Impact of Fiber Fermentation on Fecal Incontinence

描述（由申请人提供）：粪便失禁（FI），粪便的不自主泄漏，是一种慢性问题，对健康和福祉具有破坏性影响。 FI的症状管理对于维护个人的尊严，自尊和健康，减轻照顾者的负担，并防止进入养老院至关重要。 FI因稀/液体粪便而恶化，其管理的第一步是使粪便变硬。 拟议的研究解决了FI临床管理中的一个主要差距，因为缺乏对FI中粪便硬度干预的研究。 纤维对粪便稠度和FI的有益影响似乎与纤维发酵的程度有关。 优化纤维疗法和改善临床反应的关键步骤是确定纤维发酵的重要性。 这项研究的长期目标是：1）制定基于证据的建议，使用可溶性膳食纤维有效地管理FI; 2）确定可溶性膳食纤维改善粪便稠度和FI的机制。 该提案的目的是确定发酵对纤维的能力的影响，以坚定粪便的一致性，减少FI，促进补充剂的耐受性，并改善生活质量的社区生活的成人与FI的松散或液体粪便。 将采用随机、对照、组间单盲设计。 2周后。基线期，184名患有稀/液体粪便FI的社区生活成年人将随机接受安慰剂或16 g总纤维/d的阿拉伯树胶、车前子或羧甲基纤维素，代表三种发酵能力水平（分别为完全、中度和不可发酵）。 在基线期间和补充期结束时，受试者将完成粪便日记（14天）、饮食记录（7天）、FI生活质量调查，并收集所有粪便（7天）。 在使用ANCOVA控制这些测量的基线值后，比较补充后各组测量之间的差异。

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.