gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2018-28-5-117-125gastro-j-268Research ArticleНАЦИОНАЛЬНАЯ ШКОЛА ГАСТРОЭНТЕРОЛОГОВ, ГЕПАТОЛОГОВNATIONAL COLLEGE OF GASTROENTEROLOGISTS, HEPATOLOGISTSПринципы рационального питания при запореPrinciples of Rational Nutrition for Managing ConstipationШульпековаЮ. О.ShulpekovaYu. O.

кандидат  медицинских  наук, доцент кафедры пропедевтики внутренних болезней лечебного факультета ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова»  (Сеченовский  университет)  Министерства  здравоохранения  Российской Федерации.  

119991, г. Москва, ул. Погодинская, д. 1, стр. 1.

 Cand. Sci. (Med.), Ass. Prof., Department of Propaedeutics of Internal Diseases, General Medicine Faculty, I.M. Sechenov First Moscow Medical University  (Sechenov  University). 

 119991, Moscow, Pogodinskaya str., 1, building 1. 

jshulpekova@gmail.comШептулинД. А.SheptulinD. A.

студент лечебного факультета ФГАОУ ВО «Первый Московский государственный  медицинский  университет  им.  И.М.  Сеченова»  (Сеченовский  университет)  Министерства  здравоохранения  Российской Федерации.

119991, г. Москва, ул. Погодинская, д. 1, стр. 1.

 Student, General Medicine Faculty,  I.M. Sechenov First Moscow Medical University (Sechenov  University).

 119991, Moscow, Pogodinskaya str., 1, building 1. 

ШульпековаН. В.ShulpekovaN. V.

 студентка лечебного факультета ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова»  (Сеченовский университет) Министерства здравоохранения  Российской Федерации.

119991, г. Москва, ул. Погодинская, д. 1, стр. 1.

 Student, General Medicine Faculty, I.M. Sechenov First Moscow Medical University (Sechenov University).

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» (Сеченовский университет) Министерства здравоохранения Российской Федерации.РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University).Russian Federation201812112018285117125Copyright © Шульпекова Ю.О., Шептулин Д.А., Шульпекова Н.В., 20182018Шульпекова Ю.О., Шептулин Д.А., Шульпекова Н.В.Shulpekova Y.O., Sheptulin D.A., Shulpekova N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/268Цель обзора

Цель обзора: рассмотреть актуальность проблемы запора, связанного с дефицитом пищевых волокон, и принципы организации питания с целью его коррекции.

Основное содержание

Основное содержание. В странах с западным стилем питания пищевые волокна в рекомендуемых количествах употребляет только порядка 10 % людей, и первичный запор с нормальным транзитом составляет подавляющее большинство случаев. Особенная роль в поддержании функции толстой кишки принадлежит углеводам. Ведение пищевого дневника помогает подобрать оптимальный для пациента тип питания и снизить вероятность метеоризма. Особенно важная роль принадлежит пищевым волокнам — олигосахаридам и полисахаридам. Вязкие волокна в наибольшей степени способны к набуханию и проявляют метаболические эффекты на уровне тонкой кишки. Невязкие и нерастворимые волокна увеличивают объем каловых масс, стимулируют перистальтику и оказывают пребиотическое действие. Низкое содержание пищевых волокон в рационе — фактор, провоцирующий кишечный дисбиоз с сокращением популяции Bacteroides и Ruminococcus. В регуляции кишечной перистальтики и секреции заметную роль играют также флавоноиды. При запоре функционального происхождения в составе микробиоты существенно снижено содержание представителей родов Bifidobacterium и Bacteroides. Изменения состава микрофлоры коррелируют с психопатологическими симптомами. Среди штаммов, проявляющих лечебное действие при запоре: Escherichia coli Nissle 1917, пробиотическая смесь VSL#3, комбинированный пробиотик Флорасан-Д, Bifidobacterium lactis (B. lactis) DN-173 010, Bifidobacterium lactis HN019, Lactobacillus rhamnosus GG. Для профилактики и коррекции запора создаются продукты функционального питания, обогащенные олиго- и полисахаридами и пробиотиками. Продукция марки «Активия» содержит Bifidobacterium lactis DN-173 010 (ActiRegularis) в концентрации не менее 108 КОЕ/г. Потребление кисломолочных продуктов с Bifidobacterium lactis DN-173 010 способствует устранению субклинических дискомфортных ощущений в животе у практически здоровых людей, уменьшает время кишечного транзита и способствует нормализации частоты дефекации при запоре.

Заключение

Заключение. Первой ступенью лечения запора в большинстве случаев служит нормализация режима питания, введение пищевых волокон, а также добавление пробиотиков в составе продуктов функционального питания или лекарственных препаратов. 

Aim

Aim. The aim of this work was to investigate the problem of constipation associated with a deficiency in dietary fibre and to develop principles for the nutritional management of this condition.

  Main findings

  Main findings. In countries characterized by the Western-style diet, only about 10% of people consume an optimal amount of fibre daily. As a result, primary normal-transit constipation is a common problem. A special role in maintaining the function of the colon belongs to carbohydrates. Keeping a food diary helps to choose an optimal type of nutrition for a patient and reduce the likelihood of flatulence. Food fibres (oligosaccharides and polysaccharides) play an especially important role. Viscous fibres are most capable of swelling, thus exhibiting metabolic effects at the level of the small intestine. Non-viscous and insoluble fibres increase the volume of feces, stimulate peristalsis and exert a prebiotic effect. A low content of fibre in the diet is a factor provoking intestinal dysbiosis followed by a decrease in  Bacteroides and Ruminococcus populations. Flavonoids also play an important role in the regulation of intestinal peristalsis and secretion. Under constipation of functional origin, the microbiota contains a significantly reduced amount of Bifidobacterium and Bacteroides. Changes in the composition of microflora correlate with psychopathological symptoms. Strains capable of exhibiting a therapeutic effect in constipation include Escherichia coli Nissle 1917, a probiotic mixture of VSL#3, Florasan-D combined bacterium, DN-173 010 Bifidobacterium lactis (B. lactis), HN019 Bifidobacterium lactis and Lactobacillus rhamnosus GG. For the prevention and management of constipation, functional food products enriched with oligo-, polysaccharides and probiotics are developed. Thus, various products of the Activia brand contain DN-173 010 Bifidobacterium lactis (ActiRegularis) at a concentration of at least 108 CFU / g. The consumption of fermented milk products with DN-173-010 Bifidobacterium lactis contributes to the elimination of subclinical discomfort in the abdomen in practically healthy people, reduces the time of colon transit and helps to normalise the frequency of defecation.

Conclusion

Conclusion. In most cases, the first stage in managing constipation is the normalisation of the diet by means of adding dietary fibre and probiotics into the composition of functional foods or medical preparations. 

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The authors declare that there are no conflicts of interest present.