Association between the severity of constipation and sarcopenia in elderly adults: A single center university hospital based, cross sectional study
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BIOMEDICAL REPORTS 14: 2, 2021
Association between the severity of constipation
and sarcopenia in elderly adults: A single‑center
university hospital‑based, cross‑sectional study
DAISUKE ASAOKA1, TSUTOMU TAKEDA1, YOSHIHIRO INAMI1, DAIKI ABE1, YUJI SHIMADA2,
KENSHI MATSUMOTO2, HIROYA UEYAMA2, KOHEI MATSUMOTO2, HIROYUKI KOMORI2,
YOICHI AKAZAWA2, TARO OSADA2, MARIKO HOJO2 and AKIHITO NAGAHARA2
1
Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo 136‑0075;
2
Department of Gastroenterology, University of Juntendo, School of Medicine, Tokyo 113‑8421, Japan
Received April 20, 2020; Accepted September 22, 2020
DOI: 10.3892/br.2020.1378
Abstract. The aim of the present study was to investigate the use (β= 0.211, P2 ASAOKA et al: RISK FACTORS FOR CONSTIPATION
the Department of Gastroenterology of Juntendo Tokyo Koto dual X‑ray absorptiometry (DXA; Prodigy Advance, GE
Geriatric Medical Center between April 2017 and March 2020. Healthcare). Subjects were positioned for whole‑body scans in
accordance with the manufacturer's protocol. The whole‑body
Inclusion criteria. Subjects were included if all of the fat mass and lean mass were divided into several regions, such
following information was available from their medical as the arms, legs, and trunk. The appendicular lean mass was
records: i) patient profile [age, sex, body mass index (BMI)]; estimated as the sum of the lean mass of the two upper limbs
ii) use of laxative/prokinetics; iii) evaluation of sarcopenia; and the lean mass of the two lower limbs. The appendicular
iv) nutritional status [albumin level, cholesterol level, skeletal muscle mass index (SMI) was calculated as the appen‑
lymphocyte count, CONtrolling NUTritional status (CONUT) dicular lean mass divided by the square of the height (kg/m2).
score]; v) questionnaires concerning the severity of constipa‑ A low appendicular skeletal muscle mass was defined as an
tion [Constipation Scoring System (CSS)] vi) questionnaire SMI ofBIOMEDICAL REPORTS 14: 2, 2021 3
8 and 9 into the Fullness domain, questions 10, 11 and 12 into
the Constipation domain, and questions 13, 14 and 15 into the
Diarrhea domain. Domain‑specific QOL impairment in the
Izumo scale is ranked from 0 (no QOL impairment) to 15.
It has good internal consistency and has good correlation
with the Gastrointestinal Symptom Rating Scale. In each
patient, the sum of the scores obtained for the three questions
in each domain (Reflux, Upper abdominal pain, Fullness,
Constipation, and Diarrhea) was calculated and defined as the
reflux‑related QOL score, upper abdominal pain‑related QOL
score, fullness‑related QOL score, constipation‑related QOL
score, and diarrhea‑related QOL score, respectively.
Questionnaire concerning stool shape. Stool consistency
and shape were assessed by the Bristol Stool Form Scale
(BSFS) (14), which classifies stool into seven categories: 1,
nut‑like; 2, lumpy sausage; 3, sausage with cracks; 4, smooth
snake; 5, soft blobs; 6, fluffy pieces; and 7, watery.
Ethics. This study was conducted in accordance with the
tenets of the Declaration of Helsinki. The Juntendo Tokyo Figure 1. A flow chart of the participants. Of the 365 study subjects, all of
Koto Geriatric Medical Center Ethics Committee approved the following information was available from the medical records: Patient's
the study and the study protocol (protocol no. 106‑12). With profile, laxative/prokinetics use, evaluation of sarcopenia, nutritional status,
and questionnaires [Constipation Scoring System (CSS), Izumo scale and
regard to informed consent of the participants, the Juntendo Bristol Stool Form Scale (BSFS)]; 42 cases with malignant disease, 5 cases
Tokyo Koto Geriatric Medical Center Ethics Committee with inflammatory bowel disease (IBD) and gastrectomy, 2 cases with
determined that this study was exempt from the need to obtain severe neuromuscular disease and 6 cases who were unable to walk due to
patient consent. According to the decision of the Juntendo severe osteoarthritis were excluded in this study. There were 310 eligible
participants.
Tokyo Koto Geriatric Medical Center Ethics Committee, we
notified the study subjects about our study contents on the
homepage of our hospital and guaranteed them the opportu‑
nity to refuse participation. Results
Statistical analyses. Clinical characteristics were compared Clinical characteristics of the study patients. A flow chart
between the sarcopenia and non‑sarcopenia groups and of participants is shown in Fig. 1. The clinical characteris‑
univariate analyses of clinical characteristics were performed tics of the 310 eligible study subjects [149 men (48.1%) and
using χ2 test and t‑test. Correlations between the constipation 161 women (51.9%); mean age, 75.7±6.1 years; mean body
scoring system (CSS) score and various clinical parameters mass index, 23.0±3.6 kg/m2] are summarized in Table I. The
(age, BMI, albumin level, cholesterol level, lymphocyte CSS score was significantly higher in the sarcopenia group
count, CONUT score, BSFS score, and reflux‑related, upper (n=83) than in the non‑sarcopenia group (n=227) (4.9±4.9
abdominal pain‑related, fullness‑related, constipation‑related, vs. 3.6±3.6, P=0.009). In addition, age (P4 ASAOKA et al: RISK FACTORS FOR CONSTIPATION Table I. Clinical characteristics of the study patients (n=310). Patient profile Total (n=310) Sarcopenia (n=83) Non‑sarcopenia (n=227) P‑value Age (years) 75.7 (±6.1)b 79.1 (±6.1)b 74.4 (±5.7)b
BIOMEDICAL REPORTS 14: 2, 2021 5 Table III. Association between the constipation scoring system (CSS) score and other variables in the multiple regression analysis. Variables B SE 95% CI of B β t VIF P‑value Age ‑0.059 0.031 0.120, 0.002 ‑0.091 ‑1.905 ‑0.081 0.058 Sex 0.477 0.372 ‑0.256, 1.210 0.060 1.280 0.055 0.201 BMI ‑0.033 0.052 ‑0.136, 0.070 ‑0.029 ‑0.625 ‑0.027 0.533 Laxative/prokinetics use 2.027 0.432 1.176, 2.878 0.211 4.688 0.200
6 ASAOKA et al: RISK FACTORS FOR CONSTIPATION
present; however, a common neuropathy may underlie both TO, MH and AN performed the data collection. All authors
constipation and sarcopenia. contributed to the writing of the manuscript and reviewed and
In addition, we found that the severity of constipation approved the final manuscript.
was positively related to the constipation‑related QOL score
and laxative/prokinetics use, and negatively related to stool Ethics approval and consent to participate
shape (BSFS score) in this study. Wald et al (3) suggested that
chronic constipation greatly impairs a patient's QOL. There The present study was conducted in accordance with the
were few reports of the association between use of laxa‑ tenets of the Declaration of Helsinki. The Juntendo Tokyo
tive/prokinetics and severity of constipation in Japan. By the Koto Geriatric Medical Center Ethics Committee approved
recent internet survey on the actual situation of constipation the study and the study protocol. According to the decision
in the Japanese population, 77.1% of patients with functional of the Juntendo Tokyo Koto Geriatric Medical Center Ethics
constipation used laxatives (22). In our study, it was shown Committee, we notified the study subjects concerning the
that laxative/prokinetics users may have severe constipation. contents of our study on the homepage of our hospital and
In a previous study, Tanabe et al (23) reported that QOL was guaranteed them the opportunity to refuse participation.
significantly impaired in the constipated group, and that the
BSFS score in the constipation group was significantly lower Patient consent for publication
than that in the control group, indicating that the stool was
harder in the constipation group than in the control group. Not applicable.
There were several limitations to this study. First,
the single‑center university hospital‑based retrospective Competing interests
cross‑sectional design prevented us from establishing causal
associations between the severity of constipation and sarco‑ The authors declare that they have no conflicts of interest.
penia. Second, the sample size was limited and we did not
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