Impact of Fiber Fermentation on Fecal Incontinence

描述（由申请人提供）：大便失禁（FI）是一种非自愿的粪便泄漏，是一种慢性问题，对健康和福祉有衰弱的影响。FI的症状管理对于维护患者的尊严、自尊和健康、减轻护理人员的负担以及防止进入养老院至关重要。大便疏松/液体粘稠度会加重FI，治疗的第一步是加强大便粘稠度。该研究解决了FI临床管理的一个主要空白，因为缺乏对FI粪便一致性干预措施的研究。纤维对粪便稠度和FI的有益作用似乎与纤维发酵的程度有关。优化纤维治疗和提高临床疗效的关键一步是确定纤维发酵的重要性。本研究的长期目标是：1)为使用可溶性膳食纤维有效控制FI提出基于证据的建议；2)确定可溶性膳食纤维改善粪便一致性和FI的机制。本建议的目的是确定发酵对纤维增强大便一致性、降低FI、促进补充剂耐受性和改善社区生活中有稀便或液体便的FI成人的生活质量的影响。采用随机、对照、单盲组间设计。两周后。基线期，184名患有稀便/液便FI的社区生活成年人将被随机分组，接受安慰剂或16 g总纤维/d的阿拉伯胶、马前草或羧甲基纤维素，分别代表三个水平的发酵能力（完全、适度和不可发酵）。在基线和补充期结束时，受试者将完成粪便日记（14d）、饮食记录（7d）、FI生活质量调查（7d）并收集所有粪便（7d）。在使用ANCOVA控制这些测量的基线值后，将比较补充后各组测量值之间的差异。

DESCRIPTION (provided by applicant): Fecal incontinence (FI), the involuntary leakage of feces, is a chronic problem with debilitating effects on health and well-being. Symptom management of FI is essential to maintain the dignity, self-esteem, and health of the individual, ease the burden of caregivers, and prevent admission to a nursing home. FI is worsened by loose/liquid stool consistency and the first step in its management is to firm stool consistency. The proposed study addresses a major gap in clinical management of FI since there is a lack of research on interventions to firm stool consistency in FI. The beneficial effects of fiber on stool consistency and FI appear to be related to the extent to which the fiber is fermented. A pivotal step in optimizing fiber therapy and improving the clinical response is to determine the importance of fermentation of fiber. The long-range objectives of this research are 1) to develop evidenced-based recommendations for using soluble dietary fiber to effectively manage FI and 2) to determine the mechanisms by which soluble dietary fiber improves stool consistency and FI. The objectives of this proposal are to determine the impact of fermentation on a fiber's ability to firm stool consistency, reduce FI, promote supplement tolerance, and improve quality of life in community-living adults with FI of loose or liquid stools. A randomized, controlled, single blind between groups design will be used. After a 2 wk. Baseline period, 184 community-living adults with FI of loose/liquid stool will be randomized to receive placebo or 16 g of total fiber/d in gum Arabic, psyllium, or carboxy-methylcellulose, representing three levels of ferment ability (completely, moderately, and non-fermentable, respectively). During the baseline and at the end of the supplementation period, subjects will complete a stool diary (14d), diet record (7d), FI Quality of Life survey, and collect all stools (7d). Differences among the measures of the groups after supplementation will be compared after controlling for baseline values of these measures using ANCOVA.