constipation symptoms6,7.”
From Effects of dietary fibers or probiotics on functional constipation symptoms and roles of gut microbiota: a double-blinded randomized placebo trial (2023) · cites this paper as [7]
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“Although low water intake is associated with constipation (Markland et al., 2013), non-caloric beverage consumption was not tracked in this study, and thus we cannot report on the impact of water intake on outcomes.”
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Bowel Health in U.S. Shift Workers: Insights from a Cross-Sectional Study (NHANES)
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- Authors
- Markland, A. D., Palsson, O., Goode, P. S., Burgio, K. L., Busby-Whitehead, J., & Whitehead, W. E.
- Affiliations
- United States Department of Veterans Affairs (US)
- University of North Carolina at Chapel Hill (US)
- University of Alabama at Birmingham (US)
- Corresponding author
- Markland, Alayne D
- Venue
- American Journal of Gastroenterology
- Published
- 2013-05
- Volume
- 108
- Issue
- 5
- Pages
- 796-803
- ISSN
- 0002-9270 (ISSN-L)
- PMC
- PMC3786707
- OpenAlex
- W1999637841
- Cited by
- 254
- References
- 25
- Citations by year
- 2026: 15 · 2025: 23 · 2024: 39 · 2023: 16 · 2022: 16 · 2021: 17 · 2020: 33 · 2019: 15 · 2018: 17 · 2017: 17 · 2016: 22 · 2015: 12 · 2014: 8 · 2013: 3
- FWCI
- 14.17
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK031369, R01 DK31369)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Keywords
- constipation, dietary fiber, fluid intake, stool consistency, Bristol stool scale, sex differences, obesity, African American ethnicity, educational attainment, physical activity
- MeSH terms
- Adult, Aged, Black or African American, Constipation, Dietary Fiber, Drinking Behavior, Educational Status, Feeding Behavior, Female, Humans, Male, Middle Aged, Nutrition Surveys, Obesity, Risk Factors, Sex Factors, United States, Water Deprivation
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