Journal Article

O22 Dried fruit increases stool weight and patient quality of life in chronic constipation: a randomised, placebo-controlled, food intervention trial

Dimidi, Eirini, So, Daniel, Adami, Alice, Rodriguez-Mateos, Ana, Farsi, Dominic, Marchesi, Julian, Scott, Mark, Rucco, Valeria, Steenson, Simon, Bolton, Olivia, Katsirma, Zoi, Gibson, Philippa, Whelan, Kevin

2025

Overview

IntroductionChronic constipation is a common gastrointestinal (GI) disorder that impacts quality of life and has high levels of treatment dissatisfaction. Fruits containing sorbitol are recommended in clinical guidelines to manage chronic constipation despite few clinical trials. It is proposed that fruit fibre reduces gut transit time and increases stool weight, while sorbitol has osmotic effects in the gut. However, there is limited evidence on the contribution of fibre or sorbitol from food sources (alone or in combination) on constipation. Therefore, we tested the impact of dried fruit (containing fibre and sorbitol), fruit juice (sorbitol but no fibre), and a fruit-flavoured placebo (no fibre or sorbitol) on symptoms of constipation (NCT: 04086134).MethodsParticipants meeting Rome IV criteria for functional constipation were randomised to one of three arms: (1) 90 g/d dried fruit (30g each of prunes, raisins, apricots); (2) fruit juices from the same fruits (plums, grapes, apricots; volumes matched to dried fruits for sorbitol and energy); or (3) fruit cordial placebo (water/sugar with the same fruit flavourings; volumes matched for energy to other arms). The primary outcome was change in stool weight measured from 7-day total stool collection. Clinical outcomes included stool consistency/frequency, GI symptoms, constipation symptoms (PAC-SYM, CCCS) and quality of life (PAC-QOL). Differences between groups were analysed by ANCOVA (absolute endpoint values) or ANOVA (change) with Tukey post-hoc tests corrected for multiple comparisons.Results150 people with Rome IV functional constipation were recruited (88% female; mean age 33.9 y, SD ± 12.7). The primary outcome of change in stool weight was significantly different between groups (p=0.027): dried fruit (mean +21.2, SD ± 38.7 g/d), fruit juice (+13.2 ± 40.2 g/d) and placebo (+1.6 ± 25.8 g/d), with significantly greater increases following dried fruit than placebo (p=0.021). There were no significant differences in complete and/or spontaneous bowel movements or clinical scores between groups. The change in PAC-QOL satisfaction subscale scores (a lower score indicating improved quality of life) was different between groups (p=0.034): dried fruit (mean -5.8 ± 5.2); fruit juice (-5.1 ± 6.4); and placebo (-2.8 ± 6.2), with greater improvement in dried fruit vs. placebo (p=0.034). Dried fruits did not induce significant GI side effects, while change in severity of borborygmi was greater in juice (+0.1 ± 0.6) than dried fruit (-0.2 ± 0.5; p=0.016).ConclusionsThis is the largest clinical trial testing the impact of fruit in chronic constipation, indicating dried fruits (containing fibre and sorbitol) were more effective, than fruit juices (containing sorbitol alone). Analysis of gut microbiome and transit time (SmartPill™) data is currently underway.

• Publisher: BMJ Publishing Group LTD
• Subject: Clinical trials / Constipation / Digestive system / Flavorings / Food sources / Fruit juices / Fruits / Gastrointestinal tract / Intestinal microflora / Microbiomes / Placebos / Quality of life / Sorbitol / Weight