Disorders of circadian rhythms of defecation in obese patients
Objective: to evaluate circadian rhythms of the act of defecation in obese patients, depending on the presence or absence of concomitant constipation syndrome. Materials and methods: in the period from October 2020 to April 2022, 251 patients were examined. The average age of the patients was 49.8 ± 11.4 years. The ratio of men and women was 1:1.14 (117:134 people). The study included patients aged 18 to 75 years inclusive, obese: body mass index (BMI) 30 and above and waist circumference >94 cm in men and >80 cm in women who do not have organic diseases of the colon. All patients were assessed for gastroenterological complaints, stool frequency (number a week), stool type according to the Bristol scale (1-7), the time of defecation during the day to identify possible disorders of circadian rhythms, measurement of anthropometric parameters (height, body weight), calculation of BMI. Statistical data processing was performed using Statistica 10 and SAS JMP 11 programs. Results: in the study population, constipation was detected in 45.8% of obese patients. Patients with constipation were significantly more concerned about pain along the colon, bloating, as well as the need for severe straining and pain in the perianal region and along the rectum after defecation (p<0.05). Patients with obesity and constipation syndrome, compared with those without obesity, had significant changes in the frequency, consistency of stool and circadian rhythms of defecation: the frequency of defecation (number a week) 2.8 and 6.9, the average value of the type of stool on the Bristol scale 1.8 and 3.5, defecation in the morning 42.6% and 58.8%, respectively (p<0.05). Conclusions: in patients with obesity and the presence of constipation, pronounced disorders of circadian rhythms of defecation are determined. This can contribute to the progression of chronic constipation, the formation of disorders of the gut microbiota, which leads to the development of the leaky gut syndrome, the maintenance of chronic inflammation and, as a result, to the progression of obesity and metabolic changes. Restoration of physiological rhythms of the act of defecation is an important component of non-drug treatment in the complex therapy of obesity, metabolic syndrome, chronic constipation.