The role of constipation in the development of dyslipidemia in the elderly

Aim. To assess chronic constipation as a pathogenetic factor in the development and exacerbation of dyslipidemia in elderly and senile patients, with a focus on mechanisms involving gut microbiota dysbiosis and endotoxemia. Materials and Methods . A systematic review was conducted following PRISMA guidelines using a study selection flowchart. Searches were performed in PubMed, Scopus, and Web of Science (2010-2024) using the keywords: “chronic constipation,” “dyslipidemia,” “elderly,” “gut microbiota,” “endotoxemia,” “lipid metabolism,” and their synonyms. Of 2,468 identified records, 31 studies were included after removing duplicates (n = 634) and irrelevant articles (n = 1,803). Included studies were original (cohort or crosssectional), reviews, and randomized controlled trials focusing on elderly (≥ 65 years) or mixed cohorts with extrapolated data. Study quality was assessed using the Newcastle–Ottawa Scale (NOS ≥5), ROBINS-I, and the Cochrane Risk of Bias Tool. A narrative data synthesis was applied. Results. Chronic constipation contributes to dysbiosis (i.e., decreased Firmicutes, increased Bacteroidetes, and reduced levels of shortchain fatty acids), which in turn increases intestinal permeability and metabolic endotoxemia (i.e., elevated circulating lipopolysaccharides, C-reactive protein, IL-6, and TNF-α). These changes disrupt lipid metabolism, leading to elevated low-density lipoprotein cholesterol levels that results in an increased risk of cardiovascular disease (coronary artery disease, myocardial infarction, and stroke) with a hazard ratio of 1.34. Dysbiosis may also increase the risk of key geriatric syndromes such as frailty syndrome and sarcopenia. Probiotic supplementation was associated with increased stool frequency (by 1.3 times/week), and polyphenol intake was linked to reduced zonulin levels and improved lipid profiles (decreased low-density lipoprotein cholesterol). Conclusion. Constipation in individuals over 65 years of age represents a systemic risk factor for dyslipidemia through its effects on dysbiosis and endotoxemia. Modulation of the gut microbiota with probiotics and polyphenols holds promise, but long-term clinical trials are needed to confirm these findings