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Revision Panel Members Barbara Cowie, RN, MN, NCA, GNC(C) Revision Panel Co-Chair Advanced Practice Nurse Amputee Rehabilitation & Complex Continuing Care, West Park Healthcare Centre Toronto, Ontario Laura Robbs, RN, MN, ET, NCA, CETN(C) Revision Panel Co-Chair Clinical Nurse Specialist – Continence Trillium Health Centre Mississauga, Ontario Linda Galarneau, RN, GNC(C), NCA Care Coordinator, Specialized Geriatrics, Day Hospital, Providence Care St Mary’s of the Lake Kingston, Ontario Ermine Moncherie, RPN Staff Nurse West Park Healthcare Centre Toronto, Ontario Melissa Northwood, RN, BScN, MSc, GNC(C), NCA Nurse Continence Advisor Continence Care Clinics St. Joseph’s Healthcare Hamilton, Ontario Jenny Ploeg, RN, BScN, MScN, PhD Associate Professor, School of Nursing McMaster University Hamilton, Ontario Sue Sebastian, RN, MN, GNC(C), NCA Advance Practice Nurse/ Nurse Continence Advisor Veterans Centre, Sunnybrook Health Sciences Centre Toronto, Ontario Jennifer Skelly, RN, PhD Associate Professor, School of Nursing McMaster University Director, Continence Program St. Joseph’s Healthcare Hamilton, Ontario Rishma Nazarali, RN, BScN, MN Program Manager Registered Nurses’ Association of Ontario Toronto, Ontario Eliisa Fok, BSc Program Assistant Registered Nurses’ Association of Ontario Toronto, Ontario
Supplement Integration
This supplement to the nursing best practice guideline Prevention of Constipation in the Older Adult Population is a result of a scheduled revision of the guideline. Additional material has been provided in an attempt to provide the reader with current evidence to support practice. Similar to the original guideline pub- lication, this document needs to be reviewed and applied, based on the specific needs of the organization or practice setting/environment, as well as the needs and wishes of the client. This supplement should be used in conjunction with the guideline as a tool to assist in decision making for individualized client care, as well as ensuring that appropriate structures and supports are in place to provide the best possible care.
Background
In 1999, the best practice guideline on constipation was chosen as a complimentary strategy to prompted voiding. It was considered essential that constipation be addressed first if it was an issue before implementing prompted voiding. When the original guideline was developed, there was enough evidence to support the recommendations however much of it was based on expert opinion. A review of the literature published since 2005 does not suggest dramatic changes to the recommendations within this guideline, but rather suggest some refinements and stronger evidence for our approach. The research evidence supports nursing interventions related to assessment and management of constipation in the older adult.
PREVENTION OF CONSTIPATION
IN THE OLDER ADULT POPULATION
Guideline Supplement
Best Practice
Guideline
November 2011
International Affairs & Best Practice Guidelines TRANSFORMING NURSING THROUGH KNOWLEDGE
Revision Process
The Registered Nurses’ Association of Ontario (RNAO) has made a com- mitment to ensure that this practice guideline is based on the best available evidence. In order to meet this com- mitment, a regular monitoring and revision process has been established for each guideline.
A panel of nurses was assembled for this review, comprised of members from the original development panel as well as other recommended indi- viduals with particular expertise in this practice area. The revision panel members were given a mandate to review the guideline focusing on the recommendations and the original scope of the guideline.
A structured evidence review based on the scope of the original guideline was conducted to capture the relevant literature and other guidelines published since the last update published in 2005. The results of the evidence review were circulated to members of the review panel. In June 2011, the review panel was convened to reach consensus on the need to revise the existing recommendations in light of the new literature.
Review of Existing
Guidelines
One individual searched an established list of websites for guidelines and other relevant content. The website list was compiled based on existing knowledge of evidence-based practice websites and recommendations from the literature.
While the search yielded many results, no original guidelines met the inclusion criteria. One supplement was identified as an update of a guideline that was included in the original guideline:
McKay, SL, Fravel, M. , Scanlon, C. (2009). Management of Constipation. Iowa City (IA): University of Iowa Gerontological Nursing Interventions Research Center, Research Translation and Dissemination Core.
Literature Review
Concurrent to the guideline review, a search for recent literature relevant to the scope of the guideline was conducted. The search of electronic databases (CINAHL, Medline, and EMBASE) was conducted by a health sciences librarian. A research assistant (Master’s prepared nurse) completed the inclusion/exclusion review, quality appraisal and data extraction of the included articles, and prepared a
Review Process Flow Chart
New Evidence
Guideline Search
Yielded 1299 abstracts
Yielded 11 International Guidelines
123 articles met the inclusion criteria
Quality appraisal of studies
1 guideline met the inclusion criteria
Develop evidence summary table
Revisions based on new evidence
Supplement published
Dissemination
summary of the literature findings. The comprehensive data tables and reference lists were provided to all review panel members.
Review Findings
A review of the most recent literature since the publication of the last revision (2005) of the original guideline does not support changes to the original recommendations, but rather suggests stronger evidence for our approach to preventing constipation in the older adult population. The revision panel members have also updated some appendices and added one new appendix.
Literature Search
The paragraphs on page 20 and 21 of the guideline have been revised to reflect additional literature supports and revisions to the wording to enhance accuracy:
Discussion of Evidence
Consideration of all factors that place persons at risk is a logical approach for preventing all types of constipation. There is some evidence that women (Higgins & Johanson, 2004; McCrea et.al, 2009; Richmond & Wright, 2004 ) and non-Caucasions (Higgins & Johanson, 2004) have higher risk for constipation. Physiological conditions increase the probability of constipation. Persons with diabetes mellitus can have a dysfunction of the autonomic nervous system resulting in loss of the gastrocolic reflex. Females, especially multiparas, can have sacral nerve root damage from obstetric trauma while persons with multiple sclerosis have clinical evidence of spinal cord disease that can cause constipation (Chia, Fowler, Kamm, Henry & Lemieux, 1995; Haines, 1995).
Diseases/conditions cited as causing slow transit constipation include: colon cancer, dehydration, diabetes mellitus, hypercalcemia/hypokalemia, immobility, low fibre and high carbohydrate diet, Parkinson’s disease and stroke.
Recommendation 3
Review the client’s medications to identify those associated with an increased risk for developing constipation, including chronic laxative use and history of laxative use.
Level of Evidence: III
The discussion of evidence on page 21 has been revised to reflect additional literature supports:
Discussion of Evidence
Iatrogenically induced constipation can often be attributed to the administration of medications for the prevention or alleviation of pathophysiological conditions or their symptoms (Richmond & Wright, 2004). In many cases, discontinuation of these medications may not be feasible. Yet there is scant information addressing the management of medication-associated constipation (DiPalma, Cleveland, McGowan & Herrera, 2007).
The use of medication is a risk factor for constipation (Leung, 2007). A number of therapeutic categories of medications contribute to constipation. All medications can directly or indirectly affect normal bowel function in a variety of ways that include:
- Slowing down peristaltic contractions
- Decreasing neurological stimulation of the bowel
- Decreasing gastric motility
- Decreasing absorption rates
- Limiting general personal mobility
The effects of drugs on the intestinal tract have been primarily identified through clini- cal drug trials on the various medications (Hert & Huseboe, 1996), and through empirical research as to their contribution to constipation (Richmond & Wright, 2004).
Clinicians should monitor clients for the presence of constipation so that management strategies can be put into place sooner rather than later or preventative strategies can be implemented proactively. The following is a list of categories of medications that may contribute to constipation:
- Analgesics ■ (^) Continuous opioid therapy ■ (^) Non-opioid therapy: NSAIDS
- Antacids containing aluminum or calcium
- Drugs with Anticholinergic activity, such as: ■ (^) Anticonvulsants ■ (^) Antidepressants ■ (^) Antiepileptics ■ (^) Antihistamines ■ (^) Antihypertensives (calcium channel blockers, ACE inhibitors, Beta blockers) ■ (^) AntiParkinson agents ■ (^) Antipsychotics ■ (^) Antispasmodics ■ (^) Anxiolytics
- Bisphosphonates
- Carbonic anhydrase inhibitors (e.g., Acetazolamide)
- Calcium supplements
- Cytotoxic chemotherapy ■ (^) Vinca alkaloid chemotherapy ■ (^) Other cytotoxic agents
- Diuretics
- Histamine-2 blockers
- Hypnotics
- Iron supplements
- Laxatives (usually attributed to long term use of stimulant laxatives)
- Lipid-lowering drugs
- Muscle relaxants (e.g., Baclofen)
- Proton pump inhibitors
- Sedatives
Brocklehurst, 1977,1980; Choung, Locke, Schleck, Zinsmeisteri, & Talley, 2007; Hinrichs & Huseboe, 2001; Hosia-Randell, Suominen, Muurinen, & Pitkälä, 2007; Lehne, Moore, Crosby, & Hamilton, 1994; McKay, Fravel, & Scanion, 2009; Meza, Peggs & O’Brien, 1984; Richmond & Wright, 2004; Wald et al., 2008; Wrenn, 1989.
Medication list reviewed by: Lawrence D. Jackson, BScPhm Pharmacy Clinical Coordinator, Veterans Centre Sunnybrook Health Sciences Centre
Recommendation 3.
Screen for risks of polypharmacy, including duplication of both prescription and over-the-counter drugs and their adverse effects.
Level of Evidence: III
The following paragraph has been added to the discussion of evidence on page 22 of the guideline:
Discussion of Evidence:
In a study on the use of laxatives by Hosia-Randell et al. (2007), concomitant use of seven or more medications, other than laxatives and constipation-inducing drugs, was associated with the need for laxative use. This suggests that the relationship between medication and constipation is more about polypharmacy. The number of medications being used is a significant risk factor for constipation (Higgins, 2004; DiPalma, Cleveland, McGowan, & Herrera, 2007).
Recommendation 7
Fluid intake should be between 1500-2000 milliliters (ml) per day. Encourage client to take sips of fluid throughout the day and whenever possible minimize caffeinated and alcoholic beverages.
Level of Evidence: III
The following paragraph has been added to the discussion of evidence on page 23 of the guideline:
Discussion of Evidence
No additional studies as of 2011 investigate the effectiveness of fluid intake or hydration alone in the prevention of constipation. A controlled trial by Schnelle et al. (2010) found that a multicomponent intervention that included fluid intake as well as toileting assistance, exercise and improved food intake was effective in reducing constipation. However, it is not possible to determine the effect of fluid intake alone on preventing constipation. A systematic review (Leung, 2007) found conflicting evidence on the effect of fluid intake in the prevention of constipation. Adequate hydration and prevention of dehydration in the elderly has many health benefits and should continue to be supported.
Recommendation 8
Dietary fibre intake should be from 21 – 25 grams of dietary fibre per day. Dietary intake of fibre should be gradually increased once the client has a consistent fluid intake of 1500 ml per 24 hours.
Level of Evidence: III
The following paragraphs, with additional literature support, is added to the beginning of the discussion of evidence on page 24 of the guideline:
Discussion of Evidence
The adequate intake for dietary fibre is 14g/1000kcal, for the typical long term care (LTC) resident, eating approximately 1500kcal/day. A minimum of 20 grams of fibre per day is recommended by the Ontario Ministry of Health and Long Term Care Standards. However, clients who are immobile may require less dietary fibre and therefore caution should be exercised in increasing dietary fibre for specific groups of bed bound elderly. Consultation with a dietitian is highly recommended.
A randomized controlled trail (Wisten & Messner 2005) found that daily porridge with 7. grams of fibre was associated with a higher rate of defecation without laxatives and less discomfort than the control group. Another randomized controlled trial (Hale et al., 2007) found that a natural laxative given twice per day (2.8 grams fibre total per day) resulted in more bowel movements and lower costs of laxative use. A controlled blind parallel trial (Sturtzel et al., 2009) found that the addition of oat bran to the diet of seniors resulted in decreased laxative use.
In addition to dietary fibre, studies are emerging that suggest the potential usefulness of probiotic supplementation in the management of constipation among nursing home residents (Sairanen, Piirainen, Nevala and Korepla, 2007; Carlsson, Gustafson, Haglin, and Eriksson, 2009; An, Baek, Jang, Lee et al., 2010; Chmielewska & Szajewska, 2010). Current studies have shown that the balance of intestinal microflora is improved with probiotic supplementation, which exerts beneficial effects on human health in managing constipation either by decreasing harmful enzymes activities (An et al, 2010) or increasing faecal bulk and softening stool (Sairanen et al., 2007). More evidence, however, from larger controlled trials are required to evaluate with certainty the effect and efficacy of probiotic administration on constipation (Chmielewska & Szajewska, 2010; An et al., 2010).
Recommendation 9
Promote regular consistent toileting each day based on the client’s triggering meal. Safeguard the client’s visual and auditory privacy when toileting.
Level of Evidence: III
Recommendation 9.
A squat position should be used to facilitate the defecation process. For clients who are unable to use the toilet (e.g., bed-bound) simulate the squat position by placing the client in left-side lying position while bending the knees and moving the legs toward the abdomen.
Level of Evidence: III
The following sentences have been added to the end of the first paragraph in the discussion of evidence on page 25 of the guideline:
Discussion of Evidence
Schnelle et al. (2009) reported on an observational study to determine the prevalence of constipation symptoms and the effect of a brief toileting assistance trial on constipation. This study revealed that bowel movement frequency increased significantly in long term care residents when provided with toileting assistance every 2 hours or four times daily.
Recommendation 10
Physical activity should be tailored to the individual’s physical abilities, health condition, personal preference, and feasibility to ensure adherence. Frequency, intensity and duration of exercise should be based on client’s tolerance.
Level of Evidence: IV
Recommendation 10.
Walking is recommended for individuals who are fully mobile or who have limited mobility (15-20 minutes once or twice a day; or 30-60 minutes daily or 3 to 5 times per week). Ambulating at least 50 feet twice a day is recommended for individuals with limited mobility.
Level of Evidence: IV
Discussion of Evidence
The literature review indicates that very few studies have addressed the role of education in:
- Bowel health
- Early identification of individuals at risk for constipation
- Prevention of constipation
- Utilization of the health measures of exercise, hydration, and dietary fibre
- Responding to the urge to defecate in a timely and appropriate manner.
It is clinical expert opinion that supports the recommendation that nurses, other healthcare providers, clients and their families could benefit from education on bowel health. Specific to bowel hygiene care, appropriate topics include:
- Physiology of the bowel and defecation
- Definition and types of constipation
- Levels of risks for constipation
- Constipation Risk Assessment Tool(s)
- Bowel care of older adults
- Health strategies for maximizing bowel function
- Understanding self reports of constipation from older adults
- Eradication of false beliefs, i.e. need for a daily bowel movement
- Impact of medications on bowel functioning
- Impact of impaired bowel functioning on bladder emptying, urinary tract infection
- Impact of medical conditions on bowel functioning
- Impact of acute hospitalization on bowel functioning
- Effect of prolonged use of laxatives
- Effect of different types of laxatives
- Use of the Bristol Stool Form Scale
In long-term care homes, the appointment of “constipation prevention champions” or resource nurses whose role is to disseminate information and act as a point of contact for any issues relating to constipation, will also help to ensure continued success in the education program, as well as in the prevention and management of constipation (Grainger, Castledine, Wood, & Dilley, 2007).
An educational tool to assist nurses in facilitating educational programs on the topic of constipation can be found in a RNAO resource entitled, Continence-Constipation Workshop for RNs in Long-Term Care: A Facilitator`s Guide (RNAO, 2007). This can be downloaded from the RNAO website at www.rnao.org/bestpractices.
Refer to Appendix H for a list of resources for constipation information.
Additional Literature Supports: Choung et al., 2007; DiPalma, Cleveland, McGowan & Herrera, 2007; Garrigues et al., 2004; Grieve, 2006; Higgins et al., 2004; Iantorno et. al., 2007; Leung, 2007; Marfil et al., 2005; Nakaji et al., 2004; Richmond & Wright, 2004; Rosia-Randell et al., 2007; Wald et al., 2008
Recommendation 13
Organizations are encouraged to establish an interprofessional team approach to prevent and manage constipation.
Level of Evidence: IV
This recommendation has been changed to reflect current terminology, i.e. interprofessional vs. interdisciplinary. The discussion of evidence on page 29 of the guideline has been revised to reflect wording changes and additional literature supports:
Discussion of Evidence
Contributing factors for constipation may include functional deficits, mobility problems, environmental barriers, sensory deficits, dietary and hydration problems, chronic disease processes, polypharmacy, mood, cognitive and social issues. Thus, an interprofessional team approach to constipation management is recommended. The members of the team may include nurses, physiotherapists, occupational therapists, clinical pharmacists, registered dietitians, unregulated health care providers, attending physicians and specialists.
Physiotherapists assess mobility, transfers, balance and strength. Occupational therapists assess physical and social environments, including each client’s ability to perform the activities of daily living such as managing clothing and toileting. Clinical pharmacists will assist with the medication review to identify medications that may be contributing to constipation. Registered dietitians will advise regarding modifications to fluid intake, caffeine intake and fibre intake.
Front line care providers including unregulated care providers and nurses support hydration, toileting, hygiene, and managing constipation and incontinence. They are often the first ones to identify problems with constipation. Registered nurses may do initial assessments and develop behavioural treatment plans. Attending physicians may refer to any of the above allied health professionals for assistance in managing incontinence and constipation. Physicians identify any serious complications of constipation that require further medical or surgical intervention. Communication between health professionals is essential to identify and manage this health issue.
Appropriate education for all health care providers improves their knowledge and practice in dealing with constipation (Granger et al., 2007).
Recommendation 14
Nursing best practice guidelines can be effectively implemented only where there are adequate planning, resources, organizational and administrative support, as well as the appropriate facilitation of the change process by skilled facilitators. The implementation of the guideline must take into account local circumstances and should be disseminated through an active
educational and training program. In this regard, RNAO (through a panel of nurses, researchers and administrators) has developed the Toolkit: Implementation of Clinical Practice Guidelines , based on available evidence, theoretical perspectives and consensus. The Toolkit is recommended for guiding the implementation of the RNAO nursing best practice guideline Prevention of Constipation in the Older Adult Population.
Level of Evidence: IV
Organization And Policy Recommendations
Appendix C: Sample Bowel Elimination Record
The following chart has been revised to reflect the type of stool as defined by the Bristol Stool Form Scale:
Patient/Client Name: __________________________
Date:
Nights Days Evenings
BM
Time
Continent
Type (see Bristol Stool Form Scale)
Amount
Toilet
Fluid intake
Fibre intake
Treatment
Referrals/Consults
Total # of BMIs
Episodes of consti-
pation/fecal soiling
Initials
Legend:
BM (Bowel Movement): ✓ Enter time
Continent: ✓ = Continent I = Incontinent
Amount: S = small (< 250 ml) M = normal ( > 250 - < 500 ml) L = large ( > 500 ml) FO = oozing; FS = staining
Type: 1 = separate hard lumps, hard to pass 2 = sausage-shaped but lumpy 3 = like a sausage but with cracks on its surface 4 = like a sasuge or snake, smooth and soft 5 = soft blobs with clear-cut edges 6 = fluffy pieces with ragged edges, passed easily, a mushy stool 7 = watery, no solid pieces, entirely liquid. Toilet: T = toilet C = commode B = bedpan SL = side lying
Fluid intake: Record actual amount consumed per shift. Calculate 24-hour intake.
Fibre intake: Record number of fibre items consumed.
Treatments: PRN laxatives, suppositories, enemas, rectal stimulation. Enter time treatment given and initials. Regularly prescribed laxatives are recorded on Medication Administration Record (MAR).
Referrals: D = Dietitian NCA = Nurse Continence Advisor OT = Occupational Therapy P = Pharmacy PT = Physiotherapy
Enter total # of BMs:
Enter total episodes of constipation/fecal soiling:
Appendix D: Bristol Stool Form Scale
Beans, snap (green, yellow, Italian), fresh or frozen,
Food Name Serving size Weight (g) Total DietaryFibre (g) Vegetables, Asian mix (broccoli, carrots, green beans, “mini Vegetables, mixed (corn, lima beans, snap beans, peas,
- Bagel, plain (10 cm diam) 1 71 1. Breads and Buns
- Bread, mixed-grain 1 slice 35 2.
- Bread, oatmeal 1 slice 35 1.
- Bread, pita, white (17 cm diam) 1 60 1.
- Bread, pita, whole wheat (17 cm diam) 1 64 4.
- Bread, pumpernickel 1 slice 35 2.
- Bread, raisin 1 slice 35 1.
- Bread, rye 1 slice
- Bread, white, commercial 1 slice 35 0.
- Bread, whole wheat, commercial 1 slice 35 2.
- English muffin, white, toasted 1 52 1.
- English muffin, whole wheat, toasted 1 52 2.
- Roll, dinner, white 1 28 0.
- Roll, dinner, whole wheat 1 28 2.
- French toast, frozen, ready to heat, heated 1 slice 59 0. Other Bread Products
- Pancake, plain, from complete mix (13 cm diam) 1 40 0.
- Pancake, plain, frozen, ready-to-heat (13 cm diam), heated 1 41 0.
- Barley, pearled, cooked 125 mL Rice, Pasta and Other Grains
- Couscous, cooked 125 mL 83 0.
- Quinoa, cooked 125 mL 73 1.
- Macaroni, cooked 250 mL 148 1.
- Noodles, egg, cooked 250 mL 169 1.
- Pasta, fresh-refrigerated, cooked 250 mL 169 3.
- Rice, brown, long-grain, cooked 125 mL 103 1.
- Rice, white, long-grain, cooked 125 mL 83 0.
- Spaghetti, cooked 250 mL 148 2.
- Spaghetti, whole wheat, cooked 250 mL 148 4.
- Cream of wheat, regular 175 mL 186 0. Hot Cereal, cooked
- Oat bran, cooked 175 mL 179 3.
- Oatmeal, instant, apple-cinnamon 1 packet 186 2. Food Name Serving size Weight (g) Total DietaryFibre (g)
- Oatmeal, instant, regular 1 packet 186 2.
- Oatmeal, large flakes/quick 175 mL 173 2.
- All Bran Buds with psyllium, Kellogg’s™ 75 mL 27 11. Ready-to-eat
- All Bran, Kellogg’s™ 125 mL 35 11.
- Bran Flakes, Post™ 250 mL 53 7.
- Cheerios, regular General Mills™ 250 mL 24 2.
- Corn Bran, Quaker™ 250 mL 38 6.
- Corn Flakes, Kellogg’s™ 250 mL 26 0.
- Fibre 1, General Mills™ 125 mL 30 14.
- Granola with Raisins, Rogers™ 125 mL 59 5.
- Grape-Nuts, Post™ 125 mL
- Mini-Wheats with White Frosting, Kellogg’s™ 175 mL 35 3.
- Muesli, President’s Choice™ 75 mL 40 3.
- Oatmeal Crisp Almond, General Mills™ 125 mL 32 2.
- Oatmeal Crisp Maple Walnut, General Mills™ 125 mL 32 2.
- Raisin Bran, Kellogg’s™ 250 mL 59 6.
- Rice Krispies, Kellogg’s™ 250 mL 29 0.
- Shredded Wheat, Post™ 1 biscuit 25 3.
- Shreddies, Post™ 175 mL 38 4.
- Special K, Kellogg’s™ 250 mL 24 0.
- Weetabix™ 2 biscuits 35 4.
- Cheese crackers, small 15 15 0. Crackers
- Melba toast, plain 2 10 0.
- Milk crackers 2 24 0.
- Rusk toast 1 10 0.
- Wheat crackers 4 20 1.
- Wheat crackers, low fat 4 18 0.
- Whole wheat crackers 4 16 1.
- Beans, baked, plain or vegetarian, canned 175 mL 188 7. Beans, Peas and Lentils
- Beans, kidney, dark red, canned, not drained 175 mL 189 12.
- Beans, navy, canned, not drained 175 mL 194 9.
- Beans, pinto, canned, not drained 175 mL 178 8.
- Black-eyed peas, canned, not drained 175 mL 178 5. Food Name Serving size Weight (g) Total DietaryFibre (g)
- Chickpeas (garbanzo beans), canned, not drained 175 mL 178 7.
- Lentils, boiled, salted 175 mL 146 6.
- Lentils, pink, boiled 175 mL 179 5.
- Peas, split, boiled 175 mL 145 4.
- Soybeans, boiled 175 mL
- Peanut butter, chunk type, fat, sugar and salt adde 30 mL 32 2. Peanuts
- Peanut butter, natural 30 mL 31 2.
- Peanut butter, smooth type, fat, sugar and salt added 30 mL 32 1.
- Peanut butter, smooth type, light 30 mL 36 1.
- Almonds, dried 60 mL 36 4. Nuts
- Hazelnuts or filberts, dried 60 mL 34 2.
- Macadamia nuts, roasted, salted 60 mL 34 0.
- Mixed nuts, roasted 60 mL 35 2.
- Pecans, dried 60 mL 25 1.
- Pine nuts, pignolia, dried 60 mL 34 1.
- Pistachios, shelled, roasted, salted 60 mL 31 1.
- Walnuts, dried 60 mL 25 1.
- Almond butter 30 mL 32 1. Nut Butters
- Cashew butter 30 mL 32 0.
- Sesame butter, tahini 30 mL 30 2.
- Flaxseeds, whole and ground 15 mL Seeds
- Pumpkin and squash seeds, kernels, dried 60 mL
- Sunflower seed kernels, roasted, salted 60 mL
- Artichoke, boiled, drained 1 medium 120 4. Vegetables
- Asparagus, canned, drained 6 spears 108 1.
- Asparagus, fresh or frozen, boiled, drained 6 spears 90 1.
- Beans, lima, frozen, boiled, drained 125 mL
- Beans, snap (green, yellow, Italian), canned, drained 125 mL 71 1.
- 125 mL 71 1. boiled, drained
- Beets, sliced, boiled, drained 125 mL 90 1. Food Name Serving size Weight (g) Total DietaryFibre (g)
- Bok Choy, Pak-Choi, shredded, boiled, drained 125 mL 90 0.
- Broccoli, chopped, boiled, drained 125 mL
- Cabbage, green, shredded, boiled, drained 125 mL 79 1.
- Cabbage, red, shredded, raw 125 mL 37 0.
- Carrots, baby, raw 8 80 1.
- Carrots, fresh or frozen, boiled, drained 125 mL 77 1.
- Cauliflower, pieces, boiled, drained 125 mL 66 1.
- Cauliflower, pieces, raw 125 mL 53 0.
- Celery, raw 1 stalk 40 0.
- Corn, sweet, canned, cream style 125 mL 135 1.
- Cucumber, peeled, raw 4 slices 28 0.
- Kale, chopped, boiled, drained 125 mL 69 1.
- Leeks, chopped, boiled, drained 125 mL 55 0.
- Lettuce, Boston, shredded 250 mL 58 0.
- Lettuce, iceberg, shredded 250 mL 58 0.
- Mushrooms, pieces, canned, drained 125 mL 82 2.
- Mushrooms, white, sliced, stir-fried 125 mL
- Onions, green (scallion), raw 1 medium 15 0.
- Parsnip, sliced, boiled, drained 125 mL 82 2.
- Peas, green, canned, drained 125 mL
- Peas, green, frozen, boiled, drained 125 mL 85 3.
- Pepper, sweet, green, sautéed 125 mL 74 1.
- Potato, baked, flesh 1 156 3.
- Potato, baked, flesh and skin 1 173 3.
- Potato, boiled without skin 1 135 1.
- Potato, boiled, flesh and skin 1 150 2.
- Potatoes, scalloped, homemade 125 mL 129 2.
- Pumpkin, canned 125 mL 129 3.
- Radishes 3 medium 14 0.
- Spinach, boiled, drained 125 mL 95 2.
- Spinach, chopped, raw 250 mL 32 0.
- Sweet potato, baked, peeled after cooking ½ 57 1.
- Tomatoes, canned, stewed 125 mL 135 1.
- Tomatoes, canned, whole 125 mL
- Tomatoes, raw 1 123 1.
- Turnip (white turnip), cubed, boiled, drained 125 mL 82 1.
- 125 mL 74 1. corn”, snow peas, sweet red pepper), frozen, boiled, drained
- Vegetables, broccoli and cauliflower, frozen, boiled, drained 125 mL 95 2.
- 125 mL 96 2. carrots), frozen, boiled, drained
- Vegetables, peas and carrots, canned, not drained 125 mL 135 2.
- Zucchini, raw, slices 4 40 0.
- Zucchini, sliced, boiled, drained 125 mL 95 1.
- Carrot juice 125 mL Vegetable Juices and Other Products
- Coleslaw with dressing, 125 mL
- Potato salad 125 mL 132 1.
- Tomato juice 125 mL 128 0.
- Tomato juice, without added salt 125 mL 184 0.
- Tomato sauce for spaghetti, canned 125 mL 132 1.
- Tomato sauce, canned 125 mL 129 1.
- Vegetable juice cocktail 125 mL 128 0.
- Vegetable juice cocktail, low sodium 125 mL
- Apple with skin (7 cm.diam) 1 138 2. Fruits
- Applesauce, unsweetened 125 mL 129 1.
- Apricots, raw 3 105 2.
- Avocado ½ 101 6.
- Banana 1 118 2.
- Blackberries 125 mL
- Blueberries, frozen, unsweetened 125 mL 82 2.
- Cherries, sweet 10 68 1.
- Clementine 1 74 1.
- Fruit cocktail, canned, light syrup pack 125 mL 128 1.
- Grapefruit, pink or red ½
- Grapes 20 100 1.
- Kiwifruit 1 76 2.
- Lychees (litchis) 10 96 1.
- Mango ½ 104 1.
- Melon, cantaloupe, cubes 125 mL 85 0.
Food Name Serving size Weight (g) Total DietaryFibre (g)
Melon, honeydew, cubes 125 mL 90 0. Melon, watermelon, cubes 125 mL 80 0. Nectarine 1 136 2. Orange 1 131 2. Papaya, cubes 125 mL 74 1. Peach 1 98 1. Peach, canned slices, light syrup pack 125 mL 133 1. Pear with skin 1 166 5 Pear, canned halves, light syrup pack 125 mL 133 2. Pineapple, cubes 125 mL 82 1. Plum 1 66 1. Prunes, dried 3 25 1. Prunes, dried, cooked, without added sugar 60 mL 63 3. Raspberries 125 mL 65 4. Strawberries 7 84 1. Tangerine (mandarin), canned, juice pack, drained 125 mL 100 1. FruitJuices Apple juice, ready-to-drink, vitamin C added 125 mL 126 0. Cranberry juice, unsweetened, ready-to-drink 125 mL 134 0. Cranberry-apple juice-drink, ready-to-drink, low Calorie, vitamin C added
125 mL 127 0.
Grape juice, ready-to-drink, vitamin C added 125 mL 132 0. Grapefruit juice, ready-to-drink, sweetened 125 mL 132 0. Orange juice, frozen, diluted 125 mL 132 0. Orange juice, ready-to-drink 125 mL 132 0. Orange juice, ready-to-drink, refrigerated, vitamin D and calcium added
125 mL 132 0.
Prune juice, ready-to-drink 125 mL 135 1.
Reference: Nutrient Value of Some Common Foods, Health Canada. Info retrieved on Wednesday July 12, 2011 http://www.hc-sc.gc.ca/fn-an/nutrition/fiche-nutri-data/index-eng.php
Reviewed by Gargi Pannu, RD., M.Sc Clinical Registered Dietitian Veteran and Community Centre Sunnybrook Health Sciences Centre
