Yetişkinlerin Beslenme Alışkanlıklarının Konstipasyon ile İlişkisinin Belirlenmesi
Yıl 2024,
, 400 - 413, 20.06.2024
Hacı Ömer Yılmaz
,
Mustafa Özgür
Öz
Bu araştırma, yetişkinlerin beslenme alışkanlıkları ile konstipasyon durumlarının ilişkisini belirlemek amacıyla planlanmış ve yürütülmüştür. Araştırmanın verileri, çevrim içi anket aracılığıyla elde edilmiştir. Katılımcıların haftada üçten az defekasyon durumu varlığı konstipasyon (+) olarak değerlendirilmiştir. Araştırma verilerin elde edilmesi için kullanılan anket formu, sosyo-demografik özellikler, beslenme alışkanlıkları, Uluslararası Fiziksel Aktivite Formu (Kısa Versiyon) ve ulusal beslenme rehberi önerilerine göre besin gruplarının tüketim durumları yer almaktadır. Araştırma 330 katılımcı ile yürütülmüştür. Araştırmada yer alan katılımcılar arasında konstipasyon görülme sıklığı %28.8 olarak belirlenmiştir. Konstipasyon (+) olanların %55.8’i günde iki ana öğün tükettiğini ve %50.5’i öğün atladığını beyan etmiştir. Konstipasyon (+) olan katılımcıların konstipasyon (-) olan bireylere kıyasla haftalık yürüme aktivitesi istatistiksel olarak daha düşüktür (p<0.05). Süt ve ürünleri ve ekmek, tahıl ve kurubaklagil gruplarının çok değişkenli regresyon sonucuna göre anlamlı pozitif etkileri tespit edilmiştir. Sonuç olarak, konstipasyon durumu besin ve besin grupları ile yakından ilişkilidir. Özellikle süt ve ürünleri ve ekmek, tahıl ve kuru baklagil gruplarının önerilen miktarlarda tüketimi kontipasyon riskini azaltabilir ve/veya tedavisinde kullanılabilir.
Etik Beyan
Ethics committee permission was obtained from Burdur Mehmet Akif Ersoy University Non-Interventional Clinical Research Ethics Committee with the decision dated 04.10.2023 and numbered GO 2023/463.
Kaynakça
- REFERENCES
Aslam, H., Mohebbi, M., Ruusunen, A., Dawson, S. L., Williams, L. J., Berk, M., ... & Jacka, F. N. (2022). Associations between dairy consumption and constipation in adults: A cross-sectional study. Nutrition and Health, 28(1), 31-39.
- Bae, S. H. (2015). Diets for constipation. Pediatr Gastroenterol Hepatol Nutr,17, 203–208.
- Bellini, M., Tonarelli, S., Barracca, F., Rettura, F., Pancetti, A., Ceccarelli, L. & Rossi, A. (2021). Chronic constipation: is a nutritional approach reasonable? Nutrients, 13(10), 3386.
- Bharucha, A. E., Dorn, S. D., Lembo, A. & Pressman, A. (2013). American gastroenterological association medical position statement on constipation. Gastroenterology, 144(1), 211-217.
- Bharucha, A. E. & Sharma, M. (2018). Painful and painless constipation: all roads lead to (a change in) Rome. Digestive diseases and sciences, 63, 1671-1674.
- Camilleri, M., Ford, A. C., Mawe, G. M., Dinning, P. G., Rao, S. S., Chey, W. D. & Chang, L. (2017). Chronic constipation. Nature Reviews Disease Primers, 3(1), 1-19.
Cifci, I., Gokdemir, O., Aygun, O. & Guldal, D. (2023). Evaluation of functional constipation frequency and related factors. Family Practice, 40(2), 268-272.
- Coremans, G., Margaritis, V. & Gebruers, K. (2005). Is there a genetic component in chronic functional constipation? Gastroenterology, 128(4).
- Craig, C., Marshall, A., Sjostrom, M., Bauman, A., Lee, P., Macfarlane, D. & Stewart, S. (2017). International physical activity questionnaire-short form. J Am Coll Health, 65(7), 492-501.
- Fathallah, N., Bouchard, D. & de Parades, V. (2017). Diet and lifestyle rules in chronic constipation in adults: From fantasy to reality. Presse Medicale, 46(1), 23-30.
- Folden, S. L. (2002). Practice guidelines for the management of constipation in adults. Rehabilitation Nursing, 27(5), 169-175.
- Ford, A. C., Moayyedi, P., Lacy, B. E., Lembo, A. J., Saito, Y. A., Schiller, L. R. & Quigley, E. M. (2014). American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Official Journal of the American College of Gastroenterology, 109, 2-26.
- Forootan, M., Bagheri, N. & Darvishi, M. (2018). Chronic constipation: A review of literature. Medicine, 97(20).
- Harada, M., Tsuboyama-Kasaoka, N., Yonekura, Y., Shimoda, H., Ogawa, A., Kobayashi, S. & Nishi, N. (2023). Associations between lifestyle factors and constipation among survivors after the great East Japan earthquake: A 9-year follow-up study. Journal of Epidemiology, JE20220284.
- Karakaya, I. C., Kilic, Z., Yilmaz, U. & Karakaya, M. G. (2015). Relation of constipation problem and physical activity level in university students. TAF Preventive Medicine Bulletin, 14(4), 329-32.
- Konradsen, H., Lundberg, V., Florin, J. & Boström, A. M. (2022). Prevalence of constipation and use of laxatives, and association with risk factors among older patients during hospitalization: A cross sectional study. BMC Gastroenterology, 22(1), 1-10.
- Küçük, U. & Karadeniz, H. (2021). Yaşlanmaya bağlı bireylerde görülen fizyolojik, ruhsal, sosyal değişiklikler ve korunmaya yönelik önlemler. Yaşlı Sorunları Araştırma Dergisi, 14(2), 96-103.
- Lambert, K., Bird, L., Borst, A. C., Fuller, A., Wang, Y., Rogers, G. B. & Lonergan, M. (2020). Safety and efficacy of using nuts to improve bowel health in hemodialysis patients. Journal of Renal Nutrition, 30(5), 462-469.
- Lembo, A. (2023). Chronic constipation. Handbook of Gastrointestinal Motility and Disorders of Gut-Brain Interactions, 263-276.
- Lim, Y. J., Rosita, J., Chieng, J. Y. & Hazizi, A. S. (2016). The prevalence and symptoms characteristic of functional constipation using Rome III diagnostic criteria among tertiary education students. PLoS One, 11(12), e0167243.
- Malcomson, F. C., Willis, N. D., McCallum, I., Xie, L., Shivappa, N., Wirth, M. D. & Mathers, J. C. (2021). Diet-associated inflammation modulates inflammation and WNT signaling in the rectal mucosa, and the response to supplementation with dietary fiber. Cancer Prevention Research, 14(3), 337-346.
- Markland, A. D., Palsson, O., Goode, P. S., Burgio, K. L., Busby-Whitehead, J. & Whitehead, W. E. (2013). Association of low dietary intake of fiber and liquids with constipation: evidence from the National Health and Nutrition Examination Survey (NHANES). The American Journal of Gastroenterology, 108(5), 796.
- Menefee, S. A. & Wall, L.L. (2004). Inkontinans, prolapsus ve pelvik taban hastalıkları. Novak Jinekoloji (Erk A, çev. ed), 13, 690-691.
- Moreira, T. R., Leonhardt, D. & Conde, S. R. (2017). Influence of drinking a probiotic fermented milk beverage containing Bifidobacterium animalis on the symptoms of constipation. Arquivos de Gastroenterologia, 54, 206-210.
- Murakami, K., Okubo, H. & Sasaki, S. (2006). Dietary intake in relation to self-reported constipation among Japanese women aged 18–20 years. European Journal of Clinical Nutrition, 60(5), 650-657.
- Nurbadriyah, W. D. (2022). Analysis of eatıng behavior in constpation with Lawrence Green Theory Approach. Jurnal Kesehatan Mesencephalon, 8(1).
- Okuda, M., Kunitsugu, I., Yoshitake, N. & Sasaki, S. (2019). The relationship between functional constipation and dietary habits in school-age Japanese children. Journal of Nutritional Science and Vitaminology, 65(1), 38-44.
- Omagari, K., Kumamoto, R., Koyama, Y., Suzuta, M., Taniguchu, A., Fukuda, A. & Otsuka, K. (2020). Prevalence of chronic constipation and irritable bowel syndrome, and their overlap, among female undergraduate students in Japan. OBM Hepatology and Gastroenterology, 4(2), 1-18.
- Öztürk, M. (2005). Üniversitede eğitim öğretim gören öğrencilerde uluslararası fiziksel aktivite anketinin (IPAQ) geçerliliği ve güvenirliği ve fiziksel aktivite düzeyinin belirlenmesi. (Yüksek Lisans Tezi). Hacettepe Üniversitesi Sağlık Bilimleri Enstitüsü
- Rao, S. S., Rattanakovit, K. & Patcharatrakul, T. (2016). Diagnosis and management of chronic constipation in adults. Nature Reviews Gastroenterology & Hepatology, 13(5), 295-305.
- Serbest, M. O. (2015). Sporcularda gastrointestinal sistem sorunlari. Spor Hekimliği Dergisi, 50(1), 31-45.
- Serra, J., Pohl, D., Azpiroz, Chiarioni, G., Ducrotté. P. & Gourcerol. G. (2020). European society of neurogastroenterology and motility guidelines on functional constipation in adults. Neurogastroenterol Motil, 32, e13762.
- Shiga, T. M., Soares, C. A., Nascimento, J. R., Purgatto, E., Lajolo, F. M. & Cordenunsi, B. R. (2011). Ripening‐associated changes in the amounts of starch and non‐starch polysaccharides and their contributions to fruit softening in three banana cultivars. Journal of the Science of Food and Agriculture, 91(8), 1511-1516.
- Stephen, A. M., Champ, M. M. J., Cloran, S. J., Fleith, M., Van Lieshout, L., Mejborn, H. & Burley, V. J. (2017). Dietary fibre in Europe: current state of knowledge on definitions, sources, recommendations, intakes and relationships to health. Nutrition Research Reviews, 30(2), 149-190.
- Stewart, M. L. & Schroeder, N. M. (2013). Dietary treatments for childhood constipation: efficacy of dietary fiber and whole grains. Nutrition Reviews, 71(2), 98-109.
- T.C. Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü (2022). Türkiye Beslenme Rehberi (TÜBER). In 12.10.2023 Retrieved from https://hsgm.saglik.gov.tr/depo/birimler/saglikli-beslenme-ve-hareketli-hayat db/Dokumanl ar/Rehberler/Turkiye_Beslenme_Rehber_TUBER_2022_min.pdf
Ueki, T., & Nakashima, M. (2019). Relationship between constipation and medication. Journal of UOEH, 41(2), 145-151.
- Uzun, Y., Coşar, A. M. & Erkut, M. (2019). Yaşlılık ve kabızlık. Güncel Gastroenteroloji, 23(2), 97-100.
- Verkuijl, S. J., Meinds, R. J., Trzpis, M. & Broens, P. M. (2020). The influence of demographic characteristics on constipation symptoms: a detailed overview. BMC Gastroenterology, 20, 1-9.
- Wagner, C., Equit, M., Niemczyk, J. & von Gontard, A. (2015). Obesity, overweight, and eating problems in children with incontinence. Journal of Pediatric Urology, 11(4), 202-207.
- World Health Organization (WHO). (2006). Constitution of the World Health Organization. Basic Documents, Forty-fifth Edition.
- World Health Organization (WHO). (2000). Obesity: Preventing and managing the global epidemic. World Health Organization Technical Report Series, 894, 1-253.
- Yamada, M., Sekine, M., Tatsuse, T. & Fujimura, Y. (2021). Lifestyle, psychological stress, and incidence of adolescent constipation: results from the Toyama birth cohort study. BMC Public Health, 21, 1-9.
- Yang, X. J., Zhang, M., Zhu, H. M., Tang, Z., Zhao, D. D., Li, B. Y. & Gabriel, A. (2016). Epidemiological study: Correlation between diet habits and constipation among elderly in Beijing region. World Journal of Gastroenterology, 22(39), 8806–8811.
- Yurtdaş, G., Acar-Tek, N., Akbulut, G., Cemali, Ö., Arslan, N., Beyaz Coşkun, A. & Zengin, F. H. (2020). Risk factors for constipation in adults: A cross-sectional study. Journal of the American College of Nutrition, 39(8), 713-719.
- Zhang, L., Zhang, L., Yan, Y. C., Dong, F. L., Sun, W. G., Guo, X. W., Sun, L. & He, M. E. (2009). Efficacy of dietary intervention in patients with constipation. Chinese Journal of Disease Control, 13(05), 600-601.
- Zhao, X., Wang, L. & Quan, L. (2023). Association between dietary phosphorus intake and chronic constipation in adults: evidence from the National Health and Nutrition Examination Survey. BMC Gastroenterology, 23(1), 1-14.
DETERMINING THE RELATIONSHIP BETWEEN ADULTS' NUTRITIONAL HABITS AND CONSTIPATION
Yıl 2024,
, 400 - 413, 20.06.2024
Hacı Ömer Yılmaz
,
Mustafa Özgür
Öz
This study was planned and conducted to determine the relationship between dietary habits and constipation status of adults. The data of the study were obtained via an online questionnaire. The presence of less than three defecations per week was considered as constipation (+). The questionnaire form used to collect the study data included socio-demographic characteristics, eating habits, consumption status of food groups according to the International Physical Activity Form (Short Version) and national dietary guide recommendations. The study was conducted with 330 participants. The prevalence of constipation was determined as 28.8% among the participants in the study. Among those with constipation (+), 55.8% reported consuming two main meals per day and 50.5% reported skipping meals. The weekly walking activity of participants with constipation (+) was statistically lower than those with constipation (-) (p<0.05). According to the multivariate regression result, significant positive effects of dairy products and bread, cereal and legume groups were found on constipation status. As a result, constipation is closely associated with dietary habits and food groups. In particular, the consumption of dairy products and bread, cereals and legume groups in recommended amounts can reduce the risk of constipation and/or utilized in its treatment.
Kaynakça
- REFERENCES
Aslam, H., Mohebbi, M., Ruusunen, A., Dawson, S. L., Williams, L. J., Berk, M., ... & Jacka, F. N. (2022). Associations between dairy consumption and constipation in adults: A cross-sectional study. Nutrition and Health, 28(1), 31-39.
- Bae, S. H. (2015). Diets for constipation. Pediatr Gastroenterol Hepatol Nutr,17, 203–208.
- Bellini, M., Tonarelli, S., Barracca, F., Rettura, F., Pancetti, A., Ceccarelli, L. & Rossi, A. (2021). Chronic constipation: is a nutritional approach reasonable? Nutrients, 13(10), 3386.
- Bharucha, A. E., Dorn, S. D., Lembo, A. & Pressman, A. (2013). American gastroenterological association medical position statement on constipation. Gastroenterology, 144(1), 211-217.
- Bharucha, A. E. & Sharma, M. (2018). Painful and painless constipation: all roads lead to (a change in) Rome. Digestive diseases and sciences, 63, 1671-1674.
- Camilleri, M., Ford, A. C., Mawe, G. M., Dinning, P. G., Rao, S. S., Chey, W. D. & Chang, L. (2017). Chronic constipation. Nature Reviews Disease Primers, 3(1), 1-19.
Cifci, I., Gokdemir, O., Aygun, O. & Guldal, D. (2023). Evaluation of functional constipation frequency and related factors. Family Practice, 40(2), 268-272.
- Coremans, G., Margaritis, V. & Gebruers, K. (2005). Is there a genetic component in chronic functional constipation? Gastroenterology, 128(4).
- Craig, C., Marshall, A., Sjostrom, M., Bauman, A., Lee, P., Macfarlane, D. & Stewart, S. (2017). International physical activity questionnaire-short form. J Am Coll Health, 65(7), 492-501.
- Fathallah, N., Bouchard, D. & de Parades, V. (2017). Diet and lifestyle rules in chronic constipation in adults: From fantasy to reality. Presse Medicale, 46(1), 23-30.
- Folden, S. L. (2002). Practice guidelines for the management of constipation in adults. Rehabilitation Nursing, 27(5), 169-175.
- Ford, A. C., Moayyedi, P., Lacy, B. E., Lembo, A. J., Saito, Y. A., Schiller, L. R. & Quigley, E. M. (2014). American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Official Journal of the American College of Gastroenterology, 109, 2-26.
- Forootan, M., Bagheri, N. & Darvishi, M. (2018). Chronic constipation: A review of literature. Medicine, 97(20).
- Harada, M., Tsuboyama-Kasaoka, N., Yonekura, Y., Shimoda, H., Ogawa, A., Kobayashi, S. & Nishi, N. (2023). Associations between lifestyle factors and constipation among survivors after the great East Japan earthquake: A 9-year follow-up study. Journal of Epidemiology, JE20220284.
- Karakaya, I. C., Kilic, Z., Yilmaz, U. & Karakaya, M. G. (2015). Relation of constipation problem and physical activity level in university students. TAF Preventive Medicine Bulletin, 14(4), 329-32.
- Konradsen, H., Lundberg, V., Florin, J. & Boström, A. M. (2022). Prevalence of constipation and use of laxatives, and association with risk factors among older patients during hospitalization: A cross sectional study. BMC Gastroenterology, 22(1), 1-10.
- Küçük, U. & Karadeniz, H. (2021). Yaşlanmaya bağlı bireylerde görülen fizyolojik, ruhsal, sosyal değişiklikler ve korunmaya yönelik önlemler. Yaşlı Sorunları Araştırma Dergisi, 14(2), 96-103.
- Lambert, K., Bird, L., Borst, A. C., Fuller, A., Wang, Y., Rogers, G. B. & Lonergan, M. (2020). Safety and efficacy of using nuts to improve bowel health in hemodialysis patients. Journal of Renal Nutrition, 30(5), 462-469.
- Lembo, A. (2023). Chronic constipation. Handbook of Gastrointestinal Motility and Disorders of Gut-Brain Interactions, 263-276.
- Lim, Y. J., Rosita, J., Chieng, J. Y. & Hazizi, A. S. (2016). The prevalence and symptoms characteristic of functional constipation using Rome III diagnostic criteria among tertiary education students. PLoS One, 11(12), e0167243.
- Malcomson, F. C., Willis, N. D., McCallum, I., Xie, L., Shivappa, N., Wirth, M. D. & Mathers, J. C. (2021). Diet-associated inflammation modulates inflammation and WNT signaling in the rectal mucosa, and the response to supplementation with dietary fiber. Cancer Prevention Research, 14(3), 337-346.
- Markland, A. D., Palsson, O., Goode, P. S., Burgio, K. L., Busby-Whitehead, J. & Whitehead, W. E. (2013). Association of low dietary intake of fiber and liquids with constipation: evidence from the National Health and Nutrition Examination Survey (NHANES). The American Journal of Gastroenterology, 108(5), 796.
- Menefee, S. A. & Wall, L.L. (2004). Inkontinans, prolapsus ve pelvik taban hastalıkları. Novak Jinekoloji (Erk A, çev. ed), 13, 690-691.
- Moreira, T. R., Leonhardt, D. & Conde, S. R. (2017). Influence of drinking a probiotic fermented milk beverage containing Bifidobacterium animalis on the symptoms of constipation. Arquivos de Gastroenterologia, 54, 206-210.
- Murakami, K., Okubo, H. & Sasaki, S. (2006). Dietary intake in relation to self-reported constipation among Japanese women aged 18–20 years. European Journal of Clinical Nutrition, 60(5), 650-657.
- Nurbadriyah, W. D. (2022). Analysis of eatıng behavior in constpation with Lawrence Green Theory Approach. Jurnal Kesehatan Mesencephalon, 8(1).
- Okuda, M., Kunitsugu, I., Yoshitake, N. & Sasaki, S. (2019). The relationship between functional constipation and dietary habits in school-age Japanese children. Journal of Nutritional Science and Vitaminology, 65(1), 38-44.
- Omagari, K., Kumamoto, R., Koyama, Y., Suzuta, M., Taniguchu, A., Fukuda, A. & Otsuka, K. (2020). Prevalence of chronic constipation and irritable bowel syndrome, and their overlap, among female undergraduate students in Japan. OBM Hepatology and Gastroenterology, 4(2), 1-18.
- Öztürk, M. (2005). Üniversitede eğitim öğretim gören öğrencilerde uluslararası fiziksel aktivite anketinin (IPAQ) geçerliliği ve güvenirliği ve fiziksel aktivite düzeyinin belirlenmesi. (Yüksek Lisans Tezi). Hacettepe Üniversitesi Sağlık Bilimleri Enstitüsü
- Rao, S. S., Rattanakovit, K. & Patcharatrakul, T. (2016). Diagnosis and management of chronic constipation in adults. Nature Reviews Gastroenterology & Hepatology, 13(5), 295-305.
- Serbest, M. O. (2015). Sporcularda gastrointestinal sistem sorunlari. Spor Hekimliği Dergisi, 50(1), 31-45.
- Serra, J., Pohl, D., Azpiroz, Chiarioni, G., Ducrotté. P. & Gourcerol. G. (2020). European society of neurogastroenterology and motility guidelines on functional constipation in adults. Neurogastroenterol Motil, 32, e13762.
- Shiga, T. M., Soares, C. A., Nascimento, J. R., Purgatto, E., Lajolo, F. M. & Cordenunsi, B. R. (2011). Ripening‐associated changes in the amounts of starch and non‐starch polysaccharides and their contributions to fruit softening in three banana cultivars. Journal of the Science of Food and Agriculture, 91(8), 1511-1516.
- Stephen, A. M., Champ, M. M. J., Cloran, S. J., Fleith, M., Van Lieshout, L., Mejborn, H. & Burley, V. J. (2017). Dietary fibre in Europe: current state of knowledge on definitions, sources, recommendations, intakes and relationships to health. Nutrition Research Reviews, 30(2), 149-190.
- Stewart, M. L. & Schroeder, N. M. (2013). Dietary treatments for childhood constipation: efficacy of dietary fiber and whole grains. Nutrition Reviews, 71(2), 98-109.
- T.C. Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü (2022). Türkiye Beslenme Rehberi (TÜBER). In 12.10.2023 Retrieved from https://hsgm.saglik.gov.tr/depo/birimler/saglikli-beslenme-ve-hareketli-hayat db/Dokumanl ar/Rehberler/Turkiye_Beslenme_Rehber_TUBER_2022_min.pdf
Ueki, T., & Nakashima, M. (2019). Relationship between constipation and medication. Journal of UOEH, 41(2), 145-151.
- Uzun, Y., Coşar, A. M. & Erkut, M. (2019). Yaşlılık ve kabızlık. Güncel Gastroenteroloji, 23(2), 97-100.
- Verkuijl, S. J., Meinds, R. J., Trzpis, M. & Broens, P. M. (2020). The influence of demographic characteristics on constipation symptoms: a detailed overview. BMC Gastroenterology, 20, 1-9.
- Wagner, C., Equit, M., Niemczyk, J. & von Gontard, A. (2015). Obesity, overweight, and eating problems in children with incontinence. Journal of Pediatric Urology, 11(4), 202-207.
- World Health Organization (WHO). (2006). Constitution of the World Health Organization. Basic Documents, Forty-fifth Edition.
- World Health Organization (WHO). (2000). Obesity: Preventing and managing the global epidemic. World Health Organization Technical Report Series, 894, 1-253.
- Yamada, M., Sekine, M., Tatsuse, T. & Fujimura, Y. (2021). Lifestyle, psychological stress, and incidence of adolescent constipation: results from the Toyama birth cohort study. BMC Public Health, 21, 1-9.
- Yang, X. J., Zhang, M., Zhu, H. M., Tang, Z., Zhao, D. D., Li, B. Y. & Gabriel, A. (2016). Epidemiological study: Correlation between diet habits and constipation among elderly in Beijing region. World Journal of Gastroenterology, 22(39), 8806–8811.
- Yurtdaş, G., Acar-Tek, N., Akbulut, G., Cemali, Ö., Arslan, N., Beyaz Coşkun, A. & Zengin, F. H. (2020). Risk factors for constipation in adults: A cross-sectional study. Journal of the American College of Nutrition, 39(8), 713-719.
- Zhang, L., Zhang, L., Yan, Y. C., Dong, F. L., Sun, W. G., Guo, X. W., Sun, L. & He, M. E. (2009). Efficacy of dietary intervention in patients with constipation. Chinese Journal of Disease Control, 13(05), 600-601.
- Zhao, X., Wang, L. & Quan, L. (2023). Association between dietary phosphorus intake and chronic constipation in adults: evidence from the National Health and Nutrition Examination Survey. BMC Gastroenterology, 23(1), 1-14.