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obesity and chronic diarrhoea

Strong association between obesity and chronic diarrhoea

The findings could have important implications for how physicians might approach and treat symptoms of diarrhoea in patients with obesity

In the most comprehensive analysis of the relationship between body mass index (BMI) and bowel habits to date, published in Alimentary Pharmacology & Therapeutics, a team of physician-researchers at Beth Israel Deaconess Medical Center (BIDMC) found a strong association between obesity and chronic diarrhoea independent of an individual's dietary, lifestyle, psychological factors or medical conditions. The findings could have important implications for how physicians might approach and treat symptoms of diarrhoea in patients with obesity.

"While several previous studies have pointed to an association between obesity and bowel habits, all lacked data on whether dietary or other factors drive the connection," said corresponding author, Dr Sarah Ballou, a health psychologist in the Division of Gastroenterology, Hepatology, and Nutrition at BIDMC. "Our research confirms a positive association between obesity and chronic diarrhoea and reveals for the first time that this relationship is not driven by confounding factors such as diet or physical activity level."

In the study, ‘Obesity is associated with significantly increased risk for diarrhoea after controlling for demographic, dietary and medical factors: a cross-sectional analysis of the 2009-2010 National Health and Nutrition Examination Survey’, published in Alimentary Pharmacology & Therapeutics,  used the 2009-2010 National Health and Nutrition Examination Survey (NHANES) - a programme of studies administered by the CDC designed to assess the health and nutritional status of adults and children in the US - Ballou and colleagues analysed the bowel health questionnaire responses of 5,126 patients over the age of 20 years who did not report a history of irritable bowel syndrome, celiac disease or colon cancer. The team compared the reported bowel habits of patients who had a BMI associated with being underweight, normal weight, overweight, obese and severely obese.

After controlling for dietary, physical activity, diabetes, laxative use, and demographic factors, the team found that respondents who were obese or severely obese were 60 percent more likely to have experienced chronic diarrhoea compared to those with normal bowel habits or constipation.

A total of 5126 respondents completed the BHQ, had BMI data available, and met eligibility criteria. Of these, 70 (1.40%) were underweight, 1350 (26.34%) were normal weight, 1731 (33.77%) were overweight, 1097 (21.40%) were obese and 878 (17.13%) were severely obese. Up to 8.5% of obese and 11.5% of severely obese individuals had chronic diarrhoea, compared to 4.5% of normal weight individuals. Stepwise regression revealed that severe obesity was independently associated with increased risk of diarrhoea.

While the study reveals the association is not driven by compounding factors the team controlled for, questions still remain about what underlying causes may explain why obese individuals would be more likely than non-obese individuals to have diarrhoea. One possible explanation may be related to the link between obesity and chronic low-grade inflammation, which may contribute to diarrhoea. Future research clarifying this relationship and determining how obesity triggers inflammation could serve as a base for how physicians approach treating abnormal bowel habits with this patient population.

"The treatment of obesity and obesity-related medical conditions requires multidisciplinary management," said senior author, Dr Anthony Lembo, a gastroenterologist in the Division of Gastroenterology, Hepatology, and Nutrition at BIDMC. "Clinicians should be aware of the relationship between obesity and diarrheal, especially considering the potential negative impacts altered bowel habits can have on quality of life."

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