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Todhunter-Brown A, Booth L, Campbell P, Cheer B, Cowie J, Elders A, Hagen S, Jankulak K, Mason H, Millington C, Ogden M, Paterson C, Richardson D, Smith D, Sutcliffe J, Thomson K, Torrens C, McClurg D. Strategies used for childhood chronic functional constipation: the SUCCESS evidence synthesis. Health Technol Assess 2024; 28:1-266. [PMID: 38343084 PMCID: PMC11017632 DOI: 10.3310/pltr9622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Up to 30% of children have constipation at some stage in their life. Although often short-lived, in one-third of children it progresses to chronic functional constipation, potentially with overflow incontinence. Optimal management strategies remain unclear. Objective To determine the most effective interventions, and combinations and sequences of interventions, for childhood chronic functional constipation, and understand how they can best be implemented. Methods Key stakeholders, comprising two parents of children with chronic functional constipation, two adults who experienced childhood chronic functional constipation and four health professional/continence experts, contributed throughout the research. We conducted pragmatic mixed-method reviews. For all reviews, included studies focused on any interventions/strategies, delivered in any setting, to improve any outcomes in children (0-18 years) with a clinical diagnosis of chronic functional constipation (excluding studies of diagnosis/assessment) included. Dual reviewers applied inclusion criteria and assessed risk of bias. One reviewer extracted data, checked by a second reviewer. Scoping review: We systematically searched electronic databases (including Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature) (January 2011 to March 2020) and grey literature, including studies (any design) reporting any intervention/strategy. Data were coded, tabulated and mapped. Research quality was not evaluated. Systematic reviews of the evidence of effectiveness: For each different intervention, we included existing systematic reviews judged to be low risk of bias (using the Risk of Bias Assessment Tool for Systematic Reviews), updating any meta-analyses with new randomised controlled trials. Where there was no existing low risk of bias systematic reviews, we included randomised controlled trials and other primary studies. The risk of bias was judged using design-specific tools. Evidence was synthesised narratively, and a process of considered judgement was used to judge certainty in the evidence as high, moderate, low, very low or insufficient evidence. Economic synthesis: Included studies (any design, English-language) detailed intervention-related costs. Studies were categorised as cost-consequence, cost-effectiveness, cost-utility or cost-benefit, and reporting quality evaluated using the consensus health economic criteria checklist. Systematic review of implementation factors: Included studies reported data relating to implementation barriers or facilitators. Using a best-fit framework synthesis approach, factors were synthesised around the consolidated framework for implementation research domains. Results Stakeholders prioritised outcomes, developed a model which informed evidence synthesis and identified evidence gaps. Scoping review 651 studies, including 190 randomised controlled trials and 236 primary studies, conservatively reported 48 interventions/intervention combinations. Effectiveness systematic reviews studies explored service delivery models (n = 15); interventions delivered by families/carers (n = 32), wider children's workforce (n = 21), continence teams (n = 31) and specialist consultant-led teams (n = 42); complementary therapies (n = 15); and psychosocial interventions (n = 4). One intervention (probiotics) had moderate-quality evidence; all others had low to very-low-quality evidence. Thirty-one studies reported evidence relating to cost or resource use; data were insufficient to support generalisable conclusions. One hundred and six studies described implementation barriers and facilitators. Conclusions Management of childhood chronic functional constipation is complex. The available evidence remains limited, with small, poorly conducted and reported studies. Many evidence gaps were identified. Treatment recommendations within current clinical guidelines remain largely unchanged, but there is a need for research to move away from considering effectiveness of single interventions. Clinical care and future studies must consider the individual characteristics of children. Study registration This study is registered as PROSPERO CRD42019159008. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 128470) and is published in full in Health Technology Assessment; Vol. 28, No. 5. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Alex Todhunter-Brown
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Lorna Booth
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Brenda Cheer
- ERIC, The Children's Bowel and Bladder Charity, Bristol, UK
| | - Julie Cowie
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | | | | | - Charlotte Paterson
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | | | | | | | - Katie Thomson
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
- Department of Occupational Therapy, Human Nutrition and Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Claire Torrens
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
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Lionetti P, Wine E, Ran Ressler R, Minor GJ, Major G, Zemrani B, Gottrand F, Romano C. Use of fiber-containing enteral formula in pediatric clinical practice: an expert opinion review. Expert Rev Gastroenterol Hepatol 2023; 17:665-675. [PMID: 37278084 DOI: 10.1080/17474124.2023.2217355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/19/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Children who require enteral nutrition often report gastrointestinal symptoms. There is a growing interest in nutrition formulas that meet nutritional requirements and also maintain gut ecology and function. Fiber-containing enteral formulas can improve bowel function, promote the growth of healthy gut microbiota, and improve immune homeostasis. Nonetheless, guidance in clinical practice is lacking. AREAS COVERED This expert opinion article summarizes the available literature and collects the opinion of eight experts on the importance and use of fiber-containing enteral formulas in pediatrics. The present review was supported by a bibliographical literature search on Medline via PubMed to collect the most relevant articles. EXPERT OPINION The current evidence supports using fibers in enteral formulas as first-line nutrition therapy. Dietary fibers should be considered for all patients receiving enteral nutrition and can be slowly introduced from six months of age. Fiber properties that define the functional/physiological properties of the fiber must be considered. Clinicians should balance the dose of fiber with tolerability and feasibility. Introducing fiber-containing enteral formulas should be considered when initiating tube feeding. Dietary fiber should be introduced gradually, especially in fiber-naïve children, with an individualized symptom-based approach. Patients should continue with the fiber-containing enteral formulas they tolerate best.
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Affiliation(s)
- Paolo Lionetti
- Department Neurofarba, University of Florence - Gastroenterology and Nutrition Unit, Meyer Children's Hospital, Firenze, Italy
| | - Eytan Wine
- Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Rinat Ran Ressler
- Nestle Product Technology Center, Nestlé Health Sciences, Bridgewater, NJ, US
| | - Gerard J Minor
- Pediatric Gastroenterology Hepatology and Nutrition, Kidz Medical Services, Florida, USA
| | - Giles Major
- Department Gastrointestinal Health, Nestlé Institute of Health Sciences, Lausanne, Switzerland
| | - Boutaina Zemrani
- Clinical Research and Development, Pediatric Medical Nutrition, Nestlé Health Science, Lausanne, Switzerland
| | - Frédéric Gottrand
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Institute for Translational Research in Inflammation, University Lille, Lille, France
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Italy
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Yang S, Wu XL, Wang SQ, Guo XL, Guo FZ, Sun XF. Association of Dietary Energy Intake With Constipation Among Men and Women: Results From the National Health and Nutrition Examination Survey. Front Nutr 2022; 9:856138. [PMID: 35495926 PMCID: PMC9044492 DOI: 10.3389/fnut.2022.856138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/15/2022] [Indexed: 12/12/2022] Open
Abstract
BackgroundPrevious studies supported that dietary factor was associated with constipation, but the relationship between dietary energy intake and constipation has not been well-studied. Therefore, we aimed to evaluate the prevalence and correlation between energy intake and constipation among men and women.MethodsThese observational analyses included 12,587 adults (≥20 years) from the 2005–2010 cycles of the National Health and Nutrition Examination Surveys (NHANES). Constipation was defined as Bristol Stool Scale Type 1 (separate hard lumps, like nuts) or Type 2 (sausage-like but lumpy). Total energy intake was obtained from the two 24-h dietary recalls and averaged. We used the logistic regression model in Generalized Linear Model (GLM) function, controlling demographic, lifestyle, and dietary factors, to estimate the association between energy intake and constipation among men and women.ResultsThe overall weighted incidence of constipation in this research was 7.4%, the incidence in women and men was 10.4 and 4.3%, respectively. After multivariable adjustment, middle energy consumption correlated with decreased risk of constipation in men (OR:0.5, 95% CI:0.29–0.84), and lower-middle energy intake increased the constipation risk in women (OR: 1.56, 95% CI: 1.15–2.13). High energy consumption was not associated with increased or decreased constipation risk.ConclusionsTo our knowledge, this is the first research to investigate the association between energy intake and constipation; the study demonstrates that appropriate energy consumption can help reduce the risk of constipation in men, and relatively low energy intake is associated with increased constipation risk in women.
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Affiliation(s)
- Shuai Yang
- Department of Ultrasound, The First Hospital of Jilin University, Changchun, China
| | - Xiao-Li Wu
- Department of Ultrasound, The First Hospital of Jilin University, Changchun, China
| | - Shou-Qing Wang
- Department of Ultrasound, The First Hospital of Jilin University, Changchun, China
| | - Xiang-Ling Guo
- Department of Gastroenterology, Jilin Provincial People's Hospital, Changchun, China
| | - Fu-Zheng Guo
- Department of Ultrasound, The First Hospital of Jilin University, Changchun, China
| | - Xiao-Feng Sun
- Department of Ultrasound, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Xiao-Feng Sun
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Fluid intake and urinary osmolality in pediatric patients with functional constipation. Eur J Nutr 2021; 60:4647-4655. [PMID: 34409509 DOI: 10.1007/s00394-021-02657-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to evaluate fluid intake and urinary osmolality in pediatric patients with functional constipation. METHODS This was a cross-sectional, case-control study that prospectively included two groups: 36 pediatric patients older than 4 years with functional constipation (Rome III criteria) who were consecutively admitted in a public tertiary pediatric gastroenterology outpatient clinic and 93 controls with normal bowel habits. The control group was recruited from a public school and did not have any of the characteristics of the Rome III criteria. Fluid and food intakes were assessed using a daily diet inquiry and 24 h recording method. Hypohydration was defined as osmolality greater than 800 mOsm/kg H2O in a spot urine sample. RESULTS The age of the functional constipation group (median, 8.9 years; range 7.3-10.0 years) and the control group (8.8 years) was similar (p = 0.51). The proportion of boys in the functional constipation group (76.6%; 25/36) was higher (p = 0.01) than that in the control group (45.2%; 41/93). The total water intake of the functional constipation group (median 1566 mL) was lower (p < 0.001) than that of the control group (median 2177 mL). Urinary osmolality was higher (p = 0.039) in the functional constipation group (median 859 mOsm/kg H2O) than in the control group (median 775 mOsm/kg H2O). The association between hypohydration and functional constipation did not reach statistical significance (Odds ratio 2.06; 95% confidence interval 0.93-4.55; p = 0.073). CONCLUSION Compared to the control group, patients with functional constipation have lower fluid intake and higher urinary osmolality.
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Cold and Spleen-Qi Deficiency Patterns in Korean Medicine Are Associated with Low Resting Metabolic Rate. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:9532073. [PMID: 28367227 PMCID: PMC5358454 DOI: 10.1155/2017/9532073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/20/2017] [Indexed: 01/03/2023]
Abstract
Background. Korean medicine (KM) patterns such as cold, heat, deficiency, and excess patterns have been associated with alterations of resting metabolic rate (RMR). However, the association of KM patterns with accurately measured body metabolic rate has not been investigated. Methods. Data on cold (CP), heat (HP), spleen-qi deficiency (SQDP), and kidney deficiency (KDP) patterns were extracted by a factor analysis of symptoms experienced by 954 participants. A multiple regression analysis was conducted to determine the association between KM patterns and RMR measured by an indirect calorimeter. Results. The CP and SQDP scores were higher and the HP score was lower in women. The HP and SQDP scores decreased with age, while KDP scores increased with age. A multiple regression analysis revealed that CP and SQDP scores were negatively associated with RMR independently of gender and age, and the CP remained significantly and negatively associated with RMR even after adjustment for fat-free mass. Conclusions. The underlying pathology of CP and SQDP might be associated with the body's metabolic rate. Further studies are needed to investigate the usefulness of RMR measurement in pattern identification and the association of CP and SQDP with metabolic disorders.
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Some Risk Factors of Chronic Functional Constipation Identified in a Pediatric Population Sample from Romania. Gastroenterol Res Pract 2016; 2016:3989721. [PMID: 27994619 PMCID: PMC5141327 DOI: 10.1155/2016/3989721] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/26/2016] [Indexed: 12/22/2022] Open
Abstract
We conducted an observational study over a 1-year period, including 234 children aged 4–18 years and their caregivers and a matching control group. 60.73% of the children from the study group were males. Average age for the onset of constipation was 26.39 months. The frequency of defecation was 1/4.59 days (1/1.13 days in the control group). 38.49% of the patients in the sample group had a positive family history of functional constipation. The majority of children with functional constipation come from single-parent families, are raised by relatives, or come from orphanages. Constipated subjects had their last meal of the day at later hours and consumed fast foods more frequently than the children in the control sample. We found a statistically significant difference between groups regarding obesity/overweight and constipation (χ2 = 104.94, df = 2, p < 0.001) and regarding physical activity and constipation (χ2 = 18.419; df = 3; p < 0.001). There was a positive correlation between the number of hours spent watching television/using the computer and the occurrence of the disease (F = 92.162, p < 0.001, and 95% Cl). Children from broken families, with positive family history, defective dietary habits, obesity and sedentary behavior, are at higher risk to develop chronic functional constipation.
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Schmier JK, Miller PE, Levine JA, Perez V, Maki KC, Rains TM, Devareddy L, Sanders LM, Alexander DD. Cost savings of reduced constipation rates attributed to increased dietary fiber intakes: a decision-analytic model. BMC Public Health 2014; 14:374. [PMID: 24739472 PMCID: PMC3998946 DOI: 10.1186/1471-2458-14-374] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 04/12/2014] [Indexed: 12/14/2022] Open
Abstract
Background Nearly five percent of Americans suffer from functional constipation, many of whom may benefit from increasing dietary fiber consumption. The annual constipation-related healthcare cost savings associated with increasing intakes may be considerable but have not been examined previously. The objective of the present study was to estimate the economic impact of increased dietary fiber consumption on direct medical costs associated with constipation. Methods Literature searches were conducted to identify nationally representative input parameters for the U.S. population, which included prevalence of functional constipation; current dietary fiber intakes; proportion of the population meeting recommended intakes; and the percentage that would be expected to respond, in terms of alleviation of constipation, to a change in dietary fiber consumption. A dose–response analysis of published data was conducted to estimate the percent reduction in constipation prevalence per 1 g/day increase in dietary fiber intake. Annual direct medical costs for constipation were derived from the literature and updated to U.S. $ 2012. Sensitivity analyses explored the impact on adult vs. pediatric populations and the robustness of the model to each input parameter. Results The base case direct medical cost-savings was $12.7 billion annually among adults. The base case assumed that 3% of men and 6% of women currently met recommended dietary fiber intakes; each 1 g/day increase in dietary fiber intake would lead to a reduction of 1.9% in constipation prevalence; and all adults would increase their dietary fiber intake to recommended levels (mean increase of 9 g/day). Sensitivity analyses, which explored numerous alternatives, found that even if only 50% of the adult population increased dietary fiber intake by 3 g/day, annual medical costs savings exceeded $2 billion. All plausible scenarios resulted in cost savings of at least $1 billion. Conclusions Increasing dietary fiber consumption is associated with considerable cost savings, potentially exceeding $12 billion, which is a conservative estimate given the exclusion of lost productivity costs in the model. The finding that $12.7 billion in direct medical costs of constipation could be averted through simple, realistic changes in dietary practices is promising and highlights the need for strategies to increase dietary fiber intakes.
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Affiliation(s)
| | | | | | - Vanessa Perez
- Exponent Inc,, 525 W, Monroe Street Suite 1050, Chicago, IL 60661, USA.
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Abstract
OBJECTIVES The aim of the study was to test the clinical efficacy and effect on colonic transit time (CTT) of a dietary fiber mixture given to children with controlled chronic constipation (CC) after the withdrawal of stool softeners and enemas. METHODS This randomized, placebo-controlled, double-blind clinical trial involved 54 patients aged 4 to 12 years and had CC that was controlled by the use of low-dose stool softeners. The use of these softeners was discontinued when the patients were admitted to the clinical trial. The patients were randomized into 2 groups for the 4-week study period. One group received a dietary fiber mixture and the other group received a placebo (maltodextrin). The primary outcome was therapeutic failure (oral stool softeners or enemas was required to prescribe during the trial). Secondary outcomes included defecation frequency, stool consistency (measured using the Bristol Stool Form Scale), and CTT. RESULTS Therapeutic failure was observed in 34.6% (9/26) of the patients in the dietary fiber mixture group and in 35.7% (10/28) in the control group (P = 0.933). The mean increase in daily bowel movements was 0.53 in the dietary fiber mixture group and 0.23 in the control group (P = 0.014). The patients in the dietary fiber mixture group (60.0%) passed nonhardened stools more frequently than did those in the control group (16.7%, P = 0.003). The CTT was similar for both groups. CONCLUSIONS The fiber mixture did not prevent the suspension of stool softeners or lead to reduced CTT; however, the mixture promoted an increased frequency of defecation and an improvement in the stool consistency.
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Stewart ML, Schroeder NM. Dietary treatments for childhood constipation: efficacy of dietary fiber and whole grains. Nutr Rev 2013; 71:98-109. [DOI: 10.1111/nure.12010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Maria L Stewart
- Department of Human Nutrition, Food, and Animal Science; University of Hawaii at Manoa; Honolulu; Hawaii; USA
| | - Natalia M Schroeder
- Department of Human Nutrition, Food, and Animal Science; University of Hawaii at Manoa; Honolulu; Hawaii; USA
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Quitadamo P, Coccorullo P, Giannetti E, Romano C, Chiaro A, Campanozzi A, Poli E, Cucchiara S, Di Nardo G, Staiano A. A randomized, prospective, comparison study of a mixture of acacia fiber, psyllium fiber, and fructose vs polyethylene glycol 3350 with electrolytes for the treatment of chronic functional constipation in childhood. J Pediatr 2012; 161:710-5.e1. [PMID: 22677568 DOI: 10.1016/j.jpeds.2012.04.043] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 03/14/2012] [Accepted: 04/23/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare the effectiveness of a mixture of acacia fiber, psyllium fiber, and fructose (AFPFF) with polyethylene glycol 3350 combined with electrolytes (PEG+E) in the treatment of children with chronic functional constipation (CFC); and to evaluate the safety and effectiveness of AFPFF in the treatment of children with CFC. STUDY DESIGN This was a randomized, open label, prospective, controlled, parallel-group study involving 100 children (M/F: 38/62; mean age ± SD: 6.5 ± 2.7 years) who were diagnosed with CFC according to the Rome III Criteria. Children were randomly divided into 2 groups: 50 children received AFPFF (16.8 g daily) and 50 children received PEG+E (0.5 g/kg daily) for 8 weeks. Primary outcome measures were frequency of bowel movements, stool consistency, fecal incontinence, and improvement of other associated gastrointestinal symptoms. Safety was assessed with evaluation of clinical adverse effects and growth measurements. RESULTS Compliance rates were 72% for AFPFF and 96% for PEG+E. A significant improvement of constipation was seen in both groups. After 8 weeks, 77.8% of children treated with AFPFF and 83% of children treated with PEG+E had improved (P = .788). Neither PEG+E nor AFPFF caused any clinically significant side effects during the entire course of the study period. CONCLUSIONS In this randomized study, we did not find any significant difference between the efficacy of AFPFF and PEG+E in the treatment of children with CFC. Both medications were proved to be safe for CFC treatment, but PEG+E was better accepted by children.
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Affiliation(s)
- Paolo Quitadamo
- Department of Pediatrics, University "Federico II," Naples, Italy
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Kranz S, Brauchla M, Slavin JL, Miller KB. What do we know about dietary fiber intake in children and health? The effects of fiber intake on constipation, obesity, and diabetes in children. Adv Nutr 2012; 3:47-53. [PMID: 22332100 PMCID: PMC3262613 DOI: 10.3945/an.111.001362] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The effect of dietary fiber intake on chronic diseases has been explored in adults but is largely unknown in children. This paper summarizes the currently existing evidence on the implications of dietary fiber intake on constipation, obesity, and diabetes in children. Current intake studies suggest that all efforts to increase children's dietary fiber consumption should be encouraged. Available data, predominantly from adult studies, indicate significantly lower risks for obesity, diabetes, and constipation could be expected with higher dietary fiber consumption. However, there is a lack of data from clinical studies in children of various ages consuming different levels of dietary fiber to support such assumptions. The existing fiber recommendations for children are conflicting, a surprising situation, because the health benefits associated with higher dietary fiber intake are well established in adults. Data providing conclusive evidence to either support or refute some, if not all, of the current pediatric fiber intake recommendations are lacking. The opportunity to improve children's health should be a priority, because it also relates to their health later in life. The known health benefits of dietary fiber intake, as summarized in this paper, call for increased awareness of the need to examine the potential benefits to children's health through increased dietary fiber.
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Affiliation(s)
- Sibylle Kranz
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA.
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Prospective evaluation of dietary treatment in childhood constipation: high dietary fiber and wheat bran intake are associated with constipation amelioration. J Pediatr Gastroenterol Nutr 2011; 52:55-9. [PMID: 20975583 DOI: 10.1097/mpg.0b013e3181e2c6e2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate, over 24 months, the intake of dietary fiber (DF) and the bowel habit (BH) of constipated children advised a DF-rich diet containing wheat bran. PATIENTS AND METHODS BH and dietary data of 28 children with functional constipation defined by the "Boston criteria" were obtained at visit 1 (V1, n = 28) and at 4 follow-up visits (V2-V5, n = 80). At each visit the BH was rated BAD (worse/unaltered; improved but still complications) or RECOVERY (REC) (improved, no complications; asymptomatic), and a food intake questionnaire was applied. DF intake was calculated according to age (year) + 5 to 10 g/day and bran intake according to international tables. Nonparametric statistics were used. RESULTS Median age (range) was 7.25 years (0.25-15.6 years); 21 children underwent bowel washout (most before V1/V2), and 14 had the last visit at V3/V4. DF intake, bran intake, and the BH rate significantly increased at V2 and remained higher than at V1 through V2 to V5. At V1, median DF intake was 29.9% below the minimum recommended and at the last visit 49.9% above it. Twenty-four children accepted bran at 60 visits, at which median bran intake was 20 g/day and median proportion of DF due to bran 26.9%. Children had significantly higher DF and higher bran intake at V2 to V5 at which they had REC than at those at which they presented BAD BH. DF intake > age +10 g/day was associated with bran acceptance and REC. At the last visit 21 children presented REC (75%); 20 of them were asymptomatic and 18 were off washout/laxatives. CONCLUSIONS High DF and bran intake are feasible in constipated children and contribute to amelioration of constipation.
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Mello CS, Freitas KDC, Tahan S, Morais MBD. Consumo de fibra alimentar por crianças e adolescentes com constipação crônica: influência da mãe ou cuidadora e relação com excesso de peso. REVISTA PAULISTA DE PEDIATRIA 2010. [DOI: 10.1590/s0103-05822010000200010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Avaliar a influência da mãe ou da cuidadora sobre o consumo de fibra alimentar por crianças e adolescentes com constipação crônica bem como sua relação com a ocorrência de excesso de peso. MÉTODOS: Estudo transversal com 38 crianças e adolescentes com constipação funcional e suas respectivas cuidadoras. Para análise do consumo de fibra alimentar, foi utilizado o registro alimentar de três dias. Peso e estatura foram aferidos para verificar o estado nutricional. A história familiar de constipação foi investigada. RESULTADOS: A maioria dos pacientes com constipação (89,5%; 34/38) apresentava consumo insuficiente de fibra (inferior à idade +5g). Das 38 cuidadoras, apenas uma (2,6%) apresentou ingestão de fibra superior à recomendação mínima (20g/dia). Excesso de peso foi encontrado em 28,9% (11/38) dos pacientes e em 60,5% (23/38) das suas responsáveis. Associação entre excesso de peso e presença de constipação foi verificada entre as cuidadoras (p=0,046). As crianças e adolescentes do sexo feminino com excesso de peso apresentaram menor ingestão de fibra, comparadas às sem excesso de peso (p=0,011). Nos pacientes do sexo masculino, essa associação não foi observada. O consumo de fibra pelas cuidadoras com excesso de peso foi inferior ao das demais (p=0,027). Observou-se correlação entre consumo de fibra pelas crianças com constipação e suas cuidadoras, nos sexos masculino (r=+0,561; p=0,005) e feminino (r=+0,782; p<0,001). CONCLUSÕES: Observou-se relação entre o consumo de fibra alimentar por crianças e adolescentes com constipação crônica e suas respectivas cuidadoras. O consumo insuficiente de fibra associou-se ao excesso de peso e à presença de constipação no gênero feminino.
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Pereira VP, Medeiros LCS, Speridião PDGL, Lisboa VCA, Tahan S, Morais MBD. Percepção das mães sobre a importância das práticas alimentares no tratamento da constipação crônica funcional. REVISTA PAULISTA DE PEDIATRIA 2009. [DOI: 10.1590/s0103-05822009000100006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Analisar o significado das práticas alimentares compreendendo as percepções, experiências e valores sobre a alimentação de mães de crianças e adolescentes com diagnóstico de constipação crônica funcional. MÉTODOS: 17 mães foram entrevistadas com base em um questionário semidirigido, que compreendia questões relacionadas à alimentação. Para análise, as falas foram agrupadas nos temas: "ambiente familiar durante as refeições", "dificuldades relacionadas à alimentação da criança e do adolescente", "atitudes das mães frente à recusa de alimentos" e "conhecimentos maternos sobre alimentação e sua relação com a constipação crônica funcional". RESULTADOS: A idade das mães variou de 20 a 35 anos. A maioria era casada, possuía ensino fundamental incompleto e renda familiar entre dois e três salários mínimos. Observou-se, no relato das mães, que: muitas não consideram o momento das refeições em família agradável; a limitação financeira é a maior dificuldade relacionada à alimentação dos filhos; a maioria delas, frente à recusa alimentar, adota estratégias para convencer a criança a aceitar a refeição; demonstram ter noção da importância da alimentação para melhora da constipação; creem que alguns alimentos têm efeito "obstipante". CONCLUSÕES: Mães de crianças com constipação intestinal crônica sabem que a alimentação é importante no tratamento dessa afecção e, no entanto, apenas uma parcela reconhece o papel das fibras alimentares. A refeição não é um momento prazeroso e o fator financeiro é limitante para definir os alimentos que compõem a dieta dessas crianças.
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Evaluation and treatment of constipation in children: summary of updated recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2006; 43:405-7. [PMID: 16954970 DOI: 10.1097/01.mpg.0000232574.41149.0a] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Constipation is a common pediatric problem. To assist health care professionals who care for children with constipation, the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) previously published a clinical guideline based on an integration of medical evidence with expert opinion. To evaluate studies published since then, the NASPGHAN Constipation Guideline Committee performed a comprehensive and systematic review of the medical literature since 1997, to identify, review and rate the quality of new evidence. Based on this review, the recommendations of the original clinical guideline were reaffirmed with several modified according to the new evidence. Below is a summary of the evidence reviewed for this update. The complete revised guideline is available online in its entirety.
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Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2006; 43:e1-13. [PMID: 16954945 DOI: 10.1097/01.mpg.0000233159.97667.c3] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Constipation, defined as a delay or difficulty in defecation, present for 2 or more weeks, is a common pediatric problem encountered by both primary and specialty medical providers. The Constipation Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) has formulated a clinical practice guideline for the management of pediatric constipation. The Constipation Guideline Committee, consisting of two primary care pediatricians, a clinical epidemiologist, and pediatric gastroenterologists, based its recommendations on an integration of a comprehensive and systematic review of the medical literature combined with expert opinion. Consensus was achieved through Nominal Group Technique, a structured quantitative method. The Committee developed two algorithms to assist with medical management, one for older infants and children and the second for infants less than 1 year of age. The guideline provides recommendations for management by the primary care provider, including evaluation, initial treatment, follow-up management, and indications for consultation by a specialist. The Constipation Guideline Committee also provided recommendations for management by the pediatric gastroenterologist.
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Soares ACF, Lederman HM, Fagundes-Neto U, de Morais MB. Breath hydrogen test after a bean meal demonstrates delayed oro-cecal transit time in children with chronic constipation. J Pediatr Gastroenterol Nutr 2005; 41:221-4. [PMID: 16056103 DOI: 10.1097/01.mpg.0000167499.40074.d7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate oro-cecal transit time in children with chronic constipation. METHODS 34 patients with chronic functional constipation age 3 to 13 years and 15 controls without constipation. Oro-cecal transit time was evaluated using the hydrogen breath test after ingestion of lactulose and after a standard meal of cooked beans. Total and segmental colonic transit times were measured with radiopaque markers. RESULTS Of 34 patients with chronic constipation 61.8% had increased total colonic transit time (>62 hours). Oro-cecal transit time measured with lactulose as substrate was similar (p=0.727) in constipated patients with increased colonic transit time (63.8+/-16.3 minutes), in constipated patients with normal colonic transit time (66.9+/-22.9 minutes), and in controls (65.3+/-15.5 minutes). Using a test meal of beans, the hydrogen breath test showed that oro-cecal transit time of constipated patients with increased total colon transit time was higher (252.4+/-23.2 minutes) than oro-cecal transit time of constipated patients with normal colonic transit time (227.7+/-39.6 minutes) or controls (205.3+/-23.3 minutes) (p<.05). CONCLUSION Hydrogen excretion in breath after a bean test meal showed delayed oro-cecal transit time in children with chronic constipation with abnormal total colonic transit time.
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Affiliation(s)
- Ana Cristina Fontenele Soares
- Pediatric Gastroenterology Division and the Medical Imaging Department, Federal University of Sao Paulo, Sao Paulo, Brazil
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