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Practice Guideline
. 2025 Oct;38(5):e70133.
doi: 10.1111/jhn.70133.

British Dietetic Association Guidelines for the Dietary Management of Chronic Constipation in Adults

Eirini Dimidi  1 , Alice van der Schoot  1 , Kevin Barrett  2 , Adam D Farmer  3 , Miranda C Lomer  1   4 , S Mark Scott  5 , Kevin Whelan  1
Affiliations
Practice Guideline

British Dietetic Association Guidelines for the Dietary Management of Chronic Constipation in Adults

Eirini Dimidi et al. J Hum Nutr Diet. 2025 Oct.

Abstract

Background: Current clinical guidelines for chronic constipation offer limited dietary recommendations. The aim of this project was to develop the first comprehensive evidence-based dietary guidelines for the management of chronic constipation in adults.

Methods: Four systematic reviews and meta-analyses were performed to identify eligible randomised controlled trials (RCTs). The findings generated from the meta-analyses were then used to develop guideline statements using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach and a Delphi consensus survey among a multi-disciplinary expert Guideline Steering Committee. Recommendation statements were produced for treatment response, stool output, gut symptoms, adverse events, and quality of life, and only based on the findings where ≥ 2 RCTs contributed to the meta-analysis. The strength of recommendation was assessed using the GRADE approach. Consensus voting amongst the Guideline Steering Committee was performed using a modified Delphi survey approach.

Results: The four systematic reviews included a total of 75 RCTs. Fifty-nine dietary recommendation statements were generated and accepted through the Delphi survey. For dietary supplements, 15 recommendation statements relate to fibre supplements, 20 relate to probiotics, 2 to synbiotics, 5 to magnesium oxide, 2 to senna, and 3 to kiwifruit supplements. For foods, three recommendation statements related to kiwifruits, two to prunes, and two to rye bread. For drinks, five recommendation statements related to high mineral-containing water. No recommendations were made for whole diet approaches due to a lack of evidence. Twelve statements had a very low level of evidence, 39 had a low level of evidence, and 8 had moderate evidence. Twenty-seven statements were strong recommendations, and 32 were qualified recommendations.

Conclusions: These are the first comprehensive evidence-based dietary guidelines for the management of constipation based upon a robust systematic review and GRADE processes. Recommendations were made for dietary supplements, foods and drinks that have never been previously included in clinical guidelines, and can now be rapidly implemented into clinical practice, thereby improving clinical care and patient outcomes.

Keywords: constipation; diet; fibre; gut health; nutrition.

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Conflict of interest statement

Eirini Dimidi has received an education grant from Alpro, research grants from the Almond Board of California, the International Nut and Dried Fruit Council and Nestec Ltd., and has served as a consultant for Puratos and Danone. Alice van der Schoot is currently funded by a grant from the Almond Board of California. Kevin Barrett has received speaker fees and honoraria for writing articles for Bimuno and Symprove. Miranda C. Lomer has received speaker fees from Janssen, Mayoly and AbbVie. Miranda C. Lomer is a Course Director of low FODMAP courses for dietitians. Miranda C. Lomer receives royalties from Wiley Publishing in relation to an academic textbook on nutrition and dietetics in gastroenterology. Kevin Whelan has received research grants related to diet and gut health and disease from the Almond Board of California, Danone, and the International Nut and Dried Fruit Council and has received speaker fees from Danone and Yakult. Kevin Whelan is the holder of a joint patent to use volatile organic compounds as biomarkers in irritable bowel syndrome (PCT/GB2020/051604), for which there is currently no product on the market. Kevin Whelan receives royalties from Wiley Publishing in relation to an academic textbook on nutrition and dietetics in gastroenterology. The other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
A clinician‐friendly summary guide of the recommendation statements as a practical tool that facilitates the adoption of the guidelines in clinical practice.
See this image and copyright information in PMC

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