A systematic review and meta-analysis of the dietary fiber menu provision and consumption for older adults living in residential care facilities

• Published in: The American journal of clinical nutrition 2024-08, Vol.120 (2), p.431-441
• Main Authors: O'Brien, Leigh, Wilkinson, Tim J, Frampton, Chris, Gearry, Richard B, Wall, Catherine
• Format: Article
• Language: English
• Subjects: Adults; Constipation; Consumption; Diarrhea; Dietary fiber; Error analysis; Guidelines; Heterogeneity; Laxatives; Literature reviews; Meals; menu review; Meta-analysis; Nutritional requirements; older adults; Older people; residential care; Side effects; Standard error; Systematic review
• ISSN: 0002-9165; 1938-3207; 1938-3207
• DOI: 10.1016/j.ajcnut.2024.05.026

Older adults living in residential care facilities are commonly given laxatives to treat constipation; however, these may not always provide full relief, and side effects include diarrhea. Dietary fiber effectively prevents constipation, and international guidelines recommend 25 g/d for optimal laxation. Older adults in residential care rely on the facility menu to provide their nutritional requirements, including adequate dietary fiber. Little is known about how much dietary fiber is provided and consumed. We aimed to determine the provision and consumption of dietary fiber for older adults living in residential care facilities. We systematically searched available literature for studies reporting the analysis of residential care menus and meals consumed by residents aged over 65 y. A meta-analysis was performed on the studies that provided the mean amount of dietary fiber provided and consumed by residents. A random effect model was applied due to the heterogeneity of study methodologies. The literature search yielded 4406 publications, but only 28 studies were eligible for our meta-analysis. The study sample comprised 4817 residents. The mean amount of fiber provided to residents was 21.4 g/d [standard error (SE): 1.2; 95% confidence interval: 18.8, 24.2 g/d], the mean amount of fiber consumed by residents was 15.8 g/d (SE: 0.6; 95% confidence interval: 14.7, 16.9 g/d). Older adults living in care facilities are provided with dietary fiber below the recommended guidelines. Compounding this is that residents consume much less than what is provided and do not meet the recommendations for dietary fiber consumption. There is scope to improve dietary fiber provision, promote consumption to residents to aid laxation, and potentially reduce laxative use and the unwanted side effects of diarrhea. This trial was registered at PROSPERO as CRD42023427265.