Hu Lanshuo, Huang Xuanchun, Liu Shan, Fang Lihui, Zhang Jiaqi, Tang Xudong
Institute of Digestive Diseases, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.
Graduate School of Beijing University of Chinese Medicine, Beijing, China.
PLoS One. 2025 Feb 13;20(2):e0315795. doi: 10.1371/journal.pone.0315795. eCollection 2025.
High- and low-quality carbohydrate diets are linked to gut health. However, their specific relationship with constipation or diarrhea is unclear. This study uses 2005-2010 NHANES data to examine the relationship between carbohydrate quality and constipation and diarrhea, and to identify suitable populations for different carbohydrate diets.
Chronic constipation was defined as BSFS types 1 and 2, and chronic diarrhea as types 6 and 7. Dietary intake data were provided by the FPED, using data from the NHANES database. Subjects recalled foods and beverages consumed in the past 24 hours, and intake was averaged and divided into quartiles (Q). After adjusting for covariates, associations between high- and low-quality carbohydrate diets and constipation or diarrhea were assessed using weighted RCS curves and multivariate logistic regression. Results were expressed as weighted ORs and 95% CIs, with subgroup analyses performed.
A total of 11,355 people participated, with 10,488 in the constipation group and 10,516 in the diarrhea group. Multiple regression showed that high-quality carbohydrates were negatively associated with constipation (OR: 0.852, 95% CI: 0.796-0.912, P = 0.0001). Low-quality carbohydrates were positively associated with constipation (OR: 1.010, 95% CI: 1.002-1.018, P = 0.0295). There was no significant direct association between carbohydrate quality and diarrhoea (P = 0.5189, P = 0.8278). Segmented regression results showed a non-significant association between low quality carbohydrate intake above 40.65 servings/day and constipation, while quality carbohydrate intake above 3.84 servings/day was not significantly associated with diarrhoea. Subgroup analyses showed differences in carbohydrate quality and constipation or diarrhoea across populations.
High-quality carbohydrates lowered constipation risk by 33.7% and reduced diarrhea risk with intake up to 3.84 servings/day. In contrast, low-quality carbohydrates increased constipation risk by 83.4%, with risk stabilizing beyond 40.65 servings/day. These effects varied across groups, suggesting that better carbohydrate quality supports gut health, especially in sensitive individuals.
高碳水化合物饮食和低碳水化合物饮食与肠道健康有关。然而，它们与便秘或腹泻的具体关系尚不清楚。本研究使用2005 - 2010年美国国家健康与营养检查调查（NHANES）数据，来研究碳水化合物质量与便秘和腹泻之间的关系，并确定适合不同碳水化合物饮食的人群。
慢性便秘定义为布里斯托大便分类法（BSFS）的1型和2型，慢性腹泻定义为6型和7型。饮食摄入数据由食物频率问卷（FPED）提供，使用NHANES数据库中的数据。受试者回忆过去24小时内食用的食物和饮料，并将摄入量平均后分为四分位数（Q）。在调整协变量后，使用加权限制立方样条（RCS）曲线和多变量逻辑回归评估高碳水化合物饮食和低碳水化合物饮食与便秘或腹泻之间的关联。结果以加权比值比（OR）和95%置信区间（CI）表示，并进行亚组分析。
共有11355人参与，便秘组有10488人，腹泻组有10516人。多元回归显示，优质碳水化合物与便秘呈负相关（OR：0.852，95%CI：0.796 - 0.912，P = 0.0001）。劣质碳水化合物与便秘呈正相关（OR：1.010，95%CI：1.002 - 1.018，P = 0.0295）。碳水化合物质量与腹泻之间无显著直接关联（P = 0.5189，P = 0.8278）。分段回归结果显示，每日摄入量超过40.65份的劣质碳水化合物摄入与便秘之间无显著关联，而每日摄入量超过3.84份的优质碳水化合物摄入与腹泻无显著关联。亚组分析显示，不同人群在碳水化合物质量与便秘或腹泻方面存在差异。
优质碳水化合物使便秘风险降低33.7%，且每日摄入量达3.84份时腹泻风险降低。相比之下，劣质碳水化合物使便秘风险增加83.4%，摄入量超过40.65份/天后风险趋于稳定。这些影响因组而异，表明更好的碳水化合物质量有助于肠道健康，尤其是对敏感个体。
