Association Between Zinc Dietary Intake And Constipation: A Population-based Study

Association Between Zinc Dietary Intake And Constipation: A Population-based Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association Between Zinc Dietary Intake And Constipation: A Population-based Study Xuefeng Liu, Lili Tang, Wei Shen, Nai Mi, Zewei Sheng, Chang Li, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5807263/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Several studies have proposed a connection between the beginning of constipation and the consumption of dietary micronutrients. However, little study has been done on the possible connection between constipation and ZINC. This study sought to ascertain whether there was a relationship between chronic constipation and dietary zinc intake in adult National Health and Nutrition Examination Survey (NHANES) participants. Method : Data from the 2009–2010 NHANES health and nutrition survey were used in the study. 24-hour dietary recalls were used to collect dietary information from respondents. Numerous statistical techniques, including interaction testing, subgroup analysis, and curve fitting studies, were used to examine the connection between dietary zinc intake and chronic constipation. Result: Out of the 3,643 individuals in this research, 270 (7.41%) had a chronic constipation diagnosis. Increasing dietary zinc intake was associated with a decreased incidence of constipation (OR=0.78, 95% CI: 0.68-0.89), with significance at p<0.05, according to a fully adjusted multiple logistic regression analysis. as several factors were taken into consideration, the third tertile's odds ratio and 95% CI were 0.85 (0.74, 0.98), with statistical significance at p<0.05, as compared to the reference group (first tertile). Furthermore, subgroup analysis showed no correlation in most groups, while a certain negative correlation was found in males and alcohol drinkers, particularly in males and alcohol drinkers. In conclusion, this study found a negative association between zinc consumption and the prevalence of chronic constipation. In-depth prospective studies are needed to fully examine the long-term effects of zinc on chronic constipation. NHANES dietary zinc intake constipation risk factor Cross-sectional study Figures Figure 1 Figure 2 Background Approximately 10% to 20% of people globally suffer from symptoms of constipation. Hard stools or irregular bowel movements have historically been linked to the word "constipation." The symptoms of this disorder vary, however, and individuals may have anal obstruction, hard stools, straining during defecation, a sense of incomplete bowel evacuation, or the need for physical help to aid stool movement (1-2). The affected person may experience a decline in their social, mental, and physical health. However, only 20% of those who have constipation seek medical help. The high incidence of this problem results in approximately 8 million medical visits (3) and $230 million in costs (4) annually in the United States. Prolonged constipation may be caused by a variety of causes, including intestinal neurotransmitter regulation, fluid transfer, colonic motility, colonic sensory dysfunction, anorectal function, and dietary and lifestyle decisions. Importantly, dietary habits and lifestyle choices have a significant role in chronic condition (5). Modifications to these elements are believed to be significant, manageable causes of chronic constipation. An important micronutrient for human metabolism is zinc. It can assist control gene expression, encourage protein folding, and catalyze more than 100 enzymes. Patients with malnutrition, alcoholism, malabsorption syndrome, and inflammatory bowel disease are more likely to experience zinc insufficiency. Non-specific symptoms of zinc deficiency include growth retardation, intestinal-related diseases, hair loss, glossitis, nail malnutrition, lowered immunity, and male gonadal dysfunction(6). Furthermore, zinc is essential for preserving the stability and structure of proteins （7）. Additionally, it is necessary for preserving the structure and functionality of cellular membranes (8). As a result, a number of medical disorders have been linked to zinc status（9,10,11,12）. Studies have indicated that zinc may potentially function as a therapeutic target for intestinal disorders such as diarrhea, constipation, and inflammatory bowel diseas（13）.Thus, more research is required to determine how ZINC affects intestinal disorders and the symptoms that go along with them.There is still much to learn about the possible function of individual minerals in reducing constipation, despite the fact that many research have examined the effects of several dietary components on the disease, such as fiber consumption, specific mineral micronutrients, and fat intake. For example, studies have linked a deficiency in copper to an increased risk of constipation. (14)As well as a connection between dietary selenium intake and an increased risk of constipation（15）.The relationship between constipation and other specific mineral micronutrients, however, has not received significant attention. Despite the fact that the corpus of existing research addresses the association between dietary mineral micronutrient consumption and chronic constipation, there are few comprehensive population studies specifically looking at the relationship between zinc intake and chronic constipation. This original study pooled a large dataset from NHANES 2009–2010 to investigate the association between dietary zinc intake and constipation in U.S. adults, providing significant new insights and recommendations for the clinical management and prevention of constipation. Methods Survey description. A thorough survey carried out in the US is the NHANES program. Data from a representative sample of the population was gathered using this cross-sectional study design. This survey was carried out by the Centers for Disease Control's National Center for Health Statistics (16). It uses a technique that involves stratified, multistage, and random sampling approaches to gather health-related data from the general U.S. population. NHANES's main objective is to collect data on Americans' eating habits and overall health while also assessing the nutritional and health status of the country's adult and pediatric populations. Written consent was provided by each participant, and the National Center for Health Statistics' Research Ethics Review Board authorized the study. (17). Using publicly available gut health data from the 2009–2010 NHANES era, which included 13,591 persons aged 20 years or older, we carried out our investigation. A questionnaire on the frequency of their bowel movements and basic stool characteristics was given to the participants to complete. To ensure the accuracy and dependability of the findings, specific exclusion criteria were set: individuals without intestinal health questionnaire data (N = 6,370), individuals without unrecorded zinc dietary intake data (N = 1,648), and individuals without other covariate information (N = 1,570) (19–20). Ultimately, the sample for the analysis consisted of 3,643 individuals. Please see Figure 1 for more details on the patient screening procedure. The definition of constipation The NHANES database was used to characterize constipation, accounting for factors including frequency of bowel movements and stool consistency (18). Participants recorded the frequency and texture of their feces for 30 days prior to data collection. The Bristol Stool Form Scale (BSFS), which consists of cards with different colored pictures and descriptions of seven different types of stools, was used to evaluate the consistency of their stools. In line with earlier studies（19,20,21,22），those who reported having BSFS type 1 (separate hard lumps, like nuts) or BSFS type 2 (sausage-like, but lumpy) as their typical or most common stool type were labeled as having chronic constipation. Chronic constipators were also defined as individuals who reported taking laxatives at least once a week for the preceding 30 days. Those who reported having either BSFS type 6 (fluffy chunks with ragged edges, a mushy stool) or BSFS type 7 (watery, no solid pieces) as their usual or most common stool type were diagnosed with chronic diarrhea. Regular bowel motions were the category assigned to the remaining subjects. Assessment of Zinc Intake 24-hour dietary recalls were used as part of a multichannel approach to gather data on zinc consumption. In order to gather comprehensive data on every meal and beverage that people consumed over the course of a 24-hour period, beginning at midnight, this method used a respondent-driven technique. For a 24-hour recall of total nutrient consumption, each subject was interviewed twice. The first interview took place in person at a mobile screening location, and the others were performed over the phone over the course of three to ten days. The average zinc consumption was determined when subjects finished both recalls; otherwise, information from the first interview was used. Our study is primarily concerned with zinc intake from food sources; zinc intake from dietary supplements is not taken into account. (23). Covariate Covariates such as socioeconomic status (education, income), lifestyle factors (smoking, alcohol consumption), demographic characteristics (age, gender, race/ethnicity), and clinical features (body mass index, current health issues, hypertension, heart disease) were included in the study to control for potential confounders that might influence the relationship between food intake and health outcomes (24,25,26). Smokers (defined as individuals who currently smoke and have smoked at least 100 cigarettes in their lifetime) and non-smokers (defined as individuals who have never smoked or have smoked fewer than 100 cigarettes in their lifetime) were categorized based on smoking status. Individuals who consumed at least 12 alcoholic beverages during 2009 and 2010 were classified as drinkers. A person was considered to have diabetes if their glycated hemoglobin (HbA1c) level was ≥6.5%, or if they self-reported being diagnosed with diabetes (27). Hypertension was defined if a person's diastolic blood pressure exceeded 90 mmHg, systolic blood pressure exceeded 140 mmHg, or if they were taking antihypertensive medications. This was based on the theoretical framework and relevant literature on the effect of exercise on the relationship between dietary fiber and constipation. Statistical Analysis Participants were categorized into three groups based on dietary zinc intake, and their demographic characteristics were analyzed using chi-square and t-tests. Weighted multivariate logistic regression models were applied to evaluate the linear relationship between dietary zinc intake and chronic constipation. Zinc intake was also converted from a continuous to a categorical variable (tertile) to perform a trend test, assessing its linear association with chronic constipation risk. Subgroup analyses examined the relationship between dietary zinc intake and chronic constipation across different groups, including gender, BMI, alcohol consumption, smoking status, and comorbidities such as hypertension and diabetes. Interaction tests were conducted to determine the consistency of these relationships among subgroups. Nonlinear associations between dietary zinc intake and chronic constipation were explored using smoothing curve fitting. All analyses were carried out with R software (version 4.1.3) or Empowerstats (version 2.0), with statistical significance set at a two-sided p-value < 0.05. RESULTS Baseline characteristics Among the 3,643 participants analyzed, the average age was 49.39 years (SD: 17.76), with 49.96% being female and 62.14% identifying as non-Hispanic white. Constipation was reported by 270 individuals, corresponding to an overall prevalence of 7.41%. The average zinc intake for the group was 10.52 mg/day (SD: 4.23) and was divided into tertiles: tertile 1 (T1) 12.13 mg/day. Participants in the higher zinc intake groups tended to be younger, male, married, and had higher PIR scores, as well as lower rates of diabetes, smoking, and alcohol use compared to those in the lowest tertile. Moreover, constipation prevalence decreased with increased zinc intake, with rates of 9.73% in T1, 7.82% in T2, and 4.69% in T3 (Table 1). Table 1 Baseline characteristics of the study population according to the dietary zinc intake in NHANES 2009–2010 Characteristics T1(n=1213) T2(n=1215) T3(n=1215) P-value P-value* the zinc intake 6.14 ± 1.50 10.22 ± 1.21 18.29 ± 7.91 <0.001 <0.001 constipation <0.001 - No 1095 (90.27%) 1120 (92.18%) 1158 (95.31%) Yes 118 (9.73%) 95 (7.82%) 57 (4.69%) Age 51.34 ± 18.21 49.29 ± 17.99 47.53 ± 16.87 <0.001 <0.001 PIR 2.29 ± 1.50 2.53 ± 1.57 2.68 ± 1.61 <0.001 <0.001 BMI (kg/m 2 ) 29.42 ± 6.89 29.19 ± 6.86 28.87 ± 6.48 0.130 0.287 Gender <0.001 - Female 819 (67.52%) 656 (53.99%) 345 (28.40%) Male 394 (32.48%) 559 (46.01%) 870 (71.60%) Race <0.001 - Mexican American 253 (20.86%) 237 (19.51%) 186 (15.31%) Other Hispanic 148 (12.20%) 110 (9.05%) 101 (8.31%) Non-Hispanic White 497 (40.97%) 615 (50.62%) 690 (56.79%) Non-Hispanic Black 249 (20.53%) 196 (16.13%) 184 (15.14%) Other Race - Including Multi-Racial 66 (5.44%) 57 (4.69%) 54 (4.44%) Marital Status <0.001 - Married 595 (49.05%) 633 (52.10%) 661 (54.40%) Widowed 139 (11.46%) 106 (8.72%) 62 (5.10%) Divorced 150 (12.37%) 138 (11.36%) 124 (10.21%) Separated 41 (3.38%) 38 (3.13%) 34 (2.80%) Never married 201 (16.57%) 206 (16.95%) 228 (18.77%) Living with partner 87 (7.17%) 94 (7.74%) 105 (8.64%) Refused 0 (0.00%) 0 (0.00%) 1 (0.08%) Diabetes 0.002 - No 1038 (85.57%) 1081 (88.97%) 1094 (90.04%) Yes 175 (14.43%) 134 (11.03%) 121 (9.96%) Alcohol consumption <0.001 - No 414 (34.13%) 319 (26.26%) 210 (17.28%) Yes 799 (65.87%) 896 (73.74%) 1005 (82.72%) Hypertension 0.008 - No 744 (61.34%) 774 (63.70%) 818 (67.33%) Yes 469 (38.66%) 441 (36.30%) 397 (32.67%) Smoking status 0.001 - No 689 (56.80%) 675 (55.56%) 605 (49.79%) Yes 524 (43.20%) 540 (44.44%) 610 (50.21%) Abbreviations: BMI body mass index, PIR the ratio of family income to poverty The relationship between Zinc intake and constipation. Table 2 presents the associations between zinc intake and constipation prevalence. To enhance interpretability, the association between zinc intake and constipation was assessed both as a continuous variable and by categorizing zinc intake into tertiles.In the unadjusted model (Model 1), the analysis of the logarithmic form of continuous zinc intake revealed a significant inverse association (OR = 0.95, 95% CI = 0.93–0.98, p < 0.0001). This inverse association persisted after adjusting for socioeconomic and demographic factors in Model 2, with an OR of 0.97 (95% CI = 0.94–0.99, p = 0.0177). Even after controlling for all potential confounders in Model 3, the negative association between zinc intake and constipation remained significant (OR = 0.97, 95% CI = 0.95–1.00, p = 0.0237), indicating that for every unit increase in the logarithm of zinc intake, the likelihood of constipation decreased by 3%.For sensitivity analysis, zinc intake was also categorized into tertiles. In the fully adjusted model, participants in the highest tertile of zinc intake had a significantly reduced risk of constipation compared to those in the lowest tertile (OR = 0.59, 95% CI = 0.41–0.83, p = 0.0027). While this association was statistically significant, it also corresponded to a noticeable trend where higher zinc intake was linked to reduced constipation prevalence (P for trend < 0.01).These findings suggest a consistent inverse relationship between zinc intake and constipation risk, providing a quantifiable measure of the protective effects of higher zinc consumption. Table 2 Odds ratios and 95% confidence intervals for constipation according to dietary zinc intake . OR (95% CI), P value Continuous Model 1 Model 2 Model 3 0.95 (0.93, 0.98) 0.0001 0.97 (0.94, 0.99) 0.0177 0.97 (0.95, 1.00) 0.0237 Categories Tertile1 1.0 1.0 1.0 Tertile2 0.79 (0.59, 1.04) 0.0970 0.86 (0.64, 1.14) 0.2947 0.87 (0.66, 1.17) 0.3635 Tertile3 0.46 (0.33, 0.63) <0.0001 0.57 (0.41, 0.81) 0.0018 0.59 (0.41, 0.83) 0.0027 1. In the sensitivity analysis, zinc intake was transformed from a continuous variable into a categorical one (tertiles). 2. OR stands for odds ratio, while 95% Cl refers to the 95% confidence interval. 3. Model 1: No adjustments were made for covariates. 4. Model 2: Adjustments were made for sex, age, race, and marital status. 5. Model 3: Adjusted for sex, age, race, PIR, BMI, smoking habits, alcohol intake, hypertension, diabetes and marital status. Subgroup analysis. Zinc consumption and constipation were similarly negatively correlated (OR=0.96; 95% CI, 0.93-1.00, p=0.0398) among smokers in the smoking status subgroup. Furthermore, the group of drinkers also showed a negative connection (OR=0.96; 95% CI, 0.93-0.99, p=0.0197). Results were statistically significant for hypertensive patients (OR=0.69; 95% CI, 0.51-0.93, p=0.0156). The interaction effect test findings show that the relationship between zinc consumption and constipation does not significantly change between subgroups. This negative connection is not significantly correlated with gender, race, diabetes, hypertension, or any other variable (the p value of all interaction effects is larger than 0.05). Table 3 Table 3 Subgroup analysis Variable OR (95% CI) P- value P for interaction Gender 0.5988 Male 0.96 (0.93, 1.00) 0.0521 Female 0.98 (0.94, 1.01) 0.1998 Race 0.9362 Mexican American 0.96 (0.90, 1.02) 0.2241 Other Hispanic 1.00 (0.93, 1.07) 0.9678 Non-Hispanic White 0.97 (0.93, 1.00) 0.0834 Non-Hispanic Black 0.98 (0.92, 1.04) 0.4498 Mexican American 0.97 (0.85, 1.11) 0.6789 Smoking status 0.4912 Yes 0.96 (0.93, 1.00) 0.0398 No 0.98 (0.95, 1.01) 0.2177 Alcohol consumption 0.3946 Yes 0.96 (0.93, 0.99) 0.0197 No 0.99 (0.94, 1.04) 0.6315 Marital status 0.1614 Married 0.98 (0.95, 1.02) 0.3238 Widowed 0.93 (0.84, 1.03) 0.1540 Divorced 0.93 (0.85, 1.02) 0.1245 Separated 0.71 (0.50, 1.02) 0.0618 Never married 0.99 (0.94, 1.04) 0.6600 Living with partner 0.99 (0.94, 1.04) 0.6600 1. Analyses of subgroups that incorporate covariates adjusted for in Model 3 2. Abbreviations: OR (odds ratio), 95% Cl (95% confidence interval) Non-linear relationship between dietary Zinc intake and constipation. The negative correlation between zinc consumption and constipation was examined using curve-fitting technique, which produced a curve. The discovered negative linear relationship between zinc consumption and constipation prevalence is depicted in Figure 2. Discussion Our study's cross-sectional analysis of 3,643 individuals revealed that those with higher zinc intake is associated with a lower prevalence of constipatio. Subgroup analysis and interaction testing revealed that the association was not significant across most populations, but a negative correlation was specifically observed in smokers, drinkers, and individuals with hypertension. Depending on the study type and the criteria employed to determine prevalence, prior research has shown differences in the frequency of constipation ((28-29). For example, Zhang L et al. found that constipation rates were 7.01% based on stool consistency and 3.08% based on frequency of defecation (30). This study employed the Bristol Fecal Form Scale from the Intestinal Health Questionnaire to describe constipation in terms of stool texture and frequency of bowel movements. In line with the findings of Liu Q et al., the results showed a prevalence of constipation of 7.41% (31). By carefully examining the NHANES database, researchers have progressively raised awareness of possible connections between dietary factors and chronic constipation (32). Zhao et al.'s (31) evidence of a negative relationship between dietary phosphorus consumption and constipation underscored the need of evaluating chronic constipation. Likewise, Yang et al. discovered a negative relationship between dietary energy consumption and constipation, suggesting that a sufficient calorie intake may lower the likelihood of constipation in both sexes (33). Additionally, Wang et al. (34) examined the relationship between chronic constipation and the amount of carotenoids consumed by adult Americans. Their results suggest that while women may be less likely to suffer from chronic constipation if they ingest more alpha carotene, men may benefit from taking more lycopene. Zinc is the trace element that is most extensively distributed in the body, after iron.（35）. Zinc catalyzes enzyme activity, regulates gene expression, and helps with protein structure (36). Cereals, poultry, pork, and seafood are among the many foods that contain it.Seven to 80 mg of elemental zinc are included in commercial zinc supplements, which are usually prepared as zinc oxide or salts with acetate, gluconate, and sulfate(37,38). Zinc supplement use in the previous year was reported by 2.5 percent of participants in the 2002 NHANES. 7.5 to 15 mg of elemental zinc are included in multivitamins, which are taken by 62% of people(39). Numerous ailments, including upper respiratory tract infections (URI), age-related macular degeneration, ntestinal disorders, and wound healing, are frequently treated with zinc supplements.Changes in gastrointestinal motility are the cause of the prevalent and problematic gastrointestinal condition known as constipation (40). There have been positive results from researching the contributing elements. Normal intestinal motility depends on a variety of processes, such as fermentation, bile acid metabolism and mucus secretion, immunological and neurological system function, and gastrointestinal microbiota. Constipation symptoms can arise from any imbalance or dysfunction of these components, which can cause irregular intestinal movement (41).The potential link between a zinc diet and constipation has several aspects that call for further investigation. By triggering the intestinal hormone cholecystokinin (CCK), zinc indirectly controls gastrointestinal motility, hunger, and inflammatory response (42). Constipation and motility dysfunction may result from zinc's impact on the immunological and neurological systems, which may also alter gastrointestinal function, according to research findings. In summary, zinc consumption offers a wide range of possible therapeutic uses and is essential for intestinal health（40）. The strength of our study includes the use of a sizable sample size and nationally representative data from the United States’ 2009–2010 National Health and Nutrition Examination Survey (NHANES). To enhance the reliability of our statistical findings, we also conducted subgroup analyses and adjusted for potential confounding variables, including social factors that may influence constipation.However, it is crucial to acknowledge many noteworthy constraints of this study. First off, because this study is cross-sectional, it is unable to make any inferences regarding a causal relationship between zinc intake and constipation (43). Although we have seen a correlation, we cannot determine if increasing zinc consumption reduces constipation or whether those with less constipation tend to consume more zinc. This inherent limitation of cross-sectional studies emphasizes the necessity of longitudinal study to identify any potential causal relationships (44). Furthermore, our dependence on food recalls did not allow us to adequately capture the individuals' average zinc consumption. 24-hour food diaries may not be a good predictor of long-term dietary patterns, even when self-report and recall were utilized to collect the data on eating behaviors and bowel movements (45,45,47). It's possible that our reliance on food memory underrepresents the usual zinc intake. This approach is commonly utilized in large-scale nutrition research despite its ease, even if it has issues documenting long-term eating behaviors (48).Variations in the daily diet and possible recall bias might lead to an inaccurate classification of the zinc consumption quantity. This limitation may reduce the accuracy of our estimations and diminish the observed connections. Future research using more comprehensive dietary assessment techniques, including meal frequency surveys or long-term repeated 24-hour recall, might be able to more accurately reflect routine zinc consumption. The precision and dependability of the food consumption data included in our study are highly valued using this methodology(49,48,50).Even after accounting for a number of confounding variables, there are still other factors that affect constipation that have not been discussed. Future longitudinal studies are needed to better understand the relationship between dietary zinc and constipation. Thirdly, self-reported bowel motions and food consumption may potentially result in either over- or under-reporting, which might affect the accuracy of the data(51,52,53).The actual relationship between zinc consumption and constipation may be underestimated as a result of this measuring mistake.Lastly, because of variations in metabolism, zinc consumption, and genetic background.It's possible that the American study's findings won't apply to other populations. This highlights the need to conduct comparable research in various populations and restricts the external validity of our findings. Notwithstanding these drawbacks, this study offers insightful early information on a possible connection between zinc consumption and constipation. Future studies should use more thorough nutritional assessment techniques to precisely quantify long-term zinc consumption, concentrate on longitudinal study designs to demonstrate causality, and examine this relationship across different populations in order to overcome these limitations. Conclusion Our findings indicate a negative relationship between dietary zinc intake and the prevalence of chronic constipation in the whole adult population. Nevertheless, additional large-scale prospective studies are necessary to validate these results and establish a cause-and-effect relationship between dietary zinc intake and chronic constipation Abbreviations Not applicable. Declarations Ethics approval and consent to participate This study utilized data from the National Health and Nutrition Examination Survey (NHANES), a publicly available database. The NHANES protocol was approved by the National Center for Health Statistics (NCHS) Research Ethics Review Board, and informed consent was obtained from all participants. Consent for publication Not applicable. Availability of data and materials The datasets analyzed during the current study are available in the National Health and Nutrition Examination Survey (NHANES) repository (https://www.cdc.gov/nchs/nhanes/index.htm). Competing Interests The authors declare that they have no competing interests. Funding This study received no funding support. Authors' contributions Xuefeng Liu, Lili Tang, Wei Shen, Nai Mi , Zewei Sheng,Chang Li，Xiaoming Zhang, Weiru Lan, Wanni Sun, Qihui Huang,Hongwu Tao, Yuedong Liu contributed to the study's conception, design, data collection, analysis, and manuscript writing. Their specific contributions are as follows: Xuefeng Liu : Conceptualization, Methodology, Software, Investigation, Formal Analysis, Writing - Original Draft; Lili Tang : Data Curation, Writing - Original Draft; Wei Shen : Data Curation, Writing - Original Draft; Nai Mi : Formal Analysis, Writing - Original Draft; Zewei Sheng : Writing - Review & Editing; Chang Li : Conceptualization, Supervision; Xiaoming Zhang : Visualization, Investigation; Weiru Lan : Resources, Supervision, Writing - Review & Editing; Wanni Sun : Funding Acquisition, Resources; Qihui Huang : Data Curation, Software; Hongwu Tao : Resources, Supervision, Writing - Review & Editing; Yuedong Liu : Funding Acquisition, Resources, Writing - Review & Editing. Acknowledgments Not applicable. References Bharucha AE, Dorn SD, Lembo A, Pressman A. American Gastroenterological Association medical position statement on constipation. Gastroenterology. 2013;144(1):211–217. doi: 10.1053/j.gastro.2012.10.029. Schiller LR. 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Singh P, Mitsuhashi S, Ballou S, Rangan V, Sommers T, Cheng V, Iturrino-Moreda J, Friedlander D, Nee J, Lembo A (2018) Demographic and dietary associations of chronic diarrhea in a representative sample of adults in the United States. Am J Gastroenterol 113:593–600 .Wang Y, Gao X, Pedram P, Shahidi M, Du J, Yi Y, Gulliver W, Zhang H, Sun G. Significant Beneficial Association of High Dietary Selenium Intake with Reduced Body Fat in the CODING Study. Nutrients. 2016 Jan 4;8(1):24. doi: 10.3390/nu8010024. PMID: 26742059; PMCID: PMC4728638. Chun OK, Floegel A, Chung SJ, Chung CE, Song WO, Koo SI. Estimation of antioxidant intakes from diet and supplements in U.S. adults. J Nutr. 2010 Feb;140(2):317-24. doi: 10.3945/jn.109.114413. Epub 2009 Dec 23. Erratum in: J Nutr. 2010 May;140(5):1062. PMID: 20032488. Sommers T, Mitsuhashi S, Singh P, Hirsch W, Katon J, Ballou S, Rangan V, Cheng V, Friedlander D, Iturrino J, Lembo A, Nee J. Prevalence of Chronic Constipation and Chronic Diarrhea in Diabetic Individuals in the United States. Am J Gastroenterol. 2019 Jan;114(1):135-142. doi: 10.1038/s41395-018-0418-8. PMID: 30410038. Samson ME, Yeung LF, Rose CE, Qi YP, Taylor CA, Crider KS. Vitamin B-12 malabsorption and renal function are critical considerations in studies of folate and vitamin B-12 interactions in cognitive performance: NHANES 2011-2014. Am J Clin Nutr. 2022;116(1):74-85. doi:10.1093/ajcn/nqac065. Niroumand S, Khajedaluee M, Khadem-Rezaiyan M, Abrishami M, Juya M, Khodaee G, Dadgarmoghaddam M. Atherogenic Index of Plasma (AIP): A marker of cardiovascular disease. Med J Islam Repub Iran. 2015 Jul 25;29:240. PMID: 26793631; PMCID: PMC4715400. Li Y, Tong WD, Qian Y. Effect of Physical Activity on the Association Between Dietary Fiber and Constipation: Evidence From the National Health and Nutrition Examination Survey 2005-2010. J Neurogastroenterol Motil. 2021 Jan 30;27(1):97-107. doi: 10.5056/jnm20051. 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Front Nutr. 2022;9:856138. doi: 10.3389/fnut.2022.856138. Wang J, Kong W, Liu M, Wang Y, Zheng Y, Zhou Y. Association between dietary carotenoids intake and chronic constipation in American men and women adults: a cross-sectional study. BMC Public Health. 2023;23(1):1597. doi: 10.1186/s12889-023-16367-3. King JC. Zinc. In: Shils ME, Shike M, editors. Modern Nutrition in Health and Disease. 10. Philadelphia, Pa: Lippincott Williams & Wilkins; 2006. pp. 271–285. Institute of Medicine (US) Panel on Micronutrients. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington (DC): National Academies Press (US); 2001. PMID: 25057538. Matusheski NV, Caffrey A, Christensen L, Mezgec S, Surendran S, Hjorth MF, McNulty H, Pentieva K, Roager HM, Seljak BK, Vimaleswaran KS, Remmers M, Péter S. Diets, nutrients, genes and the microbiome: recent advances in personalised nutrition. Br J Nutr. 2021 Nov 28;126(10):1489-1497. doi: 10.1017/S0007114521000374. Epub 2021 Jan 29. PMID: 33509307; PMCID: PMC8524424. King JC. Zinc: an essential but elusive nutrient. Am J Clin Nutr. 2011 Aug;94(2):679S-84S. doi: 10.3945/ajcn.110.005744. Epub 2011 Jun 29. PMID: 21715515; PMCID: PMC3142737. Timbo BB, Ross MP, McCarthy PV, Lin CT. Dietary supplements in a national survey: Prevalence of use and reports of adverse events. J Am Diet Assoc. 2006 Dec;106(12):1966-74. doi: 10.1016/j.jada.2006.09.002. PMID: 17126626. Dimidi E, Christodoulides S, Scott SM, Whelan K. Mechanisms of Action of Probiotics and the Gastrointestinal Microbiota on Gut Motility and Constipation. Adv Nutr. 2017 May 15;8(3):484-494. doi: 10.3945/an.116.014407. PMID: 28507013; PMCID: PMC5421123. Kellow JE, Delvaux M, Azpiroz F, Camilleri M, Quigley EM, Thompson DG. Principles of applied neurogastroenterology: physiology/motility-sensation. Gut. 1999 Sep;45 Suppl 2(Suppl 2):II17-24. doi: 10.1136/gut.45.2008.ii17. PMID: 10457040; PMCID: PMC1766685. Nakajima S, Hira T, Iwaya H, Hara H. Zinc directly stimulates cholecystokinin secretion from enteroendocrine cells and reduces gastric emptying in rats. Mol Cell Endocrinol. 2016 Jul 15;430:108-14. doi: 10.1016/j.mce.2016.04.010. Epub 2016 Apr 20. PMID: 27107934. Yang Z, Zhang J, Zheng Y. Higher vitamin B6 dietary consumption is associated with a lower risk of glaucoma among United States adults. Front Nutr. 2024 Jun 5;11:1363539. doi: 10.3389/fnut.2024.1363539. PMID: 38903614; PMCID: PMC11188593. Zhang G, Feng W, Zhao L, Zhao X, Li T. The association between physical activity, self-efficacy, stress self-management and mental health among adolescents. Sci Rep. 2024 Mar 6;14(1):5488. doi: 10.1038/s41598-024-56149-4. PMID: 38448518; PMCID: PMC10917799. Debras C, Chazelas E, Srour B, Druesne-Pecollo N, Esseddik Y, Szabo de Edelenyi F, Agaësse C, De Sa A, Lutchia R, Gigandet S, Huybrechts I, Julia C, Kesse-Guyot E, Allès B, Andreeva VA, Galan P, Hercberg S, Deschasaux-Tanguy M, Touvier M. Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study. PLoS Med. 2022 Mar 24;19(3):e1003950. doi: 10.1371/journal.pmed.1003950. PMID: 35324894; PMCID: PMC8946744. Shan Z, Rehm CD, Rogers G, Ruan M, Wang DD, Hu FB, Mozaffarian D, Zhang FF, Bhupathiraju SN. Trends in Dietary Carbohydrate, Protein, and Fat Intake and Diet Quality Among US Adults, 1999-2016. JAMA. 2019 Sep 24;322(12):1178-1187. doi: 10.1001/jama.2019.13771. PMID: 31550032; PMCID: PMC6763999. Frank SM, Jaacks LM, Meyer K, Rose D, Adair LS, Avery CL, Taillie LS. Dietary quality and dietary greenhouse gas emissions in the USA: a comparison of the planetary health diet index, healthy eating index-2015, and dietary approaches to stop hypertension. Int J Behav Nutr Phys Act. 2024 Apr 2;21(1):36. doi: 10.1186/s12966-024-01581-y. PMID: 38566176; PMCID: PMC10988877. Osadchiy T, Poliakov I, Olivier P, Rowland M, Foster E. Progressive 24-Hour Recall: Usability Study of Short Retention Intervals in Web-Based Dietary Assessment Surveys. J Med Internet Res. 2020 Feb 3;22(2):e13266. doi: 10.2196/13266. PMID: 32012055; PMCID: PMC7055775. Pan W, Chen H, Ni C, Zong G, Yuan C, Yang M. Sex-Specific Associations of Dietary Iron Intake with Brain Iron Deposition on Imaging and Incident Dementia: A Prospective Cohort Study. J Nutr Health Aging. 2022;26(10):954-961. doi: 10.1007/s12603-022-1852-2. PMID: 36259584. Ferraro PM, Mandel EI, Curhan GC, Gambaro G, Taylor EN. Dietary Protein and Potassium, Diet-Dependent Net Acid Load, and Risk of Incident Kidney Stones. Clin J Am Soc Nephrol. 2016 Oct 7;11(10):1834-1844. doi: 10.2215/CJN.01520216. Epub 2016 Jul 21. PMID: 27445166; PMCID: PMC5053786. Ahluwalia N, Dwyer J, Terry A, Moshfegh A, Johnson C. Update on NHANES Dietary Data: Focus on Collection, Release, Analytical Considerations, and Uses to Inform Public Policy. Adv Nutr. 2016 Jan 15;7(1):121-34. doi: 10.3945/an.115.009258. PMID: 26773020; PMCID: PMC4717880. Wu D, Qu C, Huang P, Geng X, Zhang J, Shen Y, Rao Z, Zhao J. Water Intake and Handgrip Strength in US Adults: A Cross-Sectional Study Based on NHANES 2011-2014 Data. Nutrients. 2023 Oct 23;15(20):4477. doi: 10.3390/nu15204477. PMID: 37892552; PMCID: PMC10609934. Jia W, Wang H, Li C, Shi J, Yong F, Jia H. Association between dietary vitamin B1 intake and cognitive function among older adults: a cross-sectional study. J Transl Med. 2024 Feb 16;22(1):165. doi: 10.1186/s12967-024-04969-3. PMID: 38365743; PMCID: PMC10870482. Additional Declarations No competing interests reported. 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04:53:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5807263/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5807263/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":74075031,"identity":"0be7648e-71c8-4a68-a400-8ae6fd2c48d5","added_by":"auto","created_at":"2025-01-17 13:31:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":127554,"visible":true,"origin":"","legend":"\u003cp\u003e2009-2010 NHANES \u0026nbsp;Participant Selection Flowchart\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5807263/v1/37e14048e73d6ec29dc427f4.png"},{"id":74075033,"identity":"5cc66e9e-7028-4fb5-871b-502d2ba0f597","added_by":"auto","created_at":"2025-01-17 13:31:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":110559,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5807263/v1/da83c3f597027b09dd36a062.png"},{"id":75151986,"identity":"74469de9-bfb8-48d0-b87b-64c75d14c76d","added_by":"auto","created_at":"2025-01-31 09:08:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1273048,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5807263/v1/03e63f4d-c040-4a76-8fde-a60f7ac676d8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association Between Zinc Dietary Intake And Constipation: A Population-based Study","fulltext":[{"header":"Background","content":"\u003cp\u003eApproximately 10% to 20% of people globally suffer from symptoms of constipation. Hard stools or irregular bowel movements have historically been linked to the word \"constipation.\" The symptoms of this disorder vary, however, and individuals may have anal obstruction, hard stools, straining during defecation, a sense of incomplete bowel evacuation, or the need for physical help to aid stool movement (1-2). The affected person may experience a decline in their social, mental, and physical health. However, only 20% of those who have constipation seek medical help. The high incidence of this problem results in approximately 8 million medical visits (3) and $230 million in costs (4) annually in the United States. Prolonged constipation may be caused by a variety of causes, including intestinal neurotransmitter regulation, fluid transfer, colonic motility, colonic sensory dysfunction, anorectal function, and dietary and lifestyle decisions. Importantly, dietary habits and lifestyle choices have a significant role in chronic condition (5). Modifications to these elements are believed to be significant, manageable causes of chronic constipation.\u003c/p\u003e\n\u003cp\u003eAn important micronutrient for human metabolism is zinc. It can assist control gene expression, encourage protein folding, and catalyze more than 100 enzymes. Patients with malnutrition, alcoholism, malabsorption syndrome, and inflammatory bowel disease are more likely to experience zinc insufficiency. Non-specific symptoms of zinc deficiency include growth retardation, intestinal-related diseases, hair loss, glossitis, nail malnutrition, lowered immunity, and male gonadal dysfunction(6).\u0026nbsp;Furthermore, zinc is essential for preserving the stability and structure of proteins\u0026nbsp;（7）. Additionally, it is necessary for preserving the structure and functionality of cellular membranes (8). As a result, a number of medical disorders have been linked to zinc status（9,10,11,12）. Studies have indicated that zinc may potentially function as a therapeutic target for intestinal disorders such as diarrhea, constipation, and inflammatory bowel diseas（13）.Thus, more research is required to determine how ZINC affects intestinal disorders and the symptoms that go along with them.There is still much to learn about the possible function of individual minerals in reducing constipation, despite the fact that many research have examined the effects of several dietary components on the disease, such as fiber consumption, specific mineral micronutrients, and fat intake. For example, studies have linked a deficiency in copper to an increased risk of constipation. (14)As well as a connection between dietary selenium intake and an increased risk of constipation（15）.The relationship between constipation and other specific mineral micronutrients, however, has not received significant attention.\u003c/p\u003e\n\u003cp\u003eDespite the fact that the corpus of existing research addresses the association between dietary mineral micronutrient consumption and chronic constipation, there are few comprehensive population studies specifically looking at the relationship between zinc intake and chronic constipation. This original study pooled a large dataset from \u0026nbsp;NHANES 2009–2010 to investigate the association between dietary zinc intake and constipation in U.S. adults, providing significant new insights and recommendations for the clinical management and prevention of constipation.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eSurvey description.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA thorough survey carried out in the US is the NHANES program. Data from a representative sample of the population was gathered using this cross-sectional study design. This survey was carried out by the Centers for Disease Control's National Center for Health Statistics (16). It uses a technique that involves stratified, multistage, and random sampling approaches to gather health-related data from the general U.S. population.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;NHANES's main objective is to collect data on Americans' eating habits and overall health while also assessing the nutritional and health status of the country's adult and pediatric populations. Written consent was provided by each participant, and the National Center for Health Statistics' Research Ethics Review Board authorized the study. (17). Using publicly available gut health data from the 2009–2010 NHANES era, which included 13,591 persons aged 20 years or older, we carried out our investigation. A questionnaire on the frequency of their bowel movements and basic stool characteristics was given to the participants to complete. To ensure the accuracy and dependability of the findings, specific exclusion criteria were set: individuals without intestinal health questionnaire data (N = 6,370), individuals without unrecorded zinc dietary intake data (N = 1,648), and individuals without other covariate information (N = 1,570) (19–20). Ultimately, the sample for the analysis consisted of 3,643 individuals. Please see Figure 1 for more details on the patient screening procedure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe definition of constipation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe NHANES database was used to characterize constipation, accounting for factors including frequency of bowel movements and stool consistency (18). Participants recorded the frequency and texture of their feces for 30 days prior to data collection.\u0026nbsp;The Bristol Stool Form Scale (BSFS), which consists of cards with different colored pictures and descriptions of seven different types of stools, was used to evaluate the consistency of their stools.\u003c/p\u003e\n\u003cp\u003eIn line with earlier studies（19,20,21,22），those who reported having BSFS type 1 (separate hard lumps, like nuts) or BSFS type 2 (sausage-like, but lumpy) as their typical or most common stool type were labeled as having chronic constipation. Chronic constipators were also defined as individuals who reported taking laxatives at least once a week for the preceding 30 days. Those who reported having either BSFS type 6 (fluffy chunks with ragged edges, a mushy stool) or BSFS type 7 (watery, no solid pieces) as their usual or most common stool type were diagnosed with chronic diarrhea. Regular bowel motions were the category assigned to the remaining subjects.\u003c/p\u003e\n\u003cp\u003eAssessment of Zinc Intake\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e24-hour dietary recalls were used as part of a multichannel approach to gather data on zinc consumption. In order to gather comprehensive data on every meal and beverage that people consumed over the course of a 24-hour period, beginning at midnight, this method used a respondent-driven technique. For a 24-hour recall of total nutrient consumption, each subject was interviewed twice.\u0026nbsp;The first interview took place in person at a mobile screening location, and the others were performed over the phone over the course of three to ten days. The average zinc consumption was determined when subjects finished both recalls; otherwise, information from the first interview was used. Our study is primarily concerned with zinc intake from food sources; zinc intake from dietary supplements is not taken into account. (23).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCovariate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCovariates such as socioeconomic status (education, income), lifestyle factors (smoking, alcohol consumption), demographic characteristics (age, gender, race/ethnicity), and clinical features (body mass index, current health issues, hypertension, heart disease) were included in the study to control for potential confounders that might influence the relationship between food intake and health outcomes (24,25,26). Smokers (defined as individuals who currently smoke and have smoked at least 100 cigarettes in their lifetime) and non-smokers (defined as individuals who have never smoked or have smoked fewer than 100 cigarettes in their lifetime) were categorized based on smoking status. Individuals who consumed at least 12 alcoholic beverages during 2009 and 2010 were classified as drinkers. A person was considered to have diabetes if their glycated hemoglobin (HbA1c) level was ≥6.5%, or if they self-reported being diagnosed with diabetes (27). Hypertension was defined if a person's diastolic blood pressure exceeded 90 mmHg, systolic blood pressure exceeded 140 mmHg, or if they were taking antihypertensive medications. This was based on the theoretical framework and relevant literature on the effect of exercise on the relationship between dietary fiber and constipation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were categorized into three groups based on dietary zinc intake, and their demographic characteristics were analyzed using chi-square and t-tests. Weighted multivariate logistic regression models were applied to evaluate the linear relationship between dietary zinc intake and chronic constipation. Zinc intake was also converted from a continuous to a categorical variable (tertile) to perform a trend test, assessing its linear association with chronic constipation risk. Subgroup analyses examined the relationship between dietary zinc intake and chronic constipation across different groups, including gender, BMI, alcohol consumption, smoking status, and comorbidities such as hypertension and diabetes. Interaction tests were conducted to determine the consistency of these relationships among subgroups. Nonlinear associations between dietary zinc intake and chronic constipation were explored using smoothing curve fitting. All analyses were carried out with R software (version 4.1.3) or Empowerstats (version 2.0), with statistical significance set at a two-sided p-value \u0026lt; 0.05.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eBaseline characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 3,643 participants analyzed, the average age was 49.39 years (SD: 17.76), with 49.96% being female and 62.14% identifying as non-Hispanic white. Constipation was reported by 270 individuals, corresponding to an overall prevalence of 7.41%. The average zinc intake for the group was 10.52 mg/day (SD: 4.23) and was divided into tertiles: tertile 1 (T1) \u0026lt;8.34 mg/day, tertile 2 (T2) 8.35–12.12 mg/day, and tertile 3 (T3) \u0026gt;12.13 mg/day. Participants in the higher zinc intake groups tended to be younger, male, married, and had higher PIR scores, as well as lower rates of diabetes, smoking, and alcohol use compared to those in the lowest tertile. Moreover, constipation prevalence decreased with increased zinc intake, with rates of 9.73% in T1, 7.82% in T2, and 4.69% in T3 (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Baseline characteristics of the study population according to the dietary\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ezinc\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;intake in NHANES 2009–2010\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eT1(n=1213)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eT2(n=1215)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eT3(n=1215)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eP-value*\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ethe\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ezinc\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;intake\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.14 ± 1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.22 ± 1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18.29 ± 7.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003econstipation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1095 (90.27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1120 (92.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1158 (95.31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e118 (9.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e95 (7.82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e57 (4.69%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51.34 ± 18.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49.29 ± 17.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e47.53 ± 16.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePIR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.29 ± 1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.53 ± 1.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.68 ± 1.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29.42 ± 6.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29.19 ± 6.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28.87 ± 6.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.287\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e819 (67.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e656 (53.99%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e345 (28.40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e394 (32.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e559 (46.01%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e870 (71.60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMexican American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e253 (20.86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e237 (19.51%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e186 (15.31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOther Hispanic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e148 (12.20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e110 (9.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e101 (8.31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-Hispanic White\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e497 (40.97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e615 (50.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e690 (56.79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-Hispanic Black\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e249 (20.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e196 (16.13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e184 (15.14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOther Race - Including Multi-Racial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66 (5.44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e57 (4.69%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e54 (4.44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e595 (49.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e633 (52.10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e661 (54.40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e139 (11.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e106 (8.72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e62 (5.10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e150 (12.37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e138 (11.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e124 (10.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSeparated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41 (3.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38 (3.13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34 (2.80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNever married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e201 (16.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e206 (16.95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e228 (18.77%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLiving with partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e87 (7.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e94 (7.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e105 (8.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRefused\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (0.08%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1038 (85.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1081 (88.97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1094 (90.04%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e175 (14.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e134 (11.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e121 (9.96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol consumption\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e414 (34.13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e319 (26.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e210 (17.28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e799 (65.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e896 (73.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1005 (82.72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e744 (61.34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e774 (63.70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e818 (67.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e469 (38.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e441 (36.30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e397 (32.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e689 (56.80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e675 (55.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e605 (49.79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e524 (43.20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e540 (44.44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e610 (50.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: \u003cem\u003eBMI\u003c/em\u003e body mass index, \u003cem\u003ePIR\u003c/em\u003e the ratio of family income to poverty\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe relationship between Zinc intake and constipation.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 presents the associations between zinc intake and constipation prevalence. To enhance interpretability, the association between zinc intake and constipation was assessed both as a continuous variable and by categorizing zinc intake into tertiles.In the unadjusted model (Model 1), the analysis of the logarithmic form of continuous zinc intake revealed a significant inverse association (OR = 0.95, 95% CI = 0.93–0.98, p \u0026lt; 0.0001). This inverse association persisted after adjusting for socioeconomic and demographic factors in Model 2, with an OR of 0.97 (95% CI = 0.94–0.99, p = 0.0177). Even after controlling for all potential confounders in Model 3, the negative association between zinc intake and constipation remained significant (OR = 0.97, 95% CI = 0.95–1.00, p = 0.0237), indicating that for every unit increase in the logarithm of zinc intake, the likelihood of constipation decreased by 3%.For sensitivity analysis, zinc intake was also categorized into tertiles. In the fully adjusted model, participants in the highest tertile of zinc intake had a significantly reduced risk of constipation compared to those in the lowest tertile (OR = 0.59, 95% CI = 0.41–0.83, p = 0.0027). While this association was statistically significant, it also corresponded to a noticeable trend where higher zinc intake was linked to reduced constipation prevalence (P for trend \u0026lt; 0.01).These findings suggest a consistent inverse relationship between zinc intake and constipation risk, providing a quantifiable measure of the protective effects of higher zinc consumption.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Odds ratios and 95% confidence intervals for constipation according to\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003edietary\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ezinc\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;intake\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (95% CI),\u003cem\u003e\u0026nbsp;P\u003c/em\u003e value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eContinuous\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eModel 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eModel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eModel 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.95 (0.93, 0.98) 0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.97 (0.94, 0.99) 0.0177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.97 (0.95, 1.00) 0.0237\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTertile1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTertile2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.79 (0.59, 1.04) 0.0970\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.86 (0.64, 1.14) 0.2947\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.87 (0.66, 1.17) 0.3635\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTertile3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.46 (0.33, 0.63) \u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.57 (0.41, 0.81) 0.0018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.59 (0.41, 0.83) 0.0027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e1. In the sensitivity analysis, zinc intake was transformed from a continuous variable into a categorical one (tertiles).\u003c/p\u003e\n\u003cp\u003e2. OR stands for odds ratio, while 95% Cl refers to the 95% confidence interval.\u003c/p\u003e\n\u003cp\u003e3. Model 1: No adjustments were made for covariates.\u003c/p\u003e\n\u003cp\u003e4. Model 2: Adjustments were made for sex, age, race, and marital status.\u003c/p\u003e\n\u003cp\u003e5. Model 3: Adjusted for sex, age, race, PIR, BMI, smoking habits, alcohol intake, hypertension, diabetes and marital status.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubgroup analysis.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZinc consumption and constipation were similarly negatively correlated (OR=0.96; 95% CI, 0.93-1.00, p=0.0398) among smokers in the smoking status subgroup. Furthermore, the group of drinkers also showed a negative connection (OR=0.96; 95% CI, 0.93-0.99, p=0.0197). Results were statistically significant for hypertensive patients (OR=0.69; 95% CI, 0.51-0.93, p=0.0156). The interaction effect test findings show that the relationship between zinc consumption and constipation does not significantly change between subgroups. This negative connection is not significantly correlated with gender, race, diabetes, hypertension, or any other variable (the p value of all interaction effects is larger than 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Table 3 Subgroup analysis\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"592\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;for interaction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"42\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd height=\"42\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd height=\"42\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.5988\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"22\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e0.96 (0.93, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.0521\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"43\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e0.98 (0.94, 1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.1998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"43\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.9362\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"28\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMexican American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e0.96 (0.90, 1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.2241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"43\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOther Hispanic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e1.00 (0.93, 1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.9678\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"43\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-Hispanic White\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e0.97 (0.93, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.0834\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"46\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-Hispanic Black\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e0.98 (0.92, 1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.4498\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"46\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMexican American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e0.97 (0.85, 1.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6789\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"43\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.4912\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"27\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e0.96 (0.93, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.0398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"21\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e0.98 (0.95, 1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.2177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"18\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol consumption\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.3946\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"34\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e0.96 (0.93, 0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.0197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"28\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e0.99 (0.94, 1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"28\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.1614\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"28\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e0.98 (0.95, 1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.3238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"28\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e0.93 (0.84, 1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.1540\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"28\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e0.93 (0.85, 1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.1245\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"4\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSeparated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e0.71 (0.50, 1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.0618\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"4\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNever married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e0.99 (0.94, 1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"4\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLiving with partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e0.99 (0.94, 1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd height=\"4\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e1. Analyses of subgroups that incorporate covariates adjusted for in Model 3\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Abbreviations: OR (odds ratio), 95% Cl (95% confidence interval)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNon-linear relationship between dietary Zinc intake and constipation.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe negative correlation between zinc consumption and constipation was examined using curve-fitting technique, which produced a curve. The discovered negative linear relationship between zinc consumption and constipation prevalence is depicted in Figure 2.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study\u0026apos;s cross-sectional analysis of 3,643 individuals revealed that those with higher zinc intake is associated with a lower prevalence of constipatio. Subgroup analysis and interaction testing revealed that the association was not significant across most populations, but a negative correlation was specifically observed in smokers, drinkers, and individuals with hypertension.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Depending on the study type and the criteria employed to determine prevalence, prior research has shown differences in the frequency of constipation ((28-29). For example, Zhang L et al. found that constipation rates were 7.01% based on stool consistency and 3.08% based on frequency of defecation (30). This study employed the Bristol Fecal Form Scale from the Intestinal Health Questionnaire to describe constipation in terms of stool texture and frequency of bowel movements. In line with the findings of Liu Q et al., the results showed a prevalence of constipation of 7.41% (31). By carefully examining the NHANES database, researchers have progressively raised awareness of possible connections between dietary factors and chronic constipation (32). Zhao et al.\u0026apos;s (31) evidence of a negative relationship between dietary phosphorus consumption and constipation underscored the need of evaluating chronic constipation. Likewise, Yang et al. discovered a negative relationship between dietary energy consumption and constipation, suggesting that a sufficient calorie intake may lower the likelihood of constipation in both sexes (33). Additionally, Wang et al. (34) examined the relationship between chronic constipation and the amount of carotenoids consumed by adult Americans. Their results suggest that while women may be less likely to suffer from chronic constipation if they ingest more alpha carotene, men may benefit from taking more lycopene.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Zinc is the trace element that is most extensively distributed in the body, after iron.（35）. Zinc catalyzes enzyme activity, regulates gene expression, and helps with protein structure (36). Cereals, poultry, pork, and seafood are among the many foods that contain it.Seven to 80 mg of elemental zinc are included in commercial zinc supplements, which are usually prepared as zinc oxide or salts with acetate, gluconate, and sulfate(37,38). Zinc supplement use in the previous year was reported by 2.5 percent of participants in the 2002 NHANES. 7.5 to 15 mg of elemental zinc are included in multivitamins, which are taken by 62% of people(39). Numerous ailments, including upper respiratory tract infections (URI), age-related macular degeneration, ntestinal disorders, and wound healing, are frequently treated with zinc supplements.Changes in gastrointestinal motility are the cause of the prevalent and problematic gastrointestinal condition known as constipation (40). There have been positive results from researching the contributing elements. Normal intestinal motility depends on a variety of processes, such as fermentation, bile acid metabolism and mucus secretion, immunological and neurological system function, and gastrointestinal microbiota. Constipation symptoms can arise from any imbalance or dysfunction of these components, which can cause irregular intestinal movement (41).The potential link between a zinc diet and constipation has several aspects that call for further investigation. By triggering the intestinal hormone cholecystokinin (CCK), zinc indirectly controls gastrointestinal motility, hunger, and inflammatory response (42). Constipation and motility dysfunction may result from zinc\u0026apos;s impact on the immunological and neurological systems, which may also alter gastrointestinal function, according to research findings. In summary, zinc consumption offers a wide range of possible therapeutic uses and is essential for intestinal health（40）.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The strength of our study includes the use of a sizable sample size and nationally representative data from the United States\u0026rsquo; 2009\u0026ndash;2010 National Health and Nutrition Examination Survey (NHANES). To enhance the reliability of our statistical findings, we also conducted subgroup analyses and adjusted for potential confounding variables, including social factors that may influence constipation.However, it is crucial to acknowledge many noteworthy constraints of this study. First off, because this study is cross-sectional, it is unable to make any inferences regarding a causal relationship between zinc intake and constipation (43). Although we have seen a correlation, we cannot determine if increasing zinc consumption reduces constipation or whether those with less constipation tend to consume more zinc. This inherent limitation of cross-sectional studies emphasizes the necessity of longitudinal study to identify any potential causal relationships (44). Furthermore, our dependence on food recalls did not allow us to adequately capture the individuals\u0026apos; average zinc consumption. 24-hour food diaries may not be a good predictor of long-term dietary patterns, even when self-report and recall were utilized to collect the data on eating behaviors and bowel movements (45,45,47). It\u0026apos;s possible that our reliance on food memory underrepresents the usual zinc intake. This approach is commonly utilized in large-scale nutrition research despite its ease, even if it has issues documenting long-term eating behaviors (48).Variations in the daily diet and possible recall bias might lead to an inaccurate classification of the zinc consumption quantity. This limitation may reduce the accuracy of our estimations and diminish the observed connections. Future research using more comprehensive dietary assessment techniques, including meal frequency surveys or long-term repeated 24-hour recall, might be able to more accurately reflect routine zinc consumption. The precision and dependability of the food consumption data included in our study are highly valued using this methodology(49,48,50).Even after accounting for a number of confounding variables, there are still other factors that affect constipation that have not been discussed. Future longitudinal studies are needed to better understand the relationship between dietary zinc and constipation. Thirdly, self-reported bowel motions and food consumption may potentially result in either over- or under-reporting, which might affect the accuracy of the data(51,52,53).The actual relationship between zinc consumption and constipation may be underestimated as a result of this measuring mistake.Lastly, because of variations in metabolism, zinc consumption, and genetic background.It\u0026apos;s possible that the American study\u0026apos;s findings won\u0026apos;t apply to other populations. This highlights the need to conduct comparable research in various populations and restricts the external validity of our findings. Notwithstanding these drawbacks, this study offers insightful early information on a possible connection between zinc consumption and constipation. Future studies should use more thorough nutritional assessment techniques to precisely quantify long-term zinc consumption, concentrate on longitudinal study designs to demonstrate causality, and examine this relationship across different populations in order to overcome these limitations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur findings indicate a negative relationship between dietary zinc intake and the prevalence of chronic constipation in the whole adult population. Nevertheless, additional large-scale prospective studies are necessary to validate these results and establish a cause-and-effect relationship between dietary zinc intake and chronic constipation\u0026nbsp;\u003c/p\u003e\n"},{"header":"Abbreviations","content":"\u003cp\u003eNot applicable.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study utilized data from the National Health and Nutrition Examination Survey (NHANES), a publicly available database. The NHANES protocol was approved by the National Center for Health Statistics (NCHS) Research Ethics Review Board, and informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets analyzed during the current study are available in the National Health and Nutrition Examination Survey (NHANES) repository (https://www.cdc.gov/nchs/nhanes/index.htm).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no funding support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXuefeng Liu, Lili Tang, Wei Shen, Nai Mi , Zewei Sheng,Chang Li，Xiaoming Zhang, Weiru Lan, Wanni Sun, Qihui Huang,Hongwu Tao, Yuedong Liu contributed to the study's conception, design, data collection, analysis, and manuscript writing. Their specific contributions are as follows:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eXuefeng Liu\u003c/strong\u003e: Conceptualization, Methodology, Software, Investigation, Formal Analysis, Writing - Original Draft;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLili Tang\u003c/strong\u003e: Data Curation, Writing - Original Draft;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWei Shen\u003c/strong\u003e: Data Curation, Writing - Original Draft;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNai Mi\u003c/strong\u003e: Formal Analysis, Writing - Original Draft;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eZewei Sheng\u003c/strong\u003e: Writing - Review \u0026amp; Editing;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChang Li\u003c/strong\u003e: Conceptualization, Supervision;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eXiaoming Zhang\u003c/strong\u003e: Visualization, Investigation;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWeiru Lan\u003c/strong\u003e: Resources, Supervision, Writing - Review \u0026amp; Editing;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWanni Sun\u003c/strong\u003e: Funding Acquisition, Resources;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQihui Huang\u003c/strong\u003e: Data Curation, Software;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHongwu Tao\u003c/strong\u003e: Resources, Supervision, Writing - Review \u0026amp; Editing;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYuedong Liu\u003c/strong\u003e: Funding Acquisition, Resources, Writing - Review \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBharucha AE, Dorn SD, Lembo A, Pressman A. 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PMID: 38365743; PMCID: PMC10870482.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"NHANES, dietary zinc intake, constipation, risk factor, Cross-sectional study","lastPublishedDoi":"10.21203/rs.3.rs-5807263/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5807263/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Several studies have proposed a connection between the beginning of constipation and the consumption of dietary micronutrients. However, little study has been done on the possible connection between constipation and ZINC. This study sought to ascertain whether there was a relationship between chronic constipation and dietary zinc intake in adult National Health and Nutrition Examination Survey (NHANES) participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e: Data from the 2009–2010 NHANES health and nutrition survey were used in the study. 24-hour dietary recalls were used to collect dietary information from respondents. Numerous statistical techniques, including interaction testing, subgroup analysis, and curve fitting studies, were used to examine the connection between dietary zinc intake and chronic constipation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult:\u003c/strong\u003e Out of the 3,643 individuals in this research, 270 (7.41%) had a chronic constipation diagnosis. Increasing dietary zinc intake was associated with a decreased incidence of constipation (OR=0.78, 95% CI: 0.68-0.89), with significance at p\u0026lt;0.05, according to a fully adjusted multiple logistic regression analysis. as several factors were taken into consideration, the third tertile's odds ratio and 95% CI were 0.85 (0.74, 0.98), with statistical significance at p\u0026lt;0.05, as compared to the reference group (first tertile). Furthermore, subgroup analysis showed no correlation in most groups, while a certain negative correlation was found in males and alcohol drinkers, particularly in males and alcohol drinkers. In conclusion, this study found a negative association between zinc consumption and the prevalence of chronic constipation. In-depth prospective studies are needed to fully examine the long-term effects of zinc on chronic constipation.\u003c/p\u003e","manuscriptTitle":"Association Between Zinc Dietary Intake And Constipation: A Population-based Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-17 13:31:34","doi":"10.21203/rs.3.rs-5807263/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b7ee54ae-09c4-45eb-ac4e-aca35263afd6","owner":[],"postedDate":"January 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-31T09:08:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-17 13:31:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5807263","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5807263","identity":"rs-5807263","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}