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Yang X, Wang M, Ren L, Shon K, Cui G, Cheng Y, Sun Z, Wang X. Association between visceral adiposity index and bowel habits and inflammatory bowel disease: a cross-sectional study. Sci Rep 2024; 14:23923. [PMID: 39397029 PMCID: PMC11471843 DOI: 10.1038/s41598-024-73864-0] [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] [Received: 01/31/2024] [Accepted: 09/22/2024] [Indexed: 10/15/2024] Open
Abstract
Obesity has become a global public health problem, and its relationship with gastrointestinal diseases has become a major concern. The visceral adiposity index (VAI) is a novel index to assess the distribution and content of visceral fat, and this study aimed to investigate the association between VAI and bowel habits (chronic diarrhea, chronic constipation) and inflammatory bowel disease (IBD). The 2005-2010 National Health and Nutrition Examination Survey (NHANES) dataset was used for the cross-sectional survey. Bowel habits and IBD were defined by self-report. Multiple logistic regression models were used to test the linear association of VAI with bowel habits and IBD. Fitted smoothed curves and threshold effects analyses were used to characterize nonlinear relationships. This cross-sectional study included 10,391 adults (≥ 20 years). After adjusting for covariates, there was a significant negative association between VAI and chronic constipation (OR [95% CI]: 0.97 [0.95, 1.00]) but no significant association with IBD (OR [95% CI]: 0.97 [0.87, 1.07]). Additionally, there was a nonlinear association between VAI and chronic diarrhea with a breakpoint of 3.08, with a positive correlation between the two on the left side of the breakpoint and no statistical significance on the right side. Subgroup analyses and interaction tests showed that maintaining sleep health was associated with a low risk of chronic constipation. Elevated VAI levels were negatively associated with chronic constipation, and elevated levels were positively associated with chronic diarrhea at VAI < 3.08. This reminds us that maintaining moderate levels of visceral fat may prevent the onset of chronic constipation and circumvent the risk of chronic diarrhea. Notably, maintaining healthy sleep may play a positive role in reducing chronic constipation.
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Affiliation(s)
- Xiaoxian Yang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Manli Wang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Lang Ren
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Kinyu Shon
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Guoliang Cui
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Yiyao Cheng
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhiguang Sun
- Nanjing University of Chinese Medicine, Nanjing, China.
| | - Xiaohong Wang
- Xuzhou Hospital of Traditional Chinese Medicine, Xuzhou, China.
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Yang X, Sun Z. Association between weight-adjusted-waist index and bowel habits. Sci Rep 2024; 14:17658. [PMID: 39085333 PMCID: PMC11291746 DOI: 10.1038/s41598-024-66869-2] [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] [Received: 06/06/2024] [Accepted: 07/04/2024] [Indexed: 08/02/2024] Open
Abstract
Obesity has become a global public health issue and is closely related to bowel habits. The Weight-Adjusted-Waist Index (WWI), a new indicator of obesity, provides a more accurate assessment of central obesity. This study aims to investigate the relationship between WWI and bowel habits. The 2005-2010 National Health and Nutrition Examination Survey (NHANES) dataset was used for the cross-sectional survey. Bowel habits were defined by self-report. Multiple logistic regression models were used to test the linear association of WWI with chronic diarrhea and constipation. Fitted smoothed curves and threshold effects analysis were used to characterize nonlinear relationships. Subgroup analyses and interaction tests were used to determine the heterogeneity and stability of the study. This population-based study included 14,238 adults (≥ 20 years). After adjusting for covariates, there was a significant positive association between WWI and chronic diarrhea (OR [95% CI] 1.27 [1.14, 1.41]). There was a non-linear association between WWI and chronic constipation, and we found a breakpoint of 9.77, with a positive correlation on the left side of the breakpoint and no statistical significance on the right side. Subgroup analyses and interaction tests showed stable and consistent results between WWI and bowel habits across the stratification factors. Elevated levels of WWI are associated with an increased risk of chronic diarrhea. A range of WWI < 9.77 is associated with an increased risk of chronic constipation. WWI is a stable valid indicator for assessing intestinal health in U.S. adults, and we should be mindful of the importance of maintaining good levels of body fat in our daily lives to maintain healthy bowel habits.
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Affiliation(s)
- Xiaoxian Yang
- First Clinical Medical College, Nanjing University of Chinese Medicine, 138 Xianlin Rd, Nanjing, China
| | - Zhiguang Sun
- First Clinical Medical College, Nanjing University of Chinese Medicine, 138 Xianlin Rd, Nanjing, China.
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Hong Y, Chen X, Liu J. Analysis of Factors Associated with Constipation in the Population with Obesity: Evidence from the National Health and Nutrition Examination Survey. Obes Facts 2024; 17:169-182. [PMID: 38266495 PMCID: PMC10987188 DOI: 10.1159/000536318] [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: 07/19/2023] [Accepted: 01/14/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Obesity and constipation are both global problems, but the factors associated with constipation in individuals with obesity are currently understudied. The aim of our study was to explore the factors associated with constipation in people with obesity. METHODS From three cycles of the National Health and Nutrition Examination Survey (NHANES) 2005-2010, data from 14,048 persons aged ≥20 years were collected. Variables included demographics, lifestyle, comorbidities, and dietary data. Multiple logistic regression analysis was used to calculate adjusted prevalence odds ratio (OR) and assess the relationship between different variables and constipation in population with obesity. RESULTS Using stool consistency definition, multivariate analysis revealed that education ≥12th grade (OR: 0.456; 95% CI: 0.300, 0.694; p = 0.00024), hypertension (OR: 0.505; 95% CI: 0.334, 0.763; p = 0.00119), polypharmacy (OR: 1.669; 95% CI: 1.104, 2.521; p = 0.01507), high cholesterol (OR: 0.400; 95% CI: 0.213, 0.750; p = 0.00430), and high dietary fiber (OR: 0.454; 95% CI: 0.245, 0.841; p = 0.01206) were substantially linked with constipation in the population with obesity. For constipation defined using stool frequency, multivariate regression analysis show constipation in people with obesity had a significant association with the female sex (OR: 2.684; 95% CI: 1.379, 5.223; p = 0.00366 multivariate), Mexican American (OR: 0.142; 95% CI, 0.033, 0.616; p = 0.00914 multivariate), hypertension (OR: 0.569; 95% CI: 0.324, 0.998; p = 0.04916), depression (OR: 2.280; 95% CI: 1.240, 4.195; p = 0.00803), occasional/often milk consumption (OR: 0.473; 95% CI: 0.286, 0.782; p = 0.00356), medium energy (OR: 0.318; 95% CI: 0.118, 0.856; p = 0.02338), polypharmacy (OR: 1.939; 95% CI: 1.115, 3.373; p = 0.01907), and medium moisture (OR: 0.534; 95% CI: 0.285, 0.999; p = 0.04959). In nonobese people, constipation was significantly associated with the female sex and high moisture but not with hypertension and polypharmacy. CONCLUSION This study suggests that the population with obesity has many factors that affect constipation such as hypertension, polypharmacy, cholesterol, dietary fiber, depression, and so on, of which hypertension and polypharmacy were significant associated with constipation, regardless of definitions of constipation. Notably, hypertension might be associated with a reduced risk of constipation in people with obesity.
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Affiliation(s)
- Yongping Hong
- Department of Anorectal Surgery, The First People’s Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, China
| | - Xingxing Chen
- Department of Ultrasound, The First People’s Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, China
| | - Junping Liu
- Department of Anorectal Surgery, The First People’s Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, China
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Wang GN, Zhang K, Xiong YY, Liu S. The relationship between functional constipation and overweight/obesity in children: a systematic review and meta-analysis. Pediatr Res 2023; 94:1878-1886. [PMID: 37422494 DOI: 10.1038/s41390-023-02711-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/11/2023] [Accepted: 06/19/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Studies have reported the relationship between functional constipation and obesity in pediatric population. However, the results are contradictory. The purpose of this study is to evaluate the possible association between these two disorders in pediatric population. METHODS Four databases including PubMed, Embase, CENTRAL, and Web of Science were searched until 30 September 2022. The review was done in accordance with PRISMA guidelines and registered in PROSPERO (CRD42022328992) RESULTS: Nine studies met the eligibility criteria, including 7444 participants. Studies showed the risk of obesity was significantly increased in boys with functional constipation (CI: 1.12, 3.07; P = 0.016). Such an association was also observed in girls (CI: 1.42-4.47; P = 0.00). A statistically significant association was observed between overweight/obesity and increased risk of functional constipation in children and adolescents (CI: 1.14-3.97; P = 0.02). Especially in developed countries (CI: 1.49-3.46; P = 0.00); however, no significant association was observed in developing countries (CI: 0.81-5.3; P = 0.13). CONCLUSIONS There is a risk of obesity in either boys or girls with functional constipation. An association exists between the risk of functional constipation and children/adolescents with obesity, especially in developed countries, but not in developing countries. IMPACT Our study encourages further research in this field because early detection and intervention are crucial for both functional constipation and overweight/obesity in children, to better identify its complex biology and possibly optimize the treatment approaches.
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Affiliation(s)
- Gui Na Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Kun Zhang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yi Yun Xiong
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Si Liu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
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Verkuijl SJ, Trzpis M, Broens PM. The Prevalence of Bowel and Bladder Function During Early Childhood: A Population-Based Study. J Pediatr Gastroenterol Nutr 2023; 77:47-54. [PMID: 37098114 PMCID: PMC10259211 DOI: 10.1097/mpg.0000000000003804] [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: 10/13/2022] [Accepted: 03/11/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVES Our primary aim was to determine bowel and bladder function in children aged 1 month to 7 years in the general Dutch population. Second, we aimed to identify demographic factors associated with the presence of bowel and bladder dysfunction, and their coexistence. METHODS For this cross-sectional, population-based study, parents/caregivers of children aged from 1 month to 7 years were asked to complete the Early Pediatric Groningen Defecation and Fecal Continence questionnaire. Different parameters of bowel and bladder function were assessed using validated scoring systems such as the Rome IV criteria. RESULTS The mean age of the study population (N = 791) was 3.9 ± 2.2 years. The mean age at which parents/caregivers considered their child fully toilet-trained was 5.1 ± 1.5 years. Prevalence of fecal incontinence among toilet-trained children was 12%. Overall prevalence of constipation was 14%, with a constant probability and severity at all ages. We found significant associations between fecal incontinence and constipation [odds ratio (OR) = 3.88, 95% CI: 2.06-7.30], fecal incontinence and urinary incontinence (OR = 5.26, 95% CI: 2.78-9.98), and constipation and urinary incontinence (OR = 2.06, 95% CI: 1.24-3.42). CONCLUSIONS Even though most children are fully toilet-trained at 5 years, fecal incontinence is common. Constipation appears to be common in infants, toddlers, and older children. Fecal incontinence and constipation frequently coexist and are often accompanied by urinary incontinence. Increased awareness of bowel and bladder dysfunction in infants, toddlers, and young children is required to prevent these problems from continuing at older ages.
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Affiliation(s)
- Sanne J. Verkuijl
- From the Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- the Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Monika Trzpis
- the Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul M.A. Broens
- From the Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- the Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Dias FC, Boilesen SN, Tahan S, Melli L, de Morais MB. Overweight status, abdominal circumference, physical activity, and functional constipation in children. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:386-391. [PMID: 36820766 PMCID: PMC10004292 DOI: 10.1590/1806-9282.20220845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/14/2022] [Indexed: 02/22/2023]
Abstract
OBJECTIVE The aim of this study was to assess the prevalence of functional constipation and its relationship with the food intake, overweight status, and physical activity of children. METHODS This cross-sectional study included students from two public schools in the municipality of Osasco, which is located in the metropolitan area of São Paulo. Functional constipation was diagnosed if the clinical manifestations of the Rome IV criteria were present for more than 2 months. A 24-h recall survey was used to determine the daily food intake. Weight, height, abdominal circumference, and bioelectrical impedance were used to evaluate the weight status. Active commuting to school and physical activity scores were assessed using a questionnaire that has been validated in Brazil. RESULTS A total of 452 children, aged 6-12 years, were evaluated. Functional constipation was observed in 22.3% of participants. A greater abdominal circumference was associated with functional constipation in girls (p=0.036) in the bivariate analysis but not in the logistic regression model. Boys with functional constipation consumed higher quantities of fats (p=0.041). There was no statistically significant relationship between functional constipation and overweight status (44.6 and 34.5% of children with and without constipation, respectively; p=0.083) and active commuting to school (48.5 and 56.7% of children with and without constipation, respectively; p=0.179). CONCLUSION Functional constipation was associated with a greater abdominal circumference in girls in the bivariate analysis, however, without association in the logistic regression model. Boys with functional constipation consumed higher quantities of fat. No association was found between functional constipation, overweight status, and physical activity.
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Affiliation(s)
- Francine Canovas Dias
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Programa de Pós-graduação em Nutrição – São Paulo (SP), Brazil
| | - Sabine Nunes Boilesen
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Programa de Pós-graduação em Pediatria e Ciências Aplicadas à Pediatria – São Paulo (SP), Brazil
| | - Soraia Tahan
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Gastroenterologia Pediátrica – São Paulo (SP), Brazil
| | - Lígia Melli
- Centro Universitário FiEO, Fundação Instituto de Ensino para Osasco, Departamento de Ciências Biológicas e da Saúde – Osasco (SP), Brazil
| | - Mauro Batista de Morais
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Gastroenterologia Pediátrica – São Paulo (SP), Brazil
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Lazarus G, Junaidi MC, Oswari H. Relationship of Functional Constipation and Growth Status: A Systematic Review and Meta-Analysis. J Pediatr Gastroenterol Nutr 2022; 75:702-708. [PMID: 36053122 DOI: 10.1097/mpg.0000000000003600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Functional constipation (FC) and malnutrition are 2 of the most common diseases affecting children worldwide with long-term consequences. We hereby performed a systematic review and meta-analysis to analyze the relationship between these 2 entities. METHODS We searched PubMed, American Academics of Pediatrics (AAP), Cochrane, ClinicalTrials.gov (from inception to December 11, 2021) using "constipation," "growth," and "children" as the keywords. Newcastle-Ottawa Scale was used as the risk of bias assessment tool. Meta-analysis using the random-effects model was done. RESULTS Eighteen studies involving 33,410 children were chosen in this study. Meta-analysis of all the studies showed statistically significant relationship between FC with both overweight/obesity [odds ratio (OR) = 1.75; 95% confidence interval (CI) = 1.11-2.76; P = 0.02], in Asian countries subgroup, and undernutrition (OR = 2.38; 95% CI = 1.43-3.97; P < 0.001) in Asian countries using ROME criteria's subgroup. Normal weight patients were also more prevalent in non-FC patients in Asia (OR = 0.54; 95% CI = 0.38-0.76; P < 0.001). The relationship between FC and short stature is still inconclusive. CONCLUSIONS FC is correlated with the prevalence of both overweight/obesity and undernutrition. Future studies should evaluate the causal relationship and whether FC treatment could help.
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Affiliation(s)
- Glen Lazarus
- From the Gastrohepatology Division, Department of Child Health, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Roldán-Aguilar EE, Vergara-Ramos G, Jaramillo-Osorno AF. Investigaciones realizadas en Colombia relacionadas con actividad física y obesidad 2010-2020. REVISTA POLITÉCNICA 2022. [DOI: 10.33571/rpolitec.v18n36a5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introducción: La obesidad es un problema de salud pública mundial. La actividad física es una herramienta importante de promoción y prevención de este problema. Se desconoce las investigaciones realizadas en Colombia al respecto, lo cual es necesario para implementar políticas públicas eficientes. Objetivo: analizar las investigaciones colombianas encontradas en bases de datos científicas sobre la actividad física y obesidad. Metodología: revisión sistemática de artículos de investigación realizados en Colombia del año 2010 al 2020, en las bases de datos PubMed y SciELO. Resultados: de 87 artículos encontrados, 23 cumplieron los criterios de inclusión. El 91,3 % publicados en revistas indexadas internacionalmente. 69,5% estudios observacionales, 17,4% ensayos clínicos y 8,7% revisiones sistemáticas. Conclusiones: poca producción en Colombia. La mayoría en revistas indexadas, tuvieron diseño observacional y encontraron asociación entre poca actividad física con sobrepeso/obesidad. Alta prevalencia de sobrepeso/obesidad. Pocos autores fueron profesionales en el área del deporte y el entrenamiento.
Introduction: Obesity is a global public health problem. Physical activity and exercise are important tools for promoting and preventing. The research carried out in Colombia in this regard is unknown, which is necessary to implement efficient public policies. Objective: to analyze Colombian research found in scientific databases on physical activity or exercise in overweight and obesity. Methodology: literary review of research articles carried out in Colombia from 2010 to 2020, in the PubMed and SciELO databases. Results: Of 87 articles found, 23 met the inclusion criteria. 91.3% published in internationally indexed journals. 69.5% observational studies, 17.4% clinical trials and 8.7% systematic reviews. Conclusions: little production in Colombia. Most of the indexed journals had an observational design and found an association between little physical activity and overweight/obesity. High prevalence of overweight/obesity. Few authors were professionals in the area of training.
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Pediatric Aspects of Nutrition Interventions for Disorders of Gut-Brain Interaction. Am J Gastroenterol 2022; 117:995-1009. [PMID: 35416794 PMCID: PMC9169765 DOI: 10.14309/ajg.0000000000001779] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/09/2022] [Indexed: 12/11/2022]
Abstract
Dietary factors may play an important role in the generation of symptoms in children with disorders of gut-brain interaction (DGBIs). Although dietary modification may provide successful treatment, there is a relative paucity of controlled trials that have shown the effectiveness of dietary interventions. This study is a narrative review that explores the existing literature on food and pediatric DGBIs. The following have been shown to be beneficial: (i) in infants with colic, removing cow's milk from the infant's diet or from the maternal diet in those who are breastfed; (ii) in infants with regurgitation, adding thickeners to the formula or removing cow's milk protein from the infant's diet or the maternal diet in those who are breastfed; and (iii) in children with pain-predominant DGBIs, using soluble fiber supplementation or a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet. In children with functional constipation, there is no evidence that adding fiber is beneficial. Given that most dietary interventions include restriction of different foods in children, a thoughtful approach and close follow-up are needed.
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Misra S, Liaw A. Controversies on the relationship between increased body mass index and treatment-resistant chronic constipation in children. JPEN J Parenter Enteral Nutr 2021; 46:1031-1035. [PMID: 34734415 DOI: 10.1002/jpen.2300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There are conflicting reports on the association between children with increased body mass index (BMI), and constipation. This retrospective chart review of two groups of children from a primary care clinic was designed to address the controversy. METHODS Group-1: Charts of all children seen in a year for general pediatric care were reviewed for incidences of increased BMI (>85th percentile) and constipation as well as overweight recognition in the final diagnosis; Group-2: Children diagnosed with constipation at the same primary care setting for 5 years were identified by ICD-9 code. These charts were reviewed for prevalence of increased BMI and incidences of referral to subspecialty clinic. RESULTS Group-1: Three hundred nineteen (33.4%) of the 955 children had increased BMI and 28 (2.93%) had constipation. The prevalence of constipation was not increased among children with increased BMI. Group-2: 24 of the 66 children with constipation were referred to the pediatric gastroenterology clinic. children with increased BMI were three times more likely to be referred (n = 20, p = 0.04). The two groups had a similar prevalence of children with increased BMI (Group 1 = 33.4%; Group 2 = 30.3%). CONCLUSION In the general pediatric population, children with an increased BMI were not at an increased risk of developing constipation. However, children with increased BMI and constipation were three times more likely to be referred, presumably for treatment failure, to the pediatric gastroenterology clinic .Hence children with increased BMI were more likely to develop treatment resistant constipation.
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Affiliation(s)
- Sudipta Misra
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, UIC College of Medicine at Peoria and Children's Hospital Of Illinois at OSF St Francis Medical Center, Peoria, Illinois, USA.,Summerville Medical Center, Summerville, South Carolina, USA
| | - Andrew Liaw
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, UIC College of Medicine at Peoria and Children's Hospital Of Illinois at OSF St Francis Medical Center, Peoria, Illinois, USA
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Thomaz de Almeida CN, Tahan S, Areco KN, Morais MBD. Association between abuse and neglect with functional constipation and irritable bowel syndrome in adolescents. Scand J Gastroenterol 2021; 56:1146-1151. [PMID: 34469265 DOI: 10.1080/00365521.2021.1923059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To evaluate the association between violence exposure, abuse, and neglect victimization with functional constipation and irritable bowel syndrome in adolescents. METHODS Observational cross-sectional case-control study conducted with adolescents from two public schools in the municipality of Osasco, metropolitan region of São Paulo, Brazil. A self-administered questionnaire validated for Brazilian Portuguese Child Abuse Screening Tools - Children's version (ICAST-C) was used to screen the different types of violence. The definition of functional constipation and irritable bowel syndrome was performed using the Rome IV criteria for adolescents. Parents or legal guardians completed the questionnaire for socioeconomic assessment and signed the informed consent form. RESULTS 265 students aged 11-17 years, 157 females, were evaluated. Functional constipation and irritable bowel syndrome were found in 74 (27.9%) of the 265 adolescents. Violence exposure was found in 82.6% of the 265 screened adolescents, physical abuse in 91.3%, psychological abuse in 93.2%, sexual abuse in 12.1%, and neglect in 53.6%. The multiple logistic regression analysis showed an association (p < .05) between functional constipation and irritable bowel syndrome with violence exposure (OR = 2.77), physical abuse (OR = 2.17), psychological abuse (OR = 2.95), and neglect (OR= 2.31). There was no association with sexual abuse. CONCLUSIONS Functional constipation and irritable bowel syndrome were associated with violence exposure, physical abuse, psychological abuse, and neglect in adolescent students from public schools. No association was found with sexual abuse. Further studies are necessary to investigate the causal relationship between violence and functional gastrointestinal disorders.
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Affiliation(s)
- Camila Nunes Thomaz de Almeida
- Division of Pediatric Gastroenterology, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Soraia Tahan
- Division of Pediatric Gastroenterology, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Kelsy Nema Areco
- Division of Health Informatics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mauro Batista de Morais
- Division of Pediatric Gastroenterology, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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von Gontard A, Mattheus H, Anagnostakou A, Sambach H, Breuer M, Kiefer K, Holländer T, Hussong J. Behavioral comorbidity, overweight, and obesity in children with incontinence: An analysis of 1638 cases. Neurourol Urodyn 2020; 39:1985-1993. [PMID: 32806882 DOI: 10.1002/nau.24451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/12/2020] [Accepted: 06/28/2020] [Indexed: 01/06/2023]
Abstract
AIMS Children with nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) are at risk for behavioral problems, overweight, and obesity. The aim of this study was to analyze the specific behavioral and weight comorbidity in subtypes of incontinence. METHODS A total of 1638 consecutive patients presented to a tertiary incontinence clinic from 2012 to 2018 was examined prospectively according to ICCS criteria. Behavioral symptoms were measured with the Child Behavior Checklist (CBCL). Psychiatric disorders were diagnosed according to ICD-10 criteria. Weight categories were calculated according to WHO recommendations. RESULTS The mean age was 7.8 years, 67% of patients were male. Fifty-seven percent had NE (n = 934), 33% DUI (n = 547), and 40% FI (n = 656). Boys had significantly higher rates of NE and FI than girls. Of all children, 39.2% (n = 539) had a clinically relevant CBCL total score. A total of 28.3% (n = 463) had an ICD-10 psychiatric diagnosis, mainly ODD and ADHD, and 28.6% (n = 463) were overweight or obese. Boys were more often affected by behavioral symptoms, psychiatric disorders, and overweight/obesity. Children with NE had the highest rate of overweight/obesity. Except for primary nonmonosymptomatic NE, subtypes of incontinence did not differ regarding behavioral symptoms and weight categories. However, overweight/obesity was significantly associated with behavioral and psychiatric parameters. CONCLUSIONS Behavioral symptoms and psychiatric disorders, as well as overweight/obesity are important risk factors associated with incontinence, but the interaction between these factors is complex. In clinical settings, all children with incontinence should be screened with behavioral questionnaires. Also, weight should be measured, and overweight/obesity should be addressed.
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Affiliation(s)
- Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Hannah Mattheus
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Aikaterini Anagnostakou
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Heike Sambach
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Michaela Breuer
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Kathrin Kiefer
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Teresa Holländer
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Justine Hussong
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
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13
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Macêdo MIP, Albuquerque MDFM, Tahan S, Morais MBD. Is there any association between overweight, physical activity, fat and fiber intake with functional constipation in adolescents? Scand J Gastroenterol 2020; 55:414-420. [PMID: 32320314 DOI: 10.1080/00365521.2020.1749878] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objectives: To assess the prevalence of functional constipation and its association with overweight, physical activity and the estimation of fat and fiber intake in adolescents.Methods: In all, 386 adolescents aged 14-19 years from the city of Maceió (Alagoas, Northeast Brazil) were included in this study. Participants responded to standardized questionnaires that assessed bowel habits, physical activity and the estimation of fat and dietary fiber intake. Functional constipation was defined according to the Rome criteria. Weight and height were measured using standard methods. Body mass index (BMI) was used to evaluate whether a participant was overweight.Results: The prevalence of constipation was 24.9%. The median BMI was higher in female adolescents with constipation (22.6) compared with female adolescents without constipation (20.0; p = .001). Physical inactivity (fewer than 300 min of physical activity per week) was more frequent in females (62.7%; 126/201) than in males (42.2%; 78/185; p = .000). No association was observed between physical inactivity and functional constipation. Excessive intake of fat in the diet was found in 45.3% (175/386) of participants, while poor dietary fiber intake was found in 84.2% (325/386) of participants. No association was found between a fat-rich diet and constipation. Low dietary fiber intake was associated with constipation in female adolescents (odds ratio = 3.42, 95% confidence interval: 1.08 and 12.06).Conclusions: The prevalence of constipation was high among this group of adolescents. Constipation was not associated with physical inactivity but was associated with a low dietary fiber intake and higher BMI values in female adolescents.
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Affiliation(s)
- Maria Irisdalva P Macêdo
- Postgraduate Program of Pediatric at Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | | | - Soraia Tahan
- Division of Pediatric Gastroenterology at Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Mauro Batista de Morais
- Division of Pediatric Gastroenterology at Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, Brazil
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14
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Curtin C, Hyman SL, Boas DD, Hassink S, Broder-Fingert S, Ptomey LT, Gillette MD, Fleming RK, Must A, Bandini LG. Weight Management in Primary Care for Children With Autism: Expert Recommendations. Pediatrics 2020; 145:S126-S139. [PMID: 32238539 DOI: 10.1542/peds.2019-1895p] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
Research suggests that the prevalence of obesity in children with autism spectrum disorder (ASD) is higher than in typically developing children. The US Preventive Services Task Force and the American Academy of Pediatrics (AAP) have endorsed screening children for overweight and obesity as part of the standard of care for physicians. However, the pediatric provider community has been inadequately prepared to address this issue in children with ASD. The Healthy Weight Research Network, a national research network of pediatric obesity and autism experts funded by the US Health Resources and Service Administration Maternal and Child Health Bureau, developed recommendations for managing overweight and obesity in children with ASD, which include adaptations to the AAP's 2007 guidance. These recommendations were developed from extant scientific evidence in children with ASD, and when evidence was unavailable, consensus was established on the basis of clinical experience. It should be noted that these recommendations do not reflect official AAP policy. Many of the AAP recommendations remain appropriate for primary care practitioners to implement with their patients with ASD; however, the significant challenges experienced by this population in both dietary and physical activity domains, as well as the stress experienced by their families, require adaptations and modifications for both preventive and intervention efforts. These recommendations can assist pediatric providers in providing tailored guidance on weight management to children with ASD and their families.
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Affiliation(s)
- Carol Curtin
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts; .,Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Susan L Hyman
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,University of Rochester Medical Center, Rochester, New York
| | - Diane D Boas
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,The Barbara Bush Children's Hospital, Maine Medical Center, Portland, Maine
| | - Sandra Hassink
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,Institute for Healthy Childhood Weight, American Academy of Pediatrics, Itasca, Illinois
| | - Sarabeth Broder-Fingert
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,Boston Medical Center and School of Medicine, Boston University, Boston, Massachusetts
| | - Lauren T Ptomey
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,University of Kansas Medical Center, Kansas City, Kansas
| | - Meredith Dreyer Gillette
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Richard K Fleming
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,University of Massachusetts Boston, Boston, Massachusetts
| | - Aviva Must
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,School of Medicine, Tufts University, Boston, Massachusetts; and
| | - Linda G Bandini
- Healthy Weight Research Network, University of Massachusetts Medical School, Worcester, Massachusetts.,Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, Massachusetts.,Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts
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15
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Velasco-Benítez CA, Moreno-Gómez JE, Ramírez-Hernández CR. Subtipos del síndrome de intestino irritable en niños. DUAZARY 2020. [DOI: 10.21676/2389783x.3223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
La prevalencia del síndrome de intestino irritable (SII) pediátrico es 1,2%-5,4%, y los subtipos en niños latinoamericanos, no está especificada. El objetivo de este estudio es caracterizar los subtipos del SII y sus posibles asociaciones. Estudio de prevalencia en niños entre los ocho y 18 años de edad con SII según los Criterios de Roma III. Se tomaron variables sociodemográficas, familiares y clínicas. Los subtipos de SII se consideraron por la consistencia de las heces en SII con estreñimiento (SII-e); diarrea (SII-d); mixto (SII-m) y sin subtipo (SII-ss). La estadística incluyó análisis uni y bivariados. Los datos fueron analizados usando t-student a dos colas, chi2, prueba exacta de Fisher y razón de prevalencia (RP) con IC95%, siendo p<0,05 significativa. Fueron incluidos 196 niños (53,6% femeninos; mediana de 11 años); presentándose SII-ss en 64,8%, SII-e en 19,9%, SII-m en 8,7% y SII-d en 6,6%. Hubo diferencias significativas en las características de las heces (p=0,01), en la incontinencia fecal (p=0,02), en los fecalomas (p=0,00); y posibles asociaciones entre el SII-d, ciudad (p=0,00) y malnutrición (p=0,02). En conclusión, luego del SII-ss, ¼ de los niños estudiados presentó SII-e, seguido del SII-m y SII-d; presentándose el SII-d con mayor oportunidad en malnutridos.
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16
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Walter AW, Hovenkamp A, Devanarayana NM, Solanga R, Rajindrajith S, Benninga MA. Functional constipation in infancy and early childhood: epidemiology, risk factors, and healthcare consultation. BMC Pediatr 2019; 19:285. [PMID: 31416431 PMCID: PMC6694472 DOI: 10.1186/s12887-019-1652-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 07/31/2019] [Indexed: 02/08/2023] Open
Abstract
Background Functional constipation (FC) is a pediatric problem that is seen frequently. However, its prevalence in Asia remains undetermined. In this study we attempted to determine the prevalence, risk factors and therapeutic modalities of FC in infants and toddlers in Sri Lanka. Methods Children aged 6.5 months to 4 years were selected from 14 well-baby and vaccination clinics in the Gampaha District of Sri Lanka. A questionnaire with questions regarding the socio-demographic characteristics, child’s bowel habits, psycho-social risk factors and treatment modalities were filled by the mothers. FC was diagnosed according to ROME III criteria. Results A total of 1113 children were analyzed [(female n = 560 (50.3%) with a mean age of 20.7 months, standard deviation [SD] 11.2 months. FC was found in 89 (8.0%). FC was significantly and independently associated with underweight (14.3% vs 7.2%, p = 0.008. [OR and 95% CI: 2,3 (CI; 1.3–4.2)] and residence in an urban area (9.6% vs 5.6%, p = 0.013). [OR and 95% CI: 0.592 (CI; 0.396–0.95)]. Children subjected to violence showed a significantly higher prevalence of FC (20.0 vs 7.8%, p = 0.046). Children being overweight and children living with mothers subjected to violence showed a higher, though not statistically significant, tendency to develop FC. Children with FC visited healthcare clinics more frequently when compared to controls (19.6% vs 6.0%, p < 0.0001). However, only 24% of infants and toddlers with FC were treated specifically for the condition by a doctor. Conclusions FC occurred in 8% of this cohort of Sri Lankan infants and toddlers. It is significantly associated with underweight and living in an urban area. Only a quarter of them received medical attention for their constipation. Trial registration SLCP/ERC/2014/12, December 2014. Electronic supplementary material The online version of this article (10.1186/s12887-019-1652-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Willemijn Walter
- Department of Pediatrics, University of Amsterdam, Academic Medical Center, H7-248, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - Anne Hovenkamp
- Department of Pediatrics, University of Amsterdam, Academic Medical Center, H7-248, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Niranga Manjuri Devanarayana
- Senior Lecturer in Physiology, Department of Physiology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010, Sri Lanka
| | | | - Shaman Rajindrajith
- Senior lecturer in Paediatrics, Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010, Sri Lanka
| | - Marc Alexander Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
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17
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Association Between Obesity/Overweight and Functional Gastrointestinal Disorders in Children. J Pediatr Gastroenterol Nutr 2019; 68:517-520. [PMID: 30444836 DOI: 10.1097/mpg.0000000000002208] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Although emerging data indicate that obese/overweight children are more likely to develop functional gastrointestinal disorders (FGIDs) than normal-weight peers, contrasting results have been reported. The present observational, case-control study aimed at estimating the prevalence of FGIDs in obese/overweight children compared to normal-weight peers. METHODS Consecutive obese and overweight children aged 4 to 18 years attending the obesity outpatient clinic were enrolled as study cases. Normal-weight children were enrolled as comparison group. All the enrolled patients received a thorough health examination from both a pediatric endocrinologist and gastroenterologist. Moreover, they were asked to fill out the Rome III questionnaire for the diagnosis of FGIDs. Data were analyzed to compare the prevalence of FGIDs between cases and controls. RESULTS Throughout the study period we enrolled 103 cases and 115 controls. No significant age and sex differences were found between the 2 groups. FGIDs were significantly more prevalent in obese/overweight compared to normal-weight children (47.57% vs 17.39%; P < 0.0001). Increased prevalence was observed for functional constipation (18.44% vs 7.82%; P = 0.025), functional dyspepsia (23.33% vs 6.95%; P = 0.001), and irritable bowel syndrome (10.67% vs 2.60%; P = 0.024), whereas no difference was observed for functional abdominal pain (1.94% vs 2.60%; P = 1.00). CONCLUSIONS Our data suggest that there is a link between excess body fat and FGIDs in children. This finding may offer a model of patients in which the effects of food and nutritional substances, the gut microbial environment, and psychosocial factors are fitting well with the emerging biopsychosocial conceptual model for FGIDs.
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18
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Santucci NR, Hyman PE. Do Functional Gastrointestinal Disorders Affect Growth and Nutrition? J Pediatr 2018; 199:9-10. [PMID: 29731354 DOI: 10.1016/j.jpeds.2018.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/04/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Neha R Santucci
- Pediatric Gastroenterology, Hepatology and Nutrition University of Cincinnati Cincinnati Children's Hospital Medical Center Cincinnati, Ohio.
| | - Paul E Hyman
- Pediatric Gastroenterology, Hepatology and Nutrition Louisiana State University Health Sciences Center Children's Hospital of New Orleans New Orleans, Louisiana
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19
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Pawłowska K, Umławska W, Iwańczak B. A Link between Nutritional and Growth States in Pediatric Patients with Functional Gastrointestinal Disorders. J Pediatr 2018; 199:171-177. [PMID: 29709346 DOI: 10.1016/j.jpeds.2018.02.069] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/30/2018] [Accepted: 02/28/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate nutritional status and growth status of pediatric patients with functional gastrointestinal disorders (FGIDs) and to examine the relationship between nutritional status and linear growth in these children. STUDY DESIGN In total, 102 pediatric patients diagnosed with functional constipation (FC), irritable bowel syndrome (IBS), or functional abdominal pain (FAP) in years 2013-2015 were subjected to anthropometric measurements. Anthropometry comprised body height, leg and trunk lengths, body weight, mid-upper arm circumference, and 3 skinfold thicknesses. Body fat percentage was obtained with bioelectrical impedance analysis. Indices of the nutritional status and body proportions were calculated and adjusted for age and sex. RESULTS Excessive body weight and excessive fatness were the most common in children with IBS. Being underweight was most common in children with FAP, but fat deficiency was similarly frequent in the FAP and in FC groups. Short stature was the most common in children with FC. Children with IBS were the best nourished and the tallest for age and sex due to increased trunk length. Body height and linear body proportions adjusted for age and sex were positively associated with body weight and body fatness in the total sample. CONCLUSIONS Children with FGIDs present various linear growth abnormalities that are associated with body weight and body fatness. Although excessive body weight and body fat are common in children with IBS, pediatricians should be aware of the risk of malnutrition in children with other FGIDs.
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Affiliation(s)
| | - Wioleta Umławska
- Department of Human Biology, University of Wroclaw, Wroclaw, Poland
| | - Barbara Iwańczak
- Department and Clinic of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Wroclaw, Poland
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20
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Udoh EE, Rajindrajith S, Devanarayana NM, Benninga MA. Prevalence and risk factors for functional constipation in adolescent Nigerians. Arch Dis Child 2017; 102:841-844. [PMID: 28446425 DOI: 10.1136/archdischild-2016-311908] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To determine the prevalence and risk factors for functional constipation (FC) in adolescent Nigerians. METHOD A cross-sectional study was conducted in rural and urban areas of two states in the southern part of Nigeria. Adolescents aged 10-18 years were recruited from 11 secondary schools, using a stratified random sampling technique. A validated self-administered questionnaire on Rome III criteria for diagnosing FC and its predisposing factors was filled by each participant in a classroom setting. RESULTS A total of 874 questionnaires was distributed and 818 (93%) properly filled questionnaires were included in the analysis. The mean age of the participants was 14.6±2.0 years with 409 (50%) being boys. FC was present in 223 (27%) with no difference in prevalence between sexes. Prevalence of FC was 29% in urban areas and 26% in rural areas (p>0.05). The condition was significantly associated with low social class (p=0.013). Exposure to stressful life events at home and school did not predispose the participants to develop FC. CONCLUSIONS FC is a significant health problem among adolescent Nigerians. The condition is associated with low social class.
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Affiliation(s)
- Ekong Emmanuel Udoh
- Paediatrics Department, University of Uyo Teaching Hospital, Uyo, Akwa Ibom, Nigeria
| | - Shaman Rajindrajith
- Paediatrics Department, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | | | - Marc A Benninga
- Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
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21
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Ranasinghe N, Devanarayana NM, Benninga MA, van Dijk M, Rajindrajith S. Psychological maladjustment and quality of life in adolescents with constipation. Arch Dis Child 2017; 102:268-273. [PMID: 27402734 DOI: 10.1136/archdischild-2016-310694] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/18/2016] [Accepted: 06/26/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To assess psychological maladjustment in adolescents with functional constipation. STUDY DESIGN We conducted a cross-sectional survey in five schools. Adolescents aged between 13 and 18 years were included in the study. Validated questionnaires were used to collect bowel habits and demographic data, health-related quality of life (HRQoL) and psychological maladjustment. Rome III criteria were used to diagnose constipation. RESULTS 1697 adolescents were recruited (boys 779 (45.9%), mean age 15.06 years and SD 1.6 years). Prevalence of constipation was 6.7%, of whom 52 were boys (45.6%) and 62 were girls (54.4%). 38 adolescents (33.3%) with constipation and 230 controls (14.5%) had significant psychological maladjustment. Among seven different personality dimensions used to assess psychological maladjustment, children with constipation had significantly more deficits than controls in hostility and aggression (14.2 vs 12.6 in controls (mean difference 1.54, 95% CI (0.89 to 2.19) p<0.001), negative self-esteem (12.0 vs 10.5 in controls, mean difference 1.54 95% CI (0.96 to 2.06) p<0.001), negative self-adequacy (11.9 vs 9.8 controls, mean difference 2.07 95% CI (1.46 to 2.67) p<0.001), emotional unresponsiveness (12.9 vs 11.5 controls, mean difference 1.44 95% CI (0.84 to 2.04) p<0.001), emotional instability (17.1 vs 15.6, mean difference 1.53 95% CI (0.86 to 2.2) p<0.001) and negative world view (12.1 vs 10.2 controls, mean difference 1.91 95% CI (1.24 to 2.59) p<0.001). The total HRQoL of adolescents with constipation was lower than controls (70.6 vs 79.0 mean difference 9.48 95% CI (1.4 to 6.7) p<0.05). CONCLUSION A significant proportion of children with constipation are suffering from psychological maladjustment.
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Affiliation(s)
- Nishadi Ranasinghe
- Department of Paediatrics, District General Hospital Killinochchi, Kilinochchi, Sri Lanka
| | | | - Marc Alexander Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Marieke van Dijk
- Psychosocial Department and Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Shaman Rajindrajith
- Department of Pediatrics, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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22
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Koppen IJN, Kuizenga-Wessel S, Saps M, Di Lorenzo C, Benninga MA, van Etten-Jamaludin FS, Tabbers MM. Functional Defecation Disorders and Excessive Body Weight: A Systematic Review. Pediatrics 2016; 138:peds.2016-1417. [PMID: 27531145 DOI: 10.1542/peds.2016-1417] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Several studies have suggested an association between functional defecation disorders (FDDs) and overweight/obesity in children. OBJECTIVE To synthesize current evidence evaluating the association between FDDs and overweight/obesity in children. DATA SOURCES PubMed, Medline, and Embase were searched from inception until January 25, 2016. STUDY SELECTION Prospective and cross-sectional studies investigating the association between FDDs and overweight/obesity in children 0 to 18 years were included. DATA EXTRACTION Data generation was performed independently by 2 authors and quality was assessed by using quality assessment tools from the National Heart, Lung, and Blood Institute. RESULTS Eight studies were included: 2 studies evaluating the prevalence of FDDs in obese children, 3 studies evaluating the prevalence of overweight/obesity in children with FDDs, and 3 population-based studies. Both studies in obesity clinics revealed a higher prevalence of functional constipation (21%-23%) compared with the general population (3%-16%). In 3 case-control studies, the prevalence of overweight (12%-33%) and obesity (17%-20%) was found to be higher in FDD patients compared with controls (13%-23% and 0%-12%, respectively), this difference was significant in 2/3 studies. One of 3 population-based studies revealed evidence for an association between FDDs and overweight/obesity. Quality of 7/8 studies was rated fair or poor. LIMITATIONS Due to heterogeneity of the study designs, we refrained from statistically pooling. CONCLUSIONS Although several studies have revealed the potential association between FDDs and excessive bodyweight in children, results across included studies in this review differ strongly and are conflicting. Therefore, this systematic review could not confirm or refute this association.
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Affiliation(s)
- Ilan J N Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | - Sophie Kuizenga-Wessel
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands
| | - Miguel Saps
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | - Carlo Di Lorenzo
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands
| | | | - Merit M Tabbers
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands
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23
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Rajindrajith S, Devanarayana NM, Crispus Perera BJ, Benninga MA. Childhood constipation as an emerging public health problem. World J Gastroenterol 2016; 22:6864-6875. [PMID: 27570423 PMCID: PMC4974585 DOI: 10.3748/wjg.v22.i30.6864] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/16/2016] [Accepted: 06/13/2016] [Indexed: 02/06/2023] Open
Abstract
Functional constipation (FC) is a significant health problem in children and contrary to common belief, has serious ramifications on the lives of children and their families. It is defined by the Rome criteria which encourage the use of multiple clinical features for diagnosis. FC in children has a high prevalence (0.7%-29%) worldwide, both in developed and developing countries. Biopsychosocial risk factors such as psychological stress, poor dietary habits, obesity and child maltreatment are commonly identified predisposing factors for FC. FC poses a significant healthcare burden on the already overstretched health budgets of many countries in terms of out-patient care, in-patient care, expenditure for investigations and prescriptions. Complications are common and range from minor psychological disturbances, to lower health-related quality of life. FC in children also has a significant impact on families. Many paediatric clinical trials have poor methodological quality, and drugs proved to be useful in adults, are not effective in relieving symptoms in children. A significant proportion of inadequately treated children have similar symptoms as adults. These factors show that constipation is an increasing public health problem across the world with a significant medical, social and economic impact. This article highlights the potential public health impact of FC and the possibility of overcoming this problem by concentrating on modifiable risk factors rather than expending resources on high cost investigations and therapeutic modalities.
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