Dietary issues in recurrent abdominal pain

Internalizing problems are associated with oral health-related quality of life in early childhood: Outcomes from an Asian multi-ethnic prospective birth cohort

Oral health status ideally warrants for a holistic biopsychosocial approach to health and wellness. Little is known about the impact of behavioral problems on oral health-related quality of life (OHRQoL) in children due to the paucity of studies in early childhood, particularly in Asian multi-ethnic populations. This study evaluated the relationship between early child's socioemotional factors and OHRQoL, as well as its association with orofacial pain (OFP) and early childhood caries (ECC) in the Asian GUSTO birth cohort. Mother-child dyads were postnatally assessed at 3 time points. The Child Behavior Checklist (CBCL) was used to assess the child's socioemotional and behavioral problems at age 4-4.5 years together with other validated questionnaires to evaluate maternal anxiety and depression. ECC detection was performed at age 5, and OHRQoL (primary) and OFP (secondary) outcomes were assessed at age 6 from a total of 555 mother-child dyads. After a univariate regression analysis was performed to identify potential predictors and confounders, a multivariate regression model was run with predisposing factors (CBCL internalization and externalization problems, OFP, ECC) and adjusted for confounders (maternal psychosocial states, maternal education) to determine associations with OHRQoL. Results showed an association between CBCL internalization scores and poorer OHRQoL (RR = 1.03, p = 0.033, 95% CI 1.01 to 1.05), although the limited risk ratio may not have a practical applicability in psychosocially healthy children, alike the majority of those evaluated in this cohort. The average OHRQoL overall score among children with OFP was 2.39 times more than those without OFP (OR = 2.39, p < 0.001, 95% CI 2.00 to 2.86). Thus, in early childhood, OFP, and to lesser extent internalizing behaviors, may negatively impact OHRQoL. This study therefore highlights the complex relationship between OHRQoL and its predisposing socioemotional and somatic pain factors, and demands further investigations in clinically relevant populations.

Antinociceptive fatty acid patterns differ in children with psychosomatic recurrent abdominal pain and healthy controls

AIM

Stress is considered to trigger psychosomatic recurrent abdominal pain (RAP), but the mechanism behind the pain is unclear. Because the essential fatty acids, omega-6 and omega-3, are involved in pain, by regulating lipid mediators, we analysed the fatty acid patterns in children with RAP compared to healthy children.

METHODS

This was a cross-sectional study of plasma phospholipid fatty acids in 22 consecutively included children with RAP, aged six to 16 years, at an outpatient clinic specialising in RAP. The controls were 100 healthy children previously reported on and analysed in the same laboratory.

RESULTS

The children with psychosomatic RAP showed higher mean concentrations of saturated fatty acids than the controls (49.0 mol% versus 47.4 mol%) but lower mean levels of polyunsaturated fatty acids (38.6 mol% versus 39.9 mol%). Omega-3 fatty acids were lower in children with psychosomatic RAP, resulting in higher ratios of linoleic to alpha-linolenic acids (p < 0.001) and arachidonic to eicosapentaenoic acids (p = 0.01), despite a lower concentration of arachidonic acid in children with RAP (p < 0.01).

CONCLUSION

The results suggested an imbalance between nociceptive omega-6 fatty acids and antinociceptive omega-3 fatty acids in psychosomatic RAP. Further studies, including lipid mediators and oxidative products, are necessary to confirm an association.