Constipatia

De la preventie la tratament

Material adresat exclusiv personalului medical și farmaceutic

 Agenda
• Constipatia – o afectiune frecvent
intalnita

• Fibrele alimentare – tipuri si beneficii

• OptiFibre® – 100% fibre vegetale

solubile, cu efect prebiotic
 Ce este
constipatia?
Simptome si tipuri
 La nivel mondial 27% dintre adulti prezinta tulburari
gastrointestinale, care pot avea un impact asupra sanatatii

27% Simptome:

A dureri ABDOMINALE

B BALONARE

C CONSTIPATIE

D DIAREE

E flatulenta EXCESIVA

Sources: Harris 2016, Nielsen 2016/2017

 Manifestarile digestive variaza de la o persoana la alta
si pot alterna pe parcursul vietii

Prevalenta simptomele gastrointestinale:

58% 53% 34% 65%

CONSTIPATIE dureri DIAREE BALONARE /
ABDOMINALE FLATULENTA

Source: Harris 2016

 Ce este constipatia ?

❑ Constipatia este o afectiune comuna asociata

uneia sau mai multor simptome, cum ar fi:

- scaun de consistenta tare

- scaune cu o frecventa neregulata
- dureri abdominale
- balonare
- gaze excesive
- senzatie de evacuare incompleta

Rao SS, et al. Nat Rev Gastroenterol Hepatol. 2016;13:295-305; Sharma A, Rao S. Handb Exp Pharmacol. 2017;239:59-74.
Constipatia poate fi bazata pe perceptie, ceea ce
poate duce la o autodiagnosticare gresita

❖ Constipatia este o tulburare bazata pe simptome si

prevalenta acesteia variaza in functie de fiecare
persoana.

❖ Exista o lipsa de acord intre perceptia medicului si

cea a pacientului in definirea constipatiei. Multi
pacienti care se plang de constipatie nu indeplinesc
criteriile de diagnostic Roma pentru constipatia
functionala.
Constipatia poate fi bazata pe perceptie, ceea ce
poate duce la o autodiagnosticare gresita

❖ Plangerile auto-raportate de constipatie sunt inflentate de obiceiuri culturale si sociale.

❖ Constipatia perceputa este o diagnoza de asistenta medicala acceptata de North American

Nursing Diagnosis Association si este definita ca starea in care o persoana se
autodiagnosticheaza cu costipatie si asigura o miscare intestinala zilnica prin utilizarea de
laxative, clisme si supozitoare.

❖ Aceasta perceptie individuala a constipatiei este legata de milioane de dolari cheltuiti pe laxative
si adjuvante pentru eliminarea scaunului.
 Constipatia poate fi bazata pe perceptie, ceea ce
poate duce la o autodiagnosticare gresita

✓ Medicii percep constipatia in mod

obiectiv folsosind frecventa defecatiei
la un interval normal de cel putin 3
miscari intestinale pe saptamana.

Bellini M et al. Neurogastro & Motility 2018; [Epub ahead of print]

 Constipatia poate fi bazata pe perceptie, ceea ce
poate duce la o autodiagnosticare gresita

✓ Pacientii sunt preocupati mai degraba

de usurinta de trecere si de
consistenta decat de frecventa
scaunlui, perceptia fiind legata de
scaunele tensionate sau dure.

Bellini M et al. Neurogastro & Motility 2018; [Epub ahead of print]

Constipatia poate fi de mai multe tipuri

Constipatie acuta Constipatie cronica

 Constipatia acuta

❑ Acuta / ocazionala
❖ Dureaza mai putin de o saptamana

❖ Se datoreaza de obicei schimbarilor din alimentatie, calatoriilor sau stresului

❖ Poate fi cauzata si de administrarea anumitor medicamente, interventii

chirurgicale sau alte afectiuni

Camilleri M, et al. Nat Rev Dis Primers. 2017;3:17095; Rao SS, et al. Nat Rev Gastroenterol Hepatol. 2016;13:295-305.
 Constipatia cronica

❑ Cronica / frecventa (dureaza mai mult de 4 saptamani)

❖ De tip functional: este cauzata de o disfunctie a colonului si / sau sindrom
de intestin iritabil

❖ De tip secundar: dezvoltata ca urmare a unor probleme medicale, cum ar fi

disfunctii metabolice (diabet, hipotiroidism, etc.), probleme neurologice (ex.
boala Parkinson)
 Prevalenta
constipatiei

Factori de risc
 La nivel global circa 30 % din popula tie sufer a de
constipatie, cauzata de diversi factori

Consum redus de fibre Sarcina si / sau alaptarea

Lipsa activitatii fizice

Inaintarea in varsta
Stresul sau modificarile
cotidiene (ex. calatorii) Retentia voluntara
a scaunului

Anumite medicamente Anumite probleme medicale

(ex: diabet, hipotiroidism sau SII)

Sursa: NIDDK. https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/symptoms-causes. Accessed 27 July 2017. SII = sindrom de intestin iritabil
Constipatia este o afectiune frecvent intalnita,
indiferent de varsta

Adulti: prevalenta la nivel Mondial: 16%

Copii: prevalenta la nivel Mondial: 12%

 Criteriul Roma 4
Criteriile de diagnostic dupa simptomele avute in ultimele 3 luni cu debutul cu cel putin 6 luni inainte

Trebuie sa includa 2 sau mai multe dintre urmatoarele:

➢ efort ridicat la evacuarea scaunelor - mai mult de o patrime (25%) din defecari
➢ Scaune dure (BSFS 1-2) - mai mult de o patrime (25%) din defecari
➢ Senzatia de evacuare incompleta - mai mult de o patrime (25%) a defecarilor
➢ Senzatia de obstructie / blocaj anorectal - mai mult de o patrime (25%) a defecarilor
➢ Manevre manuale pentru a facilita evacuarea scaunului - mai mult de o patrime (25%) din
defecari (ex: evacuare digitala, sprijinul peretelui pelvin)
➢ Mai putin de 3 scaune spontane/saptamana

Rome Foundation. Rome IV Criteria for Functional Gastrointestinal Disorders. https://theromefoundation.org/rome-iv/. Accessed November 15, 2018.Lacy BE et al. Bowel disorders Gastroenterology 2016; 150: 1393-1407
 Scala Bristol de apreciere a aspectului
si a consistentei scaunului

Sursa: https://www.webmd.com/digestive-disorders/poop-chart-bristol-stool-scale
Efectele pe termen lung ale constipatiei netratate

❑ Chiar daca constipatia este una dintre 5 cele mai

comune afectiuni ale tractului gastrointestinal, doar o
mica parte dintre pacientii afectati cer sfatul unui
specialist in domeniul sanatatii, in momentul in care
se confrunta cu aceasta

❑ Constipatia are un impact semnificativ asupra calitatii

vietii, atat fizic cat si emotional
Efectele pe termen lung ale constipatiei netratate

❑ Din pacate constipatia este ignorata de

catre persoanele afectate, fiind perceputa
ca o afectiune comuna fara consecinte
ulterioare

❑ Netratata, constipatia poate duce in timp la

afectiuni mult mai grave, cum ar fi
cancerul de colon
Managementul
constipatiei
Managementul constipatiei – de la preventie la tratament

Indentificarea tipului constipatiei (functionala sau cronica) si a cauzelor

acesteia (mod de alimentatie, lipsa hidratarii, boli, medicatie, etc.)

Recomandari generale privind schimbarea stilului de viata

(cresterea aportului de apa si fibre din alimente, exercitii fizice, etc)

Daca simptomele persista dupa recomandarile anterioare este

indicata suplimentarea dietei cu fibre

Conform WGO*, suplimentarea dietei cu fibre este considerata cea

mai eficienta modalitate de preventie si combatere a constipatiei

Laxativele pot fi recomandate ca ultima solutie, in cazul in care

suplimentarea dietei cu fibre nu este eficienta
* World Gastroenterology Organization, 2018
Primul pas in gestionarea constipatiei este
suplimentarea dietei cu fibre

Laxativele de contact Stimuleaza nervii, irita mucoasa

Laxativele osmotice Modifica presiunea intestinala

Lubrifiantii Inmoaie scaunele, creste umiditatea

Supozitoarele Inmoaie scaunele, relaxeaza peretii intestinali

Laxative de volum Stimuleaza peristaltismul intestinal

Echilibreaza flora bacteriana, amelioreaza
Fibre si Prebiotice simptomele
Fibre dietetice, Apa Regleaza tranzitul intestinal
 Prezentare generala a laxativelor OTC pentru
tratamentul constipatiei

*Utilizate in mod obisnuit la pacientii care nu raspund la modificarile dietei si stilului de viata.

OTC: over-the counter (fara prescriptie)

Camilleri M, et al. Nat Rev Dis Primers. 2017;3:17095; Rao SS, et al. Nat Rev Gastroenterol Hepatol. 2016;13:295-305.
 Prezentare generala a laxativelor OTC pentru
tratamentul constipatiei

Camilleri M, et al. Nat Rev Dis Primers. 2017;3:17095; Rao SS, et al. Nat Rev Gastroenterol Hepatol. 2016;13:295-305.
 Primul pas in gestionarea constipatiei il
reprezinta modificarile in dieta

➢ Indiferent de etiologie,
abordarea terapeutica initiala a
constipatiei primare consta, in
general, in modificari ale dietei si
a stilului de viata, cum ar fi
incurajarea aportului adecvat de
lichide si fibre, exercitii fizice
reglate si modificarea dietei.

Rao SS, et al. Nat Rev Gastroenterol Hepatol. 2016;13:295-305; Sharma A, Rao S. Handb Exp Pharmacol. 2017;239:59-74; World Gastroenterology Organization Global Guidelines. Diet and the
Gut. April 2018; available at: http://www.worldgastroenterology.org/guidelines/global-guidelines/diet-and-the-gut.
 Laxativele sunt utilizate de pacientii
care nu raspund la modificarile stilului de viata

❖ Laxativele sunt utilizate de pacientii care

nu raspund la modificarile stilului de viata
sau ale dietei.

❖ Testarea diagnosticului poate fi adecvata

pacientilor care nu raspund unui studiu
empiric al laxativelor, pentru a intelege
fiziopatologia anorectala si/sau colonica
subiacenta.

Rao SS, et al. Nat Rev Gastroenterol Hepatol. 2016;13:295-305; Sharma A, Rao S. Handb Exp Pharmacol. 2017;239:59-74; World Gastroenterology Organization Global Guidelines. Diet and the
Gut. April 2018; available at: http://www.worldgastroenterology.org/guidelines/global-guidelines/diet-and-the-gut.
 In cazurile de constipatie, WGO recomanda
cresterea treptata a aportului de fibre

• WGO sustine:

“O dieta bogata in fibre poate avea rol de

protectie si utila terapeutic in tratamentul
constipatiei. Se recomanda o crestere
treptata a aportului de fibre prin dieta si/sau
suplimentare la 20-30 g/zi, impreuna cu o
cantitate adecvata de lichide.”

Rao SS, et al. Nat Rev Gastroenterol Hepatol. 2016;13:295-305; Sharma A, Rao S. Handb Exp Pharmacol. 2017;239:59-74; World Gastroenterology Organization Global Guidelines. Diet and the Gut. April 2018;
available at: http://www.worldgastroenterology.org/guidelines/global-guidelines/diet-and-the-gut.
 Rolul specific al fibrelor in gestionarea
constipatiei

• 2018 I Recomandarile World Gastroenterology Organization (WGO) :

“Cresterea fibrelor in dieta a fost mult timp considerata un tratament de prima
linie pentru constipatie”

Rao SS, et al. Nat Rev Gastroenterol Hepatol. 2016;13:295-305; Sharma A, Rao S. Handb Exp Pharmacol. 2017;239:59-74; World Gastroenterology Organization Global Guidelines. Diet and the Gut. April 2018;
available at: http://www.worldgastroenterology.org/guidelines/global-guidelines/diet-and-the-gut.
 Elementele de interventie dietetica in tratamentul
constipatiei functionale

❑ Respectarea orarului meselor

❑ Dieta zilnica trebuie sa includa

toate grupele de macronutrienti:
proteine, lipide si carbohidrati
(inclusiv fibre)

❑ Recomandari dietetice cu privire la

cresterea consumului de fibre
Elementele de interventie dietetica in tratamentul
constipatiei functionale

❑ Hidratarea adecvata prin consumul a cel

putin 2 litri de apa pe zi

❑ Recomandarea cresterii consumului de

fructe si legume crude in alimentatie

❑ Miscarea /exercitiile fizice, care stimuleaza

musculatura interna si usureaza digestia
 Fibre vs. laxative
Fibre1 Laxative

Ex: PHGG, dextrina de grau, inulina, tarate de grau, Ex: docusat, lapte de magneziu, PEG, senna
celuloza, psyllium
Laxativele functioneaza astfel:
Fibrele functioneaza printr-o serie de mecanisme • Irita mucoasa intestinului
diferite: • cresc cantitatea de apa de la nivel intestinal si
• cresterea volumului de scaune si scaderea timpului astfel ajuta scaunele sa retina mai mult fluid
de tranzit al colonului;
• fermentarea in colon pentru a creste absorbtia apei, Datorita actiunii lor iritante, laxativele trebuie
ceea ce duce la imbunatatirea consistentei scaunului; utilizate doar temporar, deoarece acestea pot
• utilizarea lor pe termen lung datorita proprietatilor afecta capacitatea intestinului de a absorbi nutrienti
naturale si pot deregla tranzitul intestinal.
• natura fermentabila si capacitate de absorbtie a apei

Fibrele nu au efecte adverse si pot fi utilizate pe termen lung. Laxativele pot crea dependenta, de aceea trebuie utilizate
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291444/. 1. Bae SH. Pediatr J Hepatol Nutr. 2014;17(4): 203-208.
doar temporar.
 Ce sunt fibrele?

Beneficiile fibrelor
 Definitia oficiala a fibrelor dietetice

Codex Alimentarius (2015) Definitia fibrelor dietetice

Polimeri carbohidrati cu zece sau mai multe unitati monomerice, care nu

sunt hidrolizati de enzimele endogene din intestinul subtire si prezinta
beneficii fiziologice pentru sanatate sustinute de dovezi stiintifice.

Codex Alimentarius. 2015;3; Jones JM. Nutr J. 2014;13:34; World Gastroenterology Organisation Global Guidelines. Diet and the Gut. April 2018;
available at: http://www.worldgastroenterology.org/guidelines/global-guidelines/diet-and-the-gut.
 Ce sunt fibrele?

➢Fibrele sunt carbohidrati prezenti in mod

natural in alimente sau suplimente nutritionale.

➢Insa, organismul nostru nu le poate digera ca

atare, din cauza lipsei enzimelor specifice.
 Ce sunt fibrele dietetice?
▪ Fibrele dietetice sunt in mod obisnuit definite ca carbohidrati care rezista digestiei la
nivelul intestinului subtire al oamenilor si ofera un beneficiu fiziologic pentru sanatate.

▪ Definitiile specifice variaza de la tara la tara.

▪ Definitia Codex a fost propusa pentru a trece la armonizarea internationala a

definitiilor.

▪ Armonizarea este importanta pentru dezvoltarea ghidurilor, practica clinica si

cercetare.
 Care sunt beneficiile fibrelor ?

S-a demonstrat ca fibrele alimentare ajuta la1-3:

• Risc mai mic de boli cardiovasculare

• Descurajeaza sinteza colesterolului si reduce nivelul colesterolului seric

• Promovarea pierderii in greutate corporala

• Absorbtia lenta a glucozei si imbunatatirea sensibilitatii la insulina

• Creste nivelul de antioxidanti

1. Lattimer and Haub. Nutrients. 2010; 2: 1266-89; 2. Anderson et al. Nutrition Rev. 2009; 67: 188-205; 3. Slavin. Nutrients. 2013; 5: 1417-35; 4. Yang et al. Am J Epidemiol. 2014; 181: 83-91.
 Care sunt beneficiile 1-4 fibrelor ?

➢ Fibrele au rol digestiv in reglarea tranzitului intestinal

➢ Fibrele ajuta la scaderea LDL (colesterol rau) si reglarea nivelului de glicemie

➢ Fibrele ofera o senzatie mai rapida de satietate, sustinand procesul de slabire

1.D hingra, D., Michael, M., Rajput, H. & Patil, R. T. Dietary fibre in foods: a review. J. Food Sci. Technol. 49, 255–66 (2012) 2.Administration, U. S. F. and D.
Nutrition Facts Label: Dietary Fiber. Dietary Fiber 3.Samur, G. & Mercanlıgil, S. M. Diyet Posası ve Beslenme. (T.C. Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel
Müdürlüğü Beslenme ve Fiziksel Aktiviteler Daire Baskanlığı, 2008) 2. Lattimer and Haub. Nutrients. 2010; 2: 1266-89; 3. Anderson et al. Nutrition Rev. 2009; 67:
188-205; 3. Slavin. Nutrients. 2013; 5: 1417-35; 4. Yang et al. Am J Epidemiol. 2014; 181: 83-91.
 Fibrele au un efect pozitiv asupra
intregului sistem digestiv

Odata consumate, fibrele trec prin diverse procese de absorbtie:

✓ Fibrele parcurg tractul digestiv, iar impreuna cu alimentele digerate, ajuta la reglarea
miscarilor intestinale normale1

✓ Fibrele atrag fluidele in intestin, ajutand astfel la normalizarea consistentei scaunelor2

✓ Fibrele ajuta la multiplicarea bifido-bacteriilor, esentiale intr-un proces optim de digestie3

1. Mudgil D, Sheweta B. Composition, properties and health benefits of indigestible carbohydrate polymers as dietary fiber: A review. Int J Biol Macromol 2016;1:1-6.
2. Eswaran S, Muir J, Chey WD. Fiber and Functional Gastrointestinal Disorders. Am J Gastroenterol 2013;108:718–27.
3. Kelly G. Inulin-type prebiotics - A Review: Part I. Alt Med Review. 2008;13(4):315-329.
 Caracteristicile dietelor bogate in fibre vs.dietele
occidentale (sarace in fibre)

1. Sonnenburg et al. Nature. 2016; 529: 212-215; 2. Sonnenburg and Sonnenburg. Cell Metab. 2014; 20: 779-786; 3. Deehan and Walter. Trends Endocrinol. Metab. 2016; 27: 239-242.; 4. Makki et al. Cell
Host & Microbe. 2018; 23: 708; 5. Heidemann C, et al. Circulation. 2008; 118:230
 Se recomanda comprimarea decalajului
alimentar, folosind alimente bogate in fibre

Aportul scazut de fibre dietetice se datoreaza aportului redus de

legume, fructe si cereale integrale.

Impartirea macro si micronutrientilor in farfuria ideala:

Alimente bogate in fibre dietetice
Cantitatea zilnica recomandata* de fibre difera
in functie de varsta si sex
Cantitatea de fibre Cantitatea de fibre
Varsta recomandata ( g/zi ) < 50 ani > 50 ani
recomandata ( g/zi )
2-5 15 Barbati 38 30
5 - 11 20
11 - 16 25 Femei 25 21

* Conform Organizatiei Mondiale a Sanatatii

Tipuri de fibre
 Tipuri de fibre

Fibre insolubile Fibre solubile

 Fibrele insolubile

Fibrele insolubile fermenteaza doar partial in intestinul gros, dar isi

exercita efectele benefice prin stimularea tranzitului intestinal.
Tipuri de fibre insolubile - celuloza

❑ celuloza – se gaseste preponderent in

legume, sfecla de zahar, tarate, fiind
principalul component structural al peretilor
celulari ai plantelor;
Tipuri de fibre insolubile - hemiceluloza

❑ hemicelulozele – se gasesc mai ales in

cerealele integrale si difera de celuloza mai ales
prin marimea moleculei;
Tipuri de fibre insolubile - lignina

❑ lignina – se gaseste in partile lemnoase

ale plantelor (samburii comestibili ai
fructelor, partile mai dure ale cruciferelor si
radacinoaselor, tarate, seminte de in)
 Fibrele solubile

Fibrele solubile fermenteaza in intestinul gros si contribuie la

echilibrarea florei intestinale prin hranirea bacteriilor benefice din
intestine – efect prebiotic in reglarea tranzitului intestinal.
 Tipuri de fibre solubile - Pectine

❑ pectine – se gasesc preponderent in fructe, dar in

cantitati mai mici si in legume; in apa formeaza geluri,
sunt metabolizate complet de flora intestinala
 Tipuri de fibre solubile- beta-glucani

❑ beta-glucani din cereale - cea

mai cunoscuta sursa este ovazul;
 Tipuri de fibre solubile - gume

❑ gumele - se extrag din anumite leguminoase

(guma guar), din alge (carragenan, alginat) sau
sunt obtinute din zaharuri simple prin fermentatie
microbiana (guma xanthan, gellan);
 Tipuri de fibre solubile - inulina

❑ inulina – se gaseste in radicina unor

plante, fermenteaza la nivelul colonului,
actionand ca prebiotic; se gaseste si
extrage din radacina de cicoare;
 Tipuri de fibre solubile - mucilagii

❑ mucilagiile – se obtin prin extragere din

plante (guma accacia, guma karaya,
guma tragacanth) si sunt folosite majoritar
in industria alimentara;
Fibrele solubile – caracteristici si beneficii

Dextrina de
Guma de Psyllium Inulina FOS*
grau
guar

Ajuta la combaterea
constipatiei
Ajuta la diminuarea
durerii abdominale

Ajuta la combaterea
balonarii

Efect prebiotic

Gust neutru/
administrare usoara

Nu este necesara ingerarea unei

cantitati aditionale de lichid
56

* fructooligozaharide
 Exista mai multe tipuri de fibre, insa
efectele si modul lor de actiune difera

Psyllium Dextrina de grau Metilceluloza

Inulina Tarate de grau Guma de guar partial hidrolizata (PHGG)

 Psyllium

Capacit
ate de Solubilitate/
Tip fibra Sursa absorbt Vascozitate in Efecte asupra tranzitului intestinal
ie a contact cu apa
apei

Capacitate foarte mare de

Solubila /
Plantago absorbtie a apei, inmoaie
Psyllium Da Consistenta
ovata scaunul prin cresterea
de gel
continutului de apa
 Dextrina de grau

Capacitate
Solubilitate/
de
Tip fibra Sursa Vascozitate in Efecte asupra tranzitului intestinal
absorbtie a
contact cu apa
apei

Nu retine apa, nu are beneficii

Grau
Dextrina Solubila / asupra tranzitului intestinal
tratat Nu
de grau Nevascoasa (nu are efecte benefice asupra
chimic
constipatiei)
 Tarate de grau

Capacitate
Solubilitate/
de
Tip fibra Sursa Vascozitate in Efecte asupra tranzitului intestinal
absorbtie a
contact cu apa
apei

Stimulare mecanica/Iritarea
Tarate
Grau Nu Insolubila mucoasei colonului, accelereaza
de grau
tranzitul intestinal
 Inulina

Capacitate
Solubilitate/
de
Tip fibra Sursa Vascozitate in Efecte asupra tranzitului intestinal
absorbtie a
contact cu apa
apei

Radacina Usor solubila Nu retine apa, nu are efect

Inulina Nu
de cicoare Nevascoasa laxativ
 Metilceluloza

Capacitate
Solubilitate/
de
Tip fibra Sursa Vascozitate in Efecte asupra tranzitului intestinal
absorbtie
contact cu apa
a apei

Aschii de
Se transforma in gel, fara
lemn
Metilceluloza Da Vascoasa efecte dovedite asupra
tratate
constipatiei
chimic
 Guma de guar partial hidrolizata (PHGG)

Capacitate
Solubilitate/
de
Tip fibra Sursa Vascozitate in Efecte asupra tranzitului intestinal
absorbtie a
contact cu apa
apei

Guma de Fermentarea la nivelul intestinului

guar duce la formarea de acizi grasi cu
Pastaia Solubila /
partial Nu catena scurta, care faciliteaza
de guar Nevascoasa
hidrolizata inmultirea bacteriilor benefice si
(PHGG) cresc si normalizeaza bolul fecal.1

1.

1. McRorie and Chey. Dig Dis Sci. 2016; 61:3143; 2. Johnson and McRorie. Nutr Today. 2015; 50: 2,3; 3. Bowling et al. The Lancet. 1993; 342: 1266-1268; 4. Cherbut. Proc Nutr Soc. 2003; 62: 95-99; 5. Slavin and Greenburg. Nutrition. 2003; 19: 549-52
 PHGG se diferentiaza de alte fibre alimentare
prin dovezi stiintifice

PHGG Psyllium Dextrina de grau

❖ are cele mai puternice dovezi ❖ este nefermentabil si nu ofera ❖ are anumite efecte
stiintifice pentru a-i sustine beneficii prebiotice precum prebiotice documentate
efectele benefice PHGG.
 Diferenta dintre PHGG si psyllium

PHGG Psyllium

❖ efect prebiotic;
❖ nu exista date concrete privind
beneficiile pe care le are
❖ gust neutru; asupra tranzitului intestinal

❖ usor de introdus in dieta si in diverse

preparate alimentare
 Diferenta dintre PHGG si dextrina de grau

PHGG Dextrina de grau

❖ nu exista dovezi stiintifice care sa

❖ ajuta la reglarea tranzitului intestinal, sustina efectele benefice in gestionarea
constipatiei si la gestionarea durerilor constipatiei, durerii abdominale, gazelor
abdominale, balonarii si gazelor; si balonarii
 PHGG are efecte dovedite clinic in
reglarea tranzitului intestinal

Constipatie Efect prebiotic Balonare

PHGG ajuta la reglarea tranzitului intestinal si la echilibrarea florei intestinale

 PHGG are efecte dovedite clinic in reglarea
tranzitului intestinal,comparativ cu psyllium

Efect
Constipatie Balonare
prebiotic

PHGG ajuta la reglarea tranzitului intestinal

si la echilibrarea florei intestinale

➢ In contrast cu PHGG, Psyllium nu este fermentabil si nu ofera beneficii prebiotice. Exista

date limitate pentru a confirma beneficiile sale pentru durerile abdominale, in timp ce
dovezile stiintifice sugereaza ca este posibil sa nu imbunatateasca flatulenta sau
balonarea.
 PHGG are efecte dovedite clinic in reglarea
tranzitului intestinal,comparativ cu dextrina din grau

Efect
Constipatie Balonare
prebiotic

PHGG ajuta la reglarea tranzitului intestinal

si la echilibrarea florei intestinale

➢ Dextrina din grau are unele efecte prebiotice documentate, insa utilitatea sa
pentru a ajuta la gestionarea constipatiei, a durerilor abdominale, a flatulentei
si a balonarii nu sunt sustinute de dovezi stiintifice.
 PHGG are efecte dovedite clinic in
reglarea tranzitului intestinal

Efect
Constipatie Balonare
prebiotic

PHGG ajuta la reglarea tranzitului intestinal

si la echilibrarea florei intestinale

➢ Printre fibrele descrise, PHGG are cele mai puternice dovezi stiintifice care sa sustina
utilizarea acestuia pentru constipatie si pentru a ajuta la gestionarea durerilor abdominale,
a balonarii si a flatulentei.

➢ PHGG are, de asemenea, proprietati prebiotice si are un gust neutru, ceea ce face usor de
incorporat in diferite alimente sau bauturi.
Ce este PHGG?
 Ce este PHGG(guma de guar partial hidrolizata )?

✓ Guma de guar partial hidrolizata este o fibra

solubila, cu efect prebiotic.

✓ Principalul prebiotic gasit in PHGG este

glucomannanul.

✓ Bacteriile din colon fermenteaza

glucomannanuul, iar acest proces are ca
rezultat acizi grasi cu catena scurta, cum ar fi
butiratul, care ajuta la optimizarea tranzitului
intestinal.
 Guarul este o planta cu un continut ridicat de fibre

✓ Guarul este originar din Africa si creste ca arbust, ajungand la

aproximativ 2 metri inaltime.

✓ In zonele in care creste aceasta planta, se consuma atat frunzele

cat si boabele acestui arbust, ca legume proaspete.

✓ In plus, tulpina plantei serveste ca furaj pentru animale.

✓ Pentru OptiFibre® boabele de guar se prelucreaza printr-un

proces special de hidroliza.
 Cum se produce Guma de Guar Partial Hidrolizata
(PHGG)?

PHGG este o fibra naturala, vegetala, solubila, non-vascoasa, non-

gelifianta, obtinuta din boabele de guar, printr-un proces de hidrolizare.

Cum se produce PHGG?

Este creat printr-un proces controlat de hidrolizare enzimatica, care descompune

pudra de guar in particule mai mici, reducand astfel vascozitatea si permitand
particulelor sa se dizolve usor, mentinand in acelasi timp concentratia de fibre.
Cum se produce Guma de Guar Partial Hidrolizata
(PHGG)?

Pastai de guar uscate Seminte de guar macinate Hidrolizare enzimatica PHGG

 Cum actioneaza PHGG?

✓PHGG este metabolizat de catre microbiota intestinala la nivelul intestinului gros,

unde produce acizi grasi cu catena scurta (Short Chain Fatty Acids – SCFA)

✓95% dintre acizii grasi cu catena scurta sunt absorbiti rapid de catre celulele
intestinale (colonocite) si reprezinta “hrana” pentru celulele intestinale

✓Acizii grasi cu catena scurta modifica pH-ul (baza acida) a intestinului gros,
permitand dezvoltarea bacteriilor “bune” din intestin
Beneficiile PHGG
PHGG are o aciune naturala si eficace
PHGG reechilibreaza si regleaza
activitatea intestinala
 PHGG este o fibra cu calitati prebiotice si efecte
benefice la nivelul sistemului digestiv 1,2

PHGG este o fibra care nu este digerata in tractul

digestiv superior.

Prin urmare, atunci cand este fermentata la

nivelul colonului, PHGG are efecte prebiotice.

1. Ohashi Y, et al. Beneficial Microbes. 2014 [in press]. 2. Carlson J, et al. Anaerobe. 2016;42:60-66.
 Efectele prebiotice ale PHGG

✓Stimuleaza productia de bifidobacterii, bacterii

bune cum ar fi Bifidobacterium, Bacteroides, si
Parabacteroides

✓Stimuleaza producerea de acizi grasi cu catena

scurta (Butirat) prin fermentarea lor in intestinul
gros

1. Ohashi Y, et al. Beneficial Microbes. 2014 [in press]. 2. Carlson J, et al. Anaerobe. 2016;42:60-66.
Studii clinice ale
PHGG
 PHGG creste frecventa defecarii
la subiectii sanatosi

➢ Cei care au primit PHGG ca supliment au avut o

schimbare semnificativa in numarul de miscari
intestinale zilnic

➢ Subiectii sanatosi (n = 325) au avut aproximativ

jumatate mai multe miscari intestinale (BM) pe zi
(sau inca 1 BM la 2 zile) comparativ cu martorii
(0,58 ori / zi [0,43, 0,74]), p <0,00001

Kapoor et al. Journal of Functional Foods. 2017; 22: 57-59.

 PHGG creste frecventa defecarii
la subiectii sanatosi

Rezultatele provin dintr-o meta-analiza care a

reunit efectele PHGG dintr-un total de 15 studii
controlate care au examinat modificarile
interventiei pre si post-PHGG in frecventa
defecatiei fecale (studiile variaza intre 1995-2008)

Nota: dozele de PHGG raportate au variat de la

5-36 g / zi si au fost furnizate intr-un format de
bautura sau cu apa

Kapoor et al. Journal of Functional Foods. 2017; 22: 57-59.

La pacientii cu constipatie cronica, 5 g/zi de PHGG timp de
4 saptamani au redus timpul de tranzit cu aproape 12 ore

70

60 57.28 ore

50
45.63 ore • Timpul de tranzit colonic a fost redus
40
semnificativ (cu aproximativ 12 ore)
Ore

de la perioada de pre-tratament
30
(fara PHGG) pana la sfarsitul
20
perioadei de tratament PHGG,
10 (57,28 ± 39,25 ore vs. 45,63 ± 37,27
0
ore), p = 0,026.

Pre-PHGG Post-PHGG
 La pacientii cu constipatie cronica, 5 g/zi de PHGG timp de
4 saptamani au redus timpul de tranzit cu aproape 12 ore

Studiu realizat in 2 faze (perioada de 2 saptamani fara 70

administrare fibre si 4 saptamani de administrare PHGG) 60 57.28 ore

50 45.63 ore
N = 39 pacienti cu constipatie cronica au primit 5 g PHGG
40
zilnic pentru perioada de 4 saptamani

Ore
30

Timpul de tranzit intestinal a fost masurat la momentul 20

initial si la sfarsitul perioadei de administrare PHGG 10

Pre-PHGG Post-PHGG
Nota: Timpul de tranzit intestinal se refera la timpul
necesar pentru ca alimentele sa treaca prin colon si sa se
elimine prin scaun.

Polymeros D, et al. Dig Dis Sci. 2014;59(9):2207-2214. Martelli H et al. Gastroenterology 1978; 75: 612-618.
 La pacientii cu SII,PHGG imbunatateste semnificativ
frecventa miscarilor intestinale intre saptamanile 3 si 4

Contributia a 5 grame de PHGG zilnic la numarul de

miscari intestinale la pacientii cu IBS saptamanal

7
N = 90 pacienti cu IBS la momentul initial, cu date
prezentate pentru 90 de pacienti in saptamana 12
6.5

6 Nota: Perioada de studiu stabilita initial a fost de 24 de

saptamani, cu toate acestea, din cauza scaderii
5.5 numarului de pacienti care au raportat vizite de
urmarire, datele sunt prezentate pana la saptamana 12.
5
0 1 2 3 4 5 6 7 8 9 10 11 12
Saptamani *p<0.05

Giaccari S et al. PHGG: Clin Ter 2001; 152: 21-25.

PHGG creste sezatia de defecare totala
la subiectii sanatosi

❖ La subiectii sanatosi, cei care au primit PHGG ca supliment

au avut o schimbare semnificativa a sentimentului excretor
fecal (FEF) - o evaluare subiectiva definita ca sentiment
dupa defecare

❖ Scorul mediu al sentimentului excretor fecal la subiectii

sanatosi comparativ cu martorii a fost (2,08 [1,79, 2,38]), p
<0,00001
PHGG creste senzatia de defecare totala
la subiectii sanatosi

Rezultatele provin dintr-o meta-analiza a 2 studii

randomizate incrucisate controlate - interventie PHGG
comparativ cu placebo (studiile variaza intre 2000-2008)

Nota: dozele de PHGG raportate au variat de la 5,2-7,0 g /

zi si au fost furnizate intr-o bautura.
PHGG imbunatateste volumul fecal la adultii
sanatosi

La subiectii sanatosi, cei care au inclus PHGG in dieta, au avut o

schimbare semnificativa a volumului fecal.

Rezultatele au relevat un efect semnificativ statistic (p <0,0001)

combinat al modificarilor volumului fecal (MD: 0,23, IC 95%, 0,14-
0,32)

ECA sunt interventii controlate care au evaluat FV pre si post-

PHGG (studiile variaza intre 1999-2008)

Nota: dozele de PHGG raportate au variat de la 5-15 g / zi si au

fost furnizate intr-o bautura sau intr-un alt format alimentar.
 PHGG imbunatateste volumul fecal la adultii
sanatosi

Imbunatatirile volumului fecal sunt sustinute de un alt studiu la

femei sanatoase (n = 65) care au primit zilnic 5-15 g de PHGG
sub forma de bautura timp de 2 saptamani.

imbunatatiri semnificative au aparut in grupul de 15 g, cu

volume fecale pre-administrare fata de aport raportate ca 9,5 ±
3,6 fata de 11,4 ± 5,7, p <0,05.
 PHGG imbunatateste emolierea scaunului
la adultii sanatosi

Subiectii sanatosi, cei care au primit PHGG, au

prezentat o schimbare semnificativa statistic a emolierii
fecale.

Subiectii sanatosi (n = 56) au prezentat o crestere de

aproximativ 3% a umiditatii fecale de la interventia pre-
post-PHGG (2,64% [1,09, 4,19]), p <0,00009.

Rezultatele provin dintr-o meta-analiza a 6 studii care

au evaluat pre si post-PHGG (studii variaza intre 1993-
2006).

Nota: dozele de PHGG raportate au variat de la 12,5-

36 g / zi si au fost administrate cu apa.

Kapoor et al. Journal of Functional Foods. 2017; 22: 57-59. Rao T & Quartarone G. Nutrition 2018
PHGG imbunatateste emolierea scaunului
la adultii sanatosi

imbunatatirea umiditatii fecale contribuie la o forma mai

buna a scaunului (scade duritatea fecala, deci scaunul
nu este prea dur sau nu prea moale).

O crestere a frecventei defecatiei poate rezulta si din

cresterea umiditatii fecale.
 Suplimentarea dietei cu PHGG creste numarul
miscarilor intestinale normale

Studiul a evaluat 4 saptamani de suplimentare a dietei cu PHGG (5 g / zi) la adulti cu constipatie cronica (n = 39)

% Miscari intestinale
100

✓ Dupa administrarea PHGG, tensiunea

tensionate
resimtita in timpul evacuarii a scazut cu mai
mult de 50%. 50

Polymeros D, et al. Dig Dis Sci. 2014;59(9):2207-2214.

 Suplimentarea dietei cu PHGG creste numarul
miscarilor intestinale normale

Studiul a evaluat 4 saptamani de suplimentare a dietei cu PHGG (5 g / zi) la adulti cu constipatie cronica (n = 39)

5 4.75

3 ✓ Dupa administrarea PHGG numarul

miscarilor intestinale s-a triplat.
2
1.5

Polymeros D, et al. Dig Dis Sci. 2014;59(9):2207-2214.

 Suplimentarea dietei cu PHGG reduce nevoia
utilizarii laxativelor

Suplimentarea dietei cu PHGG a redus utilizarea laxativelor cu 95% dupa 8 saptamani (n = 21)

2.5

2
Numarul de doze de laxative/zi

2 Starea initiala

95% reducere a
1.5
nevoii utilizarii Tranzitie - 4 g PHGG
laxativelor

Suplientare totala cu
1
fibre - 12 g PHGG
0.6*

0.5

<0.1*

Patrick et al. JADA. 1998; 98: 913-914

 Comparativ cu taratele de grau, PHGG normalizeaza
functia intestinului la 65% dintre pacientii cu SII

70 65%
Procentul pacientilor (%)

60

50 48% ❑ intr-un alt studiu cu pacienti cu SII (n = 134),

miscarile saptamanale intestinale au fost
40 P=0.001 normalizate dupa utilizarea PHGG (5g / zi)
30 timp de 24 de saptamani.

20 ❑ Numarul de miscari intestinale pe

10
saptamana a fost de 5-9 in saptamana 24
vs. 2 la momentul initial.
0

PHGG Tarate de grau

PHGG: 5 g/zi timp de 12 saptamani

Tarate de grau: 30 g/zi timp de 12 saptamani
 Prebioticele hranesc bacteriile intestinale bune

Bacteriile din intestin se hranesc cu ingrediente alimentare care

Ce sunt nu sunt digerabile in tractul digestiv superior, cum ar fi fibrele.
prebioticele? ▪ Aceste ingrediente alimentare care hranesc bacteriile
intestinale se numesc prebiotice.
Prebioticele prezinta numeroase beneficii la
nivelul intestinului

Prezenta prebioticelor in intestin poate duce la efecte pozitive, cum ar fi:

Cum
▪ Stimularea cresterii bacteriilor probiotice benefice;
actioneaza ▪ Cresterea productiei de acizi grasi cu lant scurt (SCFA), care poate avea
prebioticele? o varietate de beneficii pentru sanatate, inclusiv functia intestinala
imbunatatita
Este PHGG un prebiotic?

➢ PHGG este o fibra care nu este digerata in tractul digestiv superior.

➢ Prin urmare, poate avea efecte prebiotice importante atunci cand

este fermentat de bacterii colonice:

• Stimularea productiei de bacterii benefice si sanatoase, inclusiv

Bifidobacterium, Bacteroides si Parabacteroides

• Cresterea produsului unui important SCFA numit butirat

PHGG promoveaza cresterea bacteriilor benefice

80

70

60

50

40

30

20

10

0
Lactobacillus Bifidobacterium s pp. Parabacteroides Bacteroides
PHGG constribuie la cresterea Lactobacillus

La 15 femei care sufereau de constipaie, 11 g

PHGG / zi timp de 3 saptamani au dus la o crestere
a speciilor Lactobacillus in fecale de la 33% la 67%
(perioada de control fata de saptamana 3)

Inainte de administrarea PHGG

Dupa administrarea PHGG

Takahashi et al. J. Nutr. Sci. Vitaminol. 1994; 40: 256

 PHGG contribuie la cresterea Bifidobacterium s pp.

La 9 adulti sanatosi, 7 g PHGG / zi timp de 2

saptamani au dus la o crestere a Bifidobacterium
spp. in numarul total de celule bacteriene de la
14,7% la 31,7%.

Inainte de administrarea PHGG

Dupa administrarea PHGG

Okubo et al. Biosci. Biotech. Biochem. 1994; 58: 1366, 1367

 PHGG contribuie la cresterea
parabacteroides & bacteroides

Probele de fecale de la 6 donatori sanatosi

au fost expuse la 0,5 g PHGG si masurate
pentru modificari bacteriene. Rezultatele
au aratat ca parabacteroides a crescut de
la 3,48% la 10,62%, iar bacteroides spp.
de la 27,12% la 33,05%.

Inainte de administrarea PHGG

Dupa administrarea PHGG

Carlson et al. Anaerobe. 2016;

 Crestere semnificativa a concentratiei fecale a speciilor de
Bifidobacterium atat in timpul administrarii, cat si dupa incetarea
acesteia

11.8
11.7±0.2
11.6

11.4

11.2 11.3±0.2

11
11.0±0.2
10.8

10.6

Starea initiala Momentul administrarii Dupa administrare

 Crestere semnificativa a concentratiei fecale a speciilor de
Bifidobacterium atat in timpul administrarii, cat si dupa incetarea
acesteia

Studiu deschis cu femei sanatoase

(n = 10), care au consumat 6 g/zi PHGG
timp de 2 saptamani urmate de dietele lor
normale timp de 2 saptamani. Acest lucru a
dus la:

Cresterea semnificativa a concentratiei

fecale a speciilor de Bifidobacterium
(bacterii producatoare de butirat)
comparativ cu valoarea initiala, atat
in t​ impul administrarii de PHGG, cat si in
perioada de dupa administrare.
 Dupa 24 de ore, un studiu in vitro demonstreaza ca PHGG creste
c e l m a i m u l t t o t a l u l S C FA , c o m p a r a t i v c u a l t e t i p u r i d e f i b r e

60

50

Inainte
40
Dupa 24h
mg/mL

30

20

10

Control Soia FOS Inulina PHGG Psyllium Celuloza

Velazquez et al. Anaerobe 2000; 6: 87-92
P H G G c r e s t e c e l m a i m u l t t o t a l u l S C FA ,
comparativ cu alte tipuri de fibre

• La 24 de ore, PHGG a produs cel mai

inalt nivel de SCFA total (inclusiv
acetat, propionat si butirat).

• Productie tipica de SCFA dupa 24 de

ore. a fost de 42,4 ± 5,5 mg / ml,
PHGG a fost de 54,6 ± 0,7 mg / ml
 PHGG reduce durerea abdominala la pacientii
care sufera de constipatie cronica

Pacienti care sufera de durere abdominala

100

90
Inainte
80

70 -50% Dupa administrarea PHGG

60
Nr. de saptamani

50

40

30 Reducerea cu 50% a
20 durerilor abdominale
10

Polymeros D, et al. Dig Dis Sci. 2014;59(9):2207-2214

 PHGG reduce balonarea la pacientii care sufera de
constipatie cronica

Pacienti care sufera de balonare

100

90
Inainte

80
Dupa administrarea PHGG
70 -50%
Nr. de saptamani

60

50

40

30

20

10

0
Tranzit lent Tranzit normal
Polymeros D, et al. Dig Dis Sci. 2014;59(9):2207-2214
 PHGG ajuta la
ameliorarea balonarii

Reducerea Balonarii Abdominale*

Subgrupe Run-in Perioada de Studiu % Reducere

Barbati 26.3±14.5 16.0±6.2* 39%

Barbati, <45 ani 26.6±10.5 17.0±10.9* 36%

Barbati, IMC <25 kg/m2 29.0±17.2 18.0±10.8* 38%

*Russo L et al. The Saudi Journal of Gastroenterology. 2015; 21(2):104-110

 S-a dovedit ca PHGG amelioreaza
simptomele SII, cum ar fi balonarea
❑ Acest studiu a fost conceput in a avea o perioada de 2 saptamani fara fibre
PHGG, urmata de o perioada de suplimentare de 4 saptamani de PHGG,
administrata zilnic cu apa, dupa micul-dejun. Doza de PHGG nu a fost
raportata in studiu.

❑ *Nota: Balonarea abdominala se refera la o evaluare subiectiva a GI

masurata pe o scala analogica vizuala (VAS) 0-100 mm.
Reducerea Balonarii Abdominale*
Subgrupe Run-in Perioada de % Reducere
Studiu
Barbati 26.3±14.5 16.0±6.2* 39%
Barbati, <45 ani 26.6±10.5 17.0±10.9* 36%
Barbati, IMC <25 kg/m2 29.0±17.2 18.0±10.8* 38%

Russo L et al. The Saudi Journal of Gastroenterology. 2015; 21(2):104-110

PHGG ajuta la gestionarea flatulentei,
in cazul pacientilor cu SII

N=134 pacienti cu IBS la momentul initial, cu

date prezentate pentru 90 de pacienti in 12
saptamani (datorita pierderii de urmarire).

Administrare: 5g PHGG/ zi, timp de 12 saptamani

Rezultat: Diminuare a simptomelor cu peste 68%

Inainte Saptamana 3 Saptamana 12

Flatulenta Giaccari S et al. PHGG: La Clinica Terapeutica 2001; 152: 21-25.

PHGG ajuta la gestionarea balonarii,
in cazul pacientilor cu SII

N=134 pacienti cu IBS la momentul initial, cu

date prezentate pentru 90 de pacienti in 12
saptamani (datorita pierderii de urmarire).
Administrare: 5g PHGG/ zi, timp de 12 saptamani

Rezultat: Diminuare a simptomelor cu peste 50%

Inainte Saptamana 3 Saptamana 12

Balonare Giaccari S et al. PHGG: La Clinica Terapeutica 2001; 152: 21-25.

PHGG ajuta la gestionarea crampelor abdominale ,
in cazul pacientilor cu SII

N=134 pacienti cu IBS la momentul initial, cu

date prezentate pentru 90 de pacienti in 12
saptamani (datorita pierderii de urmarire).

Administrare: 5g PHGG/ zi, timp de 12 saptamani

Rezultat: Diminuare a simptomelor cu peste 50%

Inainte Saptamana 3 Saptamana 12

Crampe abdominale Giaccari S et al. PHGG: La Clinica Terapeutica 2001; 152: 21-25.
PHGG imbunatateste simptomele GI
ale pacientilor care sufera de SII

❑ Intr-un studiu randomizat, pacienti cu SII au

fost repartizati in doua grupuri si au primit o
batura aromata de mar cu 2 masuri de
PHGG, gupa 1-10g/ zi (n=40) si grupa 2- 5g/
zi (n=46) pentru 12 saptamani.

❑ Pacientii au fost evaluati la momentul initial,

in timpul perioadei de tratament de 12
saptamani (lunile 1 si 3) si la 6 luni.
 PHGG imbunatateste simptomele GI
ale pacientilor care sufera de SII
Dispepsie Simptome Intestinale Simptome digestive Total

12 11.42

10
8 7.2
6.37
6 4.96
4.65
4
4.42
2
2.47
0
Momentul initial 1 luna 3 luni 6 luni

Parisi et al. Digestive Diseases and Sciences. 2005; 50(6): 1107-1112.

PHGG imbunatateste simptomele GI
ale pacientilor care sufera de SII

Scorul total reprezinta simptomele

totale GI, in timp ce trei scoruri de
subscala au fost incluse pentru
dispepsie, digestie (include gaze,
eructatii si distensie abdominala) si
simptome intestinale (include trecerea
scazuta/ crescuta a scaunelor,
scaunele dure si nevoia urgenta de a
defeca).
 PHGG imbunatateste simptomele GI
ale pacientilor care sufera de SII

Ambele grupuri au prezentat

imbunatatiri semnificative in scorul
total al simptomelor GI (GSRS)
precum si cele trei scoruri GSRS
pentru dispepsie, simptome
digestive si simptome intestinale la
1 si 3 luni comparativ cu valoarea
initiala. La 6 luni, scorurile GI au fost
mai mari comparativ cu sfarsitul
perioadei de 3 luni.
 Tolerabilitatea PHGG

In anul 1993, un grup de experti ai Birolui de Cercetari in stiinte

ale Vietii al Federatiei Societatilor Americane pentru Biologie
Experimentala au concluzionat ca PHGG, consumata pana la
20g/ zi, adaugata in alimentele conventionale este sigura.1

➢ Cercetarile sustin o buna toleranta a nivelurilor de pana

la 40 de grame pe zi la adultii sanatosi.2

➢ Intr-un cadru clinic, ICU si pacientii chirurgicali au tolerat

20-22 g/L PHGG intr-o formula enterala.3-4

1.Anderson SA, and Fisher KD. Fed Am Soc Exp Biol. 1993:1-61. 2. Takahashi H, et al. Nutr Res. 1993;13:649-657. 3.Rushdi et al. Clin Nutr. 2004;23(6):1344-1352. 4. Homann H et al. Clin Nutr Suppl. 2004;1:59-62. 5.
Ustundag G et al. Turk J Gastro 2010; 21(4): 360-364. 6. Romano C et al. World J Gastro 2013; 19(2): 235-240.
 Administrarea PHGG este eficace si in cazul
copiilor care sufera de constipatie

❑ La copiii care sufera de constipatie (n=31), 3-5 grame

de PHGG (dozata in functie de varsta) zilnic timp de 4
saptamani a fost la fel de eficienta precum lactuoza in
ameliorarea retinerii scaunului, a constipatiei si a
durerii abdominale asociate constipatiei.1

❑ Autorii nu au raportat efecte adverse pentru grupul

PHGG, in timp ce copiii carora li s-a administrat
lactuoza au raportat mai multe flatulente.

1.Ustundag G et al. Turk J Gastro 2010; 21(4): 360-364

 Administrarea PHGG este eficace si in cazul
copiilor care sufera de dureri abdominale

❑ La copiii (n=60) cu dureri abdominale cronice

si SII, 5 grame zilnice de PHGG timp de 4
saptamani a redus scorurile IBS Birmingham, a
normalizat tranzitul intestinal si a redus
intensitatea durerii abdominale.1

❑ Autorii au raportat conformitate optima/

siguranta PHGG la copii, fara efecte adverse.

1.Romano C et al. World J Gastro 2013; 19(2): 235-240

 Beneficiile PHGG la nivelul intestinului 1

✓ Cu o vascozitate redusa si o tolerabilitate crescuta,

PHGG joaca un rol important in reglarea tranzitului intestinal

1. Quartarone G, Minerva Gastroenterol Dietol, 2013, 59 (4); 329-40

 Ce este
OptiFibre®?
OptiFibre®

OptiFibre® este un produs 100% de origine

vegetala, cu efect prebiotic, care ajuta la
reglarea tranzitului intestinal.
 OptiFibre® contine 100%
guma de guar partial hidrolizata

✓ 100% fibre vegetale

solubile
 OptiFibre® este usor de folosit si
nu isi mareste volumul in contact cu bauturi sau alimente

✓ 100% fibre vegetale

solubile

✓ nu isi mareste ✓ usor de folosit

volumul in apa
Cum se administreaza
OptiFibre®?
 OptiFibre® are o adresabilitate multipla

Adulti & Femei insarcinate

Copii > 3 ani sau care alapteaza Varstnici

OptiFibre® este un aliment destinat unor scopuri medicale speciale, care poate fi recomandat
adultilor, copiilor cu varsta de peste 3 ani, femeilor insarcinate sau care alapteaza si varstinicilor.
Beneficiile OptiFibre

➢ OptiFibre® este un produs 100% natural, contine un singur

ingredient, nu contine coloranti, arome sau conservanti.

➢ OptiFibre® nu contine gluten si fructoza. Ca urmare a

procesului de productie, OptiFibre poate contine urme de
lapte/lactoza.

➢ OptiFibre® poate fi consumat de persoanele care sufera

de hemoroizi, duce la normalizarea scaunului, ceea ce
reduce durerile la defecatie.
 OptiFibre® nu are gust sau miros si
se dizolva in bauturi sau alimente moi

✓ nu are gust si se dizolva complet in lichide sau alimente moi,

fara a afecta gustul sau consistenta acestora
Cum se administreaza OptiFibre?
 Cat timp se foloseste OptiFibre?

➢ Trecerea la o dieta bogata in fibre nu se poate face in mod brusc, ci

intr-o anumita perioada de timp, treptat. De asemenea, rezultatele
aportului de fibre se pot observa dupa 2-3 zile de consum.

➢ Se recomanda administrarea regulata de OptiFibre® pentru minim 3

saptamani pentru un efect sustinut.

➢ Consumul regulat de OptiFibre® contribuie la asigurarea aportului

zilnic recomandat de fibre.

➢ O dieta variata si echilibrata si un stil de viata sanatos sunt, de

asemenea, foarte importante.
 Cum se consuma OptiFibre ® ?

✓ 1 masura de OptiFibre® se dizolva in 200ml apa sau bauturi non-carbogazoase

200 ml

✓ OptiFibre® se poate amesteca si in ✓ 1 masura = 5g OptiFibre®

alimente semisolide (ex. iaurt, piure).

Dupa consumul de OptiFibre® NU este necesar un aport

suplimentar de lichide, ca in cazul altor produse pe baza de fibre.
 OptiFibre®
D o v e d i t c l i n i c c a r e d u c e c o n s t i p a ti a 1 - 3

✓ 60% dintre pacienti au observat o imbunatatire a tranzitului intestinal

dupa primele 2-3 zile, iar 85% in mai putin de o saptamana.
1. Homann HH, et al. Clinical Nutrition Supplements 2004
2. Patrick PG, et al. J Am Diet Ass. 1998; 98; 912–914
3. Ipsos research, May 2012.
 OptiFibre®
D o v e d i t c l i n i c c a r e d u c e n e v o i a u t i l i z a r ii d e l a x a t iv e 1 - 3

✓ 60% dintre pacienti au observat o imbunatatire a tranzitului intestinal

dupa primele 2-3 zile, iar 85% in mai putin de o saptamana.
1. Homann HH, et al. Clinical Nutrition Supplements 2004
2. Patrick PG, et al. J Am Diet Ass. 1998; 98; 912–914
3. Ipsos research, May 2012.
 OptiFibre®
Dovedit clinic ca ajuta la reducea balonarii si flatulentei 1-3

✓ OptiFibre® are o toleranta buna si poate fi

administrat pe termen lung fara efecte adverse

1. Giaccari S, et al. La Clinical Terapeutica. 2001;152(1):21-25.

2. Sariano C et al. Long-term fiber intervention program. Journal of the American Dietetic Association 2000s. 100(9):A82
3. Kasper H et al. Ernährungsmedizin und Diätetik. 12., überarb. Aufl. München: Elsevier, Urban & Fischer; 2014
 Peste 95 % dintre consumatorii romani care au testat
Op tiF ib re ® au fost multumiti de efectele acestu ia

Cat de multumiti ati fost de efectele OptiFibre® ?

Peste 95% dintre respondenti au fost

multumiti de OptiFibre®

Studiu efectuat in perioada Feb – Martie 2019 pe un esantion de 230 de persoane cu probleme de tranzit intestianal.
 9 d in 10 dintre consumatorii romani care au testat
OptiFibre ® ar recomanda produsul prietenilor

Ati recomanda OptiFibre® familiei, prietenilor dvs.?

89,48% ar recomanda OptiFibre®

Studiu efectuat in perioada Feb – Martie 2019 pe un esantion de 230 de persoane cu probleme de tranzit intestianal.
 OptiFibre® - ajutorul de nadedje
in reglarea tranzitului intestinal

100% origine vegetala gust neutru usor de folosit

nu isi mareste poate fi folosit pe

volumul in apa termen lung
 Referinte
studii clinice

Peste 130 de studii

clinice dovedesc
eficacitatea OptiFibre
 Studii clinice
Reference Study Design PHGG Dosage Population Significant Effect on Constipation?
Kapoor et al, 2017 Meta-analysis Dosage & formulation Meta-analyses in healthy adults included Yes
(adult meta-analyses) varies by study; range of 7 studies: 4 RCTs, 3 observational Significant pooled effect on fecal volume (pre- to post-PHGG: 0.23; 95% CI, 0.14–0.32) in 4 RCTs; similar
dosage: 5 - 36 g/day; all studies; n=325 significant effect on fecal volume vs placebo in 2 placebo-controlled trials
but 1 study were ≤15
Pooled estimates for significant change in # of BMs/day (pre- to post-PHGG): +0.58 BMs/day (95% CI, 0.43–0.74)
g/day
in healthy subjects; +0.63 BMs/day (95% CI, 0.46-0.81) in subjects receiving <10 g PHGG/day
Kapoor et al, 2017 Meta-analyses Dosage & formulation Meta-analysis in elderly/children Yes
(children/elderly meta- varies by study; range of included 3 studies: 1 RCT; 2 Pooled estimate for significant change in # of BMs/day (pre- to post-PHGG): +0.85 BMs/day (95% CI, 0.43–0.74)
analyses) dosage: 4 – 10.5 g/day observational studies; n=66 in elderly/ children
Polymeros et al, 2014 Open-label, single- 5 g/day for 4 weeks Adults with IBS-C (per Rome III); n=39 Yes
arm study completers After 4 weeks of PHGG, median (IQR) Bristol score was increased from baseline by almost 2 units: pre-treatment:
1.8 (1.8-2.5) vs post-treatment: 3.7 (3.4-4.5), P<0.001
Increase in median (IQR) # of complete spontaneous BMs from 0 (0–0)/week pretreatment to 1.25 (0.25–
3)/week post-treatment (p<0.001); increase in median (IQR) # of spontaneous BMs from 1.5 (0–2.5) pre-
treatment to 4.75 (2.25–6.75) post-treatment (p<0.001)
Tanaka, 2013 Open-label, single- 12 g/day for 1 week Hospitalized elderly adults using Yes
arm study laxatives; n=14 Fecal defecation frequency improved (p < 0.05), even as consumption of laxative aids declined
Ishihara et al, 2012 Open-label, single- 10.5 g/day for 24 weeks Elderly adults with senility; n=21 Yes
arm study Fecal defecation frequency improved to 5.3 times/week during PHGG ingestion; decreased to 4.8 times/week
when PHGG was discontinued
Maeda et al, 2012 Open-label, single- 10 g/day for 6 weeks Dialysis patients with constipation; Yes
arm study mean age 70 years; n=35 Constipation scores decreased after PHGG (from 7.9 to 5.0; p<0.01); post-PHGG score indicates amelioration of
constipation
Inoue & Kato, 2009 Open-label, single- 7 g/day for 4 weeks Frail elderly with constipation; n=14 Yes
arm study Fecal defecation frequency increased significantly
Nakagawa et al, 2008 Randomized, 5.2 g/day for 2 weeks Healthy adults; n=50 Yes
placebo-controlled PHGG increased fecal volume (p < 0.05)
crossover study PHGG increased (p<0.01) fecal defecation frequency from 3.88 ± 0.17 at baseline to 4.66 ± 0.23 times/week after
the 1st week and 5.34 ± 0.26 after the 2nd week
 Studii clinice
Reference Study Design PHGG Dosage Population Significant Effect on Constipation?
Sakata & Shimbo 2006 Open-label, single- 12.5 g/day added to a strict Healthy women; n=9 No
arm study diet (fall session) PHGG: increased fecal bulk in 4 subjects, and decreased bulk in 2; softened stools in 3 subjects, and made stools
harder in 4; increased fecal moisture in 5 subjects and decreased moisture in 2.
Compared to strict diet
alone (earlier spring
session)
Giaccari et al, 2001 Open-label, single- 5 g/day for 24 weeks Patients with IBS, 14-71 yr old (n=133 Yes
arm study from weeks 1-4; increasing dropout rate BMs/week were significantly (P<0.05) increased at weeks 3 and 12 (no statistical analysis after week 12 due to high
over remainder of study) dropout rate); mean (SD) at baseline: 5.62 (4.29), at week 3: 6.23 (2.37), and at week 12: 6.66 (1.6).
Tanaka et al, 2000 Randomized, placebo- 7 g/day for 2 weeks Healthy women (mean age 27.7 years); Yes
controlled, crossover n=46 Fecal volume increased significantly (p<0.05) after 2 weeks vs pre-treatment period; similar trend for increased
study fecal volume vs placebo control
Among subjects with <4 BMs/week during placebo (n=16), PHGG increased fecal defecation frequency from 3.2 ±
0.7 to 4.0 ± 0.9 times/ week
Okazaki et al, 1999a Randomized, placebo- 10 g/day for 2 weeks Healthy adults; n=14 (all but 1 were Yes
controlled trial women) PHGG increased fecal volume significantly (p<0.01)
PHGG increased BMs/week from 5.29 ± 2.61 to 6.86 ± 2.11 after 1 week and to 7.14 ± 3.59 after 2 weeks (p<0.01)
Okazaki et al, 1999b Randomized, placebo- 5 g/day for 2 weeks Healthy women; n=15 Yes
controlled trial PHGG increased fecal volume significantly (p<0.01)
PHGG increased BMs/week from 3.67 ± 1.45 to 5.53 ± 2.23 after 1 week and to 5.21 ± 1.76 after 2 weeks (p<0.05)
Patrick et al, 1998 Open-label, single- Started at 4 g/day Elderly residents who regularly Yes
arm study increased to 12 g/day, consumed laxatives; n=16 Stool consistency maintained as PHGG gradually replaced regular laxative use
while decreasing laxative Similar BM frequency in the laxative (1.1 ± 1.0 times/day) and PHGG (1.0 ± 0.6 times/day) phases
dosing “Ease of BMs” maintained as PHGG gradually replaced regular laxative use
Yamatoya et al, 1995 Randomized, parallel 5 g/day vs 15 g/day for 2 Healthy women; n=65 Yes
group study weeks Significant (p<0.05) increase in BM frequency in both groups
Trending increase in fecal volume observed in both groups
 Studii clinice
Reference Study Design PHGG Dosage Population Significant Effect on Constipation?
Takahashi et al, 1994 Open-label, single-arm 11 g/day for 3 weeks Women w/constipation, ages 18-48 years Yes
study (mean 28.7); n=15 Significant increase in mean BMs/day from 0.46 ± 0.03 to 0.66 ± 0.05 with PHGG consumption. Three weeks after PHGG
was stopped, daily frequency of BMs decreased significantly to 0.52 ± 0.04
Fecal moisture increased significantly from 69.1% to 73.8% (pre- vs post-PHGG); average fecal weight also increased
from 88.9 ± 8.2 to 104 ± 10.3 g per day;
Takahashi et al, 1993 Open-label, single-arm 36 g/day for 4 weeks Healthy men; n=8 Yes
study Mean BMs/day increased significantly at weeks 3 and 4 of PHGG administration (vs both control and free diet periods);
control diet period = 0.89 ± 0.15; free diet period = 0.93 ± 0.14; PHGG week 3 = 1.09 ± 0.16; PHGG week 4 = 1.13 ± 0.13
Significant (p<0.05) increase in fecal weight (122.6 ± 11.7 to 195.2 ± 17.7 g per day) pre- vs post-PHGG

Romano et al, 2013 Randomized, placebo- 5 g/day for 4 weeks Children ages 8-16 years with chronic Yes
controlled study abdominal pain (CAP) or IBS (per Rome III); 40% of children in the PHGG group had normalized bowel habits (ie, Bristol ratings of 3 or 4) at 4 and 8 weeks, vs 13.3%
n=60 in the control group (p=0.025).
Bristol scores in the IBS-C & IBS-D subgroups trended toward greater improvement (ie, were increased and were
decreased, respectively) vs placebo but did not reach statistical significance
Üstündağ et al, 2010 Randomized design 3, 4, or 5 g/day for ages 4-6, Children, ages 4-16 years with constipation Yes
with active control 6-12, and 12-16 years, (per Rome III); n=61 Mean weekly BMs increased (p<0.05) from 4 ± 0.7 to 6 ± 1.06 in the lactulose group and from 4 ± 0.7 to 5 ± 1.7 in the
respectively, for 4 weeks PHGG group. Although the increase in the lactulose group was larger (vs PHGG; p<0.05), the authors noted that parents
and children were satisfied with the increased defecation frequency, and decreased abdominal pain and stool
vs lactulose syrup (1 withholding obtained with PHGG
ml/kg/day) for 4 weeks Stool softness improved in both groups (PHGG: 2.1 to 3.9; Lactulose: 2.8 to 4.3; p<0.05); the difference between groups
was not statistically significant
 Studii clinice
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