Mediterranean Diet Adherence is Associated with Lower Prevalence of Functional Gastrointestinal Disorders in Children and Adolescents

The prevalence of rumination syndrome and rumination disorder: A systematic review and meta-analysis

BACKGROUND

Rumination is characterized by the repeated regurgitation of food. Rumination syndrome is a disorder of gut-brain interaction diagnosed by Rome criteria, whereas rumination disorder is a feeding and eating disorder diagnosed by DSM-5 criteria. We aimed to determine the global prevalence of rumination according to these criteria across all age groups.

METHODS

We performed a systematic review and meta-analysis of studies reporting the prevalence of rumination syndrome according to Rome III and Rome IV and rumination disorder according to the following validated DSM-5 assessments: PARDI, EDA-5, EDY-Q, STEP, and STEP-CHILD. We searched MEDLINE, EMBASE, and PsychINFO (from January 1, 2006, to June 1, 2023) to identify studies reporting the prevalence of rumination in community settings in participants of any age. We did a meta-analysis to estimate the pooled prevalence and odds ratio (OR) of rumination according to diagnostic criteria, country, and characteristics such as age and sex.

KEY RESULTS

The search strategy generated 1243 studies, of which 147 studies appeared to be relevant. Thirty studies were included, with a total of 114,228 participants, of whom 61,534 of these were adults and 52,694 were children. The pooled prevalence of rumination syndrome in children of all ages according to Rome III criteria was 1.0% (95% CI 0.3-1.6; I2 91.1%), but no data were available for adults. According to Rome IV criteria, the pooled prevalence of rumination syndrome in children of all ages was 0.4% (95% CI 0.2-0.6; I2 56.4%) and 3.7% in adults (95% CI 2.3-5.1; I2 91.4%). The pooled prevalence of rumination disorder in children of all ages according to EDY-Q was 2.1% (95% CI 0.9-3.4; I2 = 78.1%), but only one study utilizing EDY-Q in adults was included (0.7% [95% CI 0.4-1.0]). No data were available for children or adults using any other validated DSM-5 assessments for rumination disorder. Irrespective of diagnostic criteria, the pooled prevalence of rumination was higher in adults compared to children and adolescents (3.0% [95% CI 1.4-4.7; I2 = 98.1%] vs. 0.8% [95% CI 0.4-1.3; I2 = 90.8%]), but higher in adolescents than in children (1.1% [95% CI 0.3-2.0; I2 = 92.8%] vs. 0.1% [95% CI 0.0-0.2; I2 = 24.5%]). In adults, factors independently associated with rumination were female gender (OR 1.4 [95% CI 1.0-2.0]), anxiety (OR 2.3 [95% CI 2.1-2.6]), and depression (OR 1.8 [95% CI 1.2-2.9]). No association between gender and rumination was seen in children.

CONCLUSIONS AND INFERENCES

The prevalence of rumination is more common in adults than in children. In adults, rumination is associated with female gender, anxiety, and depression. Future population studies should aim to better understand why this behavior is more common in adults and also compare validated DSM-5 assessments for rumination disorder with Rome criteria for rumination syndrome as prevalence may differ.

Dichotomous effect of dietary fiber in pediatrics: a narrative review of the health benefits and tolerance of fiber

Dietary fibers are associated with favorable gastrointestinal, immune, and metabolic health outcomes when consumed at sufficient levels. Despite the well-described benefits of dietary fibers, children and adolescents continue to fall short of daily recommended levels. This gap in fiber intake (i.e., "fiber gap") might increase the risk of developing early-onset pediatric obesity and obesity-related comorbidities such as type 2 diabetes mellitus into adulthood. The structure-dependent physicochemical properties of dietary fiber are diverse. Differences in solubility, viscosity, water-holding capacity, binding capability, bulking effect, and fermentability influence the physiological effects of dietary fibers that aid in regulating appetite, glycemic and lipidemic responses, and inflammation. Of growing interest is the fermentation of fibers by the gut microbiota, which yields both beneficial and less favorable end-products such as short-chain fatty acids (e.g., acetate, propionate, and butyrate) that impart metabolic and immunomodulatory properties, and gases (e.g., hydrogen, carbon dioxide, and methane) that cause gastrointestinal symptoms, respectively. This narrative review summarizes (1) the implications of fibers on the gut microbiota and the pathophysiology of pediatric obesity, (2) some factors that potentially contribute to the fiber gap with an emphasis on undesirable gastrointestinal symptoms, (3) some methods to alleviate fiber-induced symptoms, and (4) the therapeutic potential of whole foods and commonly marketed fiber supplements for improved health in pediatric obesity.

Association between breakfast consumption, breakfast quality, mental health and quality of life in Turkish adolescents: A high school-based cross-sectional study

This study aimed to determine the frequency of breakfast consumption and breakfast quality among adolescents and to evaluate the relationships between breakfast consumption, breakfast quality, mental health, and health-related quality of life. This cross-sectional study included 449 students from 17 high schools between December 2022 and May 2023. A face-to-face questionnaire measuring the frequency of breakfast consumption, Mediterranean diet quality index (KIDMED), health-related quality of life (KIDSCREEN), and depression, anxiety and stress scales (DASS-21) was performed. Of the students, 54.1% skipped breakfast 2 or more times a week and 75.9% had poor breakfast quality. There were significant differences in breakfast quality classification according to the frequency of breakfast consumption (p = 0.003). Breakfast consumption ≤1 time/week or 2-5 times/week was associated with depression, anxiety and low adherence to the Mediterranean diet. No relationship was observed between breakfast quality and stress, depression or anxiety (p = 0.620, p = 0.586, p = 0.539, respectively) or between breakfast quality and the KIDSCREEN-27 subscales (p > 0.05). However, those eating poor-quality breakfasts had better results in physical wellbeing (p = 0.022), psychological wellbeing (p = 0.024), autonomy and parent relations (p = 0.017) than breakfast-skippers and also scored lower for depression, stress and anxiety (all p < 0.001). In conclusion, the frequency of breakfast consumption had a stronger association with reduced symptoms of stress, depression and anxiety, as well as improvements in all dimensions of health-related quality of life, compared to the quality of breakfast consumed. Given the association of breakfast consumption with mental health outcomes in adolescents, our findings are of great importance, especially to parents, clinicians and nutritional educators.

Clinical trial: A Mediterranean diet is feasible and improves gastrointestinal and psychological symptoms in irritable bowel syndrome

BACKGROUND

Diet is fundamental to the care of irritable bowel syndrome (IBS). However, some approaches are not appropriate for individuals experiencing psychological symptoms.

AIMS

To assess feasibility of a Mediterranean diet in IBS and its impact on gastrointestinal and psychological symptoms.

METHODS

We recruited adults with Rome IV IBS and mild or moderate anxiety and/or depressive symptoms to an unblinded 6-week randomised controlled trial. Patients were randomised to Mediterranean diet counselling or habitual diet. We collected gastrointestinal and psychological symptom data, dietary data and stool samples for metagenomic sequencing.

RESULTS

We randomised 59 individuals (29 Mediterranean diet, 30 control); 48 completed the study. The Mediterranean Diet Adherence Screener score was higher in the Mediterranean diet group than controls at week 6 (7.5 [95% CI: 6.9-8.0] vs. 5.7 [5.2-6.3], p < 0.001), and there was a greater score increase than controls (2.1 [95% CI: 1.3-2.9] vs. 0.5 [95% CI: 0.1-1.0], p = 0.004), demonstrating Mediterranean diet feasibility. There was a greater proportion of gastrointestinal symptom responders in the Mediterranean diet group than controls (24/29, 83% vs. 11/30, 37%, p < 0.001) and depression responders (15/29, 52% vs. 6/30 20%, p = 0.015). There was no difference in FODMAP intake at week 6 (p = 0.51). Gastrointestinal adverse events were similar (p = 0.588). There were no differences in change in microbiome parameters between groups.

CONCLUSIONS

A Mediterranean diet is feasible in IBS and leads to improvement in gastrointestinal and psychological symptoms. Although this study was unblinded, these findings together with the broader benefits of the Mediterranean diet, provide strong impetus for future research in IBS. Australia New Zealand Clinical Trials Registry: ACTRN12620001362987.

The Association Between a Mediterranean Diet and Symptoms of Irritable Bowel Syndrome

BACKGROUND & AIMS

Low adherence to Mediterranean diet (MD) has been shown to be associated with a higher prevalence of irritable bowel syndrome (IBS), but its association with IBS symptoms is not established. We aim to assess the association between MD and IBS symptoms, identify components of MD associated with IBS symptoms, and determine if a symptom-modified MD is associated with changes in the gut microbiome.

METHODS

One hundred and six Rome +IBS and 108 health control participants completed diet history and gastrointestinal symptom questionnaires. Adherence to MD was measured using Alternate Mediterranean Diet and Mediterranean Diet Adherence Screener. Sparse partial least squares analysis identified MD food items associated with IBS symptoms. Stool samples were collected for 16S ribosomal RNA gene sequencing and microbial composition analysis in IBS subjects.

RESULTS

Alternate Mediterranean Diet and Mediterranean Diet Adherence Screener scores were similar between IBS and health control subjects and did not correlate with Irritable Bowel Syndrome Severity Scoring System, abdominal pain, or bloating. Among IBS participants, a higher consumption of fruits, vegetables, sugar, and butter was associated with a greater severity of IBS symptoms. Multivariate analysis identified several MD foods to be associated with increased IBS symptoms. A higher adherence to symptom-modified MD was associated with a lower abundance of potentially harmful Faecalitalea, Streptococcus, and Intestinibacter, and higher abundance of potentially beneficial Holdemanella from the Firmicutes phylum.

CONCLUSIONS

A standard MD was not associated with IBS symptom severity, although certain MD foods were associated with increased IBS symptoms. Our study suggests that standard MD may not be suitable for all patients with IBS and likely needs to be personalized in those with increased symptoms.

Prevalence of functional gastrointestinal disorders in Italian children living in different regions: analysis of the difference and the role of diet

BACKGROUND

Functional Gastrointestinal Disorders (FGIDs) are common in pediatric age.

AIMS

To estimate the prevalence of FGIDs in Italian children and evaluate the impact of diet.

METHODS

Healthy children aged 4-18 years were recruited in a multicenter cross-sectional study. We evaluated their eating habits and the presence of FGIDs, using Rome IV criteria, 3-day food diaries and Mediterranean Diet Quality Index (KIDMED) questionnaires.

RESULTS

Seven hundred forty subjects were enrolled:369 children aged 4-9 years (Group A), and 371 adolescents 10-18 years old (Group B). The overall prevalence of FGIDs was 26.4% in Group A and 26.2% in Group B, with a significant higher prevalence in females in both groups. The most frequent disorders were functional constipation, functional dyspepsia, and abdominal migraine. No significant difference in FGIDs prevalence was found between Northern and Southern Italy, despite significant variation in diet. In Group A there was a significant difference in KIDMED between North and South (5.3 ± 1 vs 6 ± 1.2, respectively; p = 0.001). A significant association between FGIDs and KIDMED was found in Group A (OR=0.83, p = 0.034), but not in Group B (OR=0.89, p = 0.166).

CONCLUSIONS

FGIDs are common in Italian children, with a higher prevalence in females. Despite significant differences in dietary habits between North and South, FGIDs prevalence does not vary significantly.

Examining the Association between Coffee Intake and the Risk of Developing Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis

Irritable bowel syndrome (IBS) is a highly prevalent disorder of brain-gut interaction with a significant impact on quality of life. Coffee is a widely consumed beverage with numerous bioactive compounds that have potential effects on human health and disease states. Current studies on the effect of regular coffee consumption on the risk of developing IBS symptoms have yielded conflicting results. This systematic review and meta-analysis aimed to determine whether coffee intake is associated with developing IBS. A systematic literature search was performed in three electronic databases, namely PubMed, EMBASE, and The Cochrane Library, from inception until 31 March 2023. All original studies reporting associations between coffee intake and IBS were considered for inclusion. Odds ratios (ORs) were calculated for each study, and estimates were pooled, and where appropriate, 95% confidence intervals (95% CI) and p-values were calculated. Eight studies comprising 432,022 patients were included in the final meta-analysis. Using a fixed-effects model, coffee drinkers (any intake) had a reduced likelihood of developing IBS compared to controls, with a pooled OR of 0.84 (95% CI: 0.80 to 0.84). Sensitivity analysis confirmed the stability of the estimates. Future research should prioritise prospective cohort studies that are robust and closely track the development of incident IBS in previously healthy individuals.

Mediterranean diet is associated with better gastrointestinal health and quality of life, and less nutrient deficiency in children/adolescents with disabilities

Background

Children and adolescents with disabilities face various nutritional problems. This study aimed to examine dietary characteristics, nutritional status and problems, gastrointestinal health, and quality of life in children and adolescents with disabilities.

Methods

This study included 5-18 years old children and adolescents (n = 1,991) with disabilities. We used the Mediterranean Diet Quality Index (KIDMED), the Gastrointestinal Symptom Rating Scale (GSRS), and the Pediatric Quality of Life Inventory (PedsQL) to assess diet characteristics, gastrointestinal problems, and life quality. We collected retrospective 24-h food record to assess energy and nutrient intakes.

Results

The rate of stunting in children with disabilities varies between 16.5% and 19.8%. When comparing disability types, more children with physical disabilities were underweight (8.8% vs. 6.7%) and stunted (19.8% vs. 16.5%), while more children with intellectual disabilities were tall (7.9% vs. 5.5%) and overweight/obese (21.1 vs. 17.2%; p < 0.05). Wasting (9.3%) and overweight/obesity (23.8%) were more common in children with disabilities aged 5-7 years (p < 0.001). Eating problems such as loss of appetite, food refusal, food neophobia, and food selectivity were more common in children aged 5-7 years, and problems with fast eating and overeating were more common in adolescents aged 13-18 years (p < 0.05). Among children and adolescents with disabilities, the nutrients with inadequate intakes were vitamin E, vitamin B1, folate, potassium, calcium, and iron, while the nutrients with intakes above the requirements were proteins, carbohydrates, vitamins A, B2, B6, B12, and C, phosphorus, zinc, and sodium. Participants with good Mediterranean diet quality had higher energy and nutrient intakes and higher percentages of meeting nutrient requirements (p < 0.05). KIDMED scores were negatively correlated with GSRS total (r = -0.14, p < 0.001) and subcomponent scores (abdominal pain, diarrhea, reflux, indigestion, and constipation; p < 0.05), and significantly and positively correlated with PedsQL total (r = 0.12, p < 0.001). A one-unit increase in the GSRS score resulted in a 14.4 times decrease in the PedsQL score, and a one-unit increase in the KIDMED score resulted in a 10.8 times increase in the PedsQL score (p = 0.001).

Conclusion

Overweight/obesity, stunting/wasting, nutritional problems, and deficiencies are common among disabled children and adolescents. Mediterranean diet is associated with a better quality of life, and gastrointestinal health in children with disabilities.

Impact of Mediterranean Dietary Education on Symptoms for Adults at Risk for Nonalcoholic Fatty Liver Disease

This 2-month quasi-experimental study focused on the impact of education regarding the Mediterranean diet on symptoms for adults who are at risk for nonalcoholic fatty liver disease (NAFLD). The study was conducted on a sample of 28 adults who presented to Pinnacle clinical research for NAFLD screening via a fibroscan. These individuals who are at risk for NAFLD received a single 15-minute one-on-one in person education regarding the Mediterranean diet. The diet encourages fruits, vegetables, whole grains, legumes, nuts, seeds, fish, and olive oil. The results of the study showed that the Mediterranean diet education was associated with significant improvement of abdominal symptoms ( t = 3.34, p = .03), improvement of fatigue symptoms ( t = 5.88, p < .001), and decrease in hepatic steatosis ( t = 5.77, p < .001). Our study suggests that the education on the Mediterranean diet may be associated with improvement of self-reported abdominal symptoms, fatigue, and steatosis score.

Efficacy of Different Dietary Patterns in the Treatment of Functional Gastrointestinal Disorders in Children and Adolescents: A Systematic Review of Intervention Studies

Functional gastrointestinal disorders (FGIDs) are common in children and adolescents. In recent years, interest in the role of diet in the treatment of FGIDs has increased. Currently, interest focuses on the low-FODMAP diet (LFD), the fructose- or lactose-restricted diet (FRD or LRD), the gluten-free diet (GFD), and the Mediterranean diet (MD). In this review, we focus on the role of these dietary patterns in the FGIDs most commonly diagnosed in clinical practice, namely irritable bowel syndrome (IBS), functional abdominal pain (FAP), functional dyspepsia (FD), and functional constipation (FC). Fifteen clinical trials were systematically reviewed (both RCTs and single-arm clinical trials). We demonstrated the lack of high-quality intervention trials. Based on current evidence, low-FODMAP diet, LRD, FRD, and GFD have no place in daily clinical practice for the management of children and adolescents with FGIDs. Nevertheless, some patients with IBS or RAP may experience some benefit from the use of a low-FODMAP diet or FRD/LRD. Limited data suggest that MD may be promising in the management of FGIDs, especially in IBS patients, but more data are required to investigate the mechanisms of its protective effects.

The Mediterranean Diet in Paediatric Gastrointestinal Disorders

The Mediterranean diet is considered one of the healthiest dietary patterns worldwide, thanks to a combination of foods rich mainly in antioxidants and anti-inflammatory nutrients. Many studies have demonstrated a strong relationship between the Mediterranean diet and some chronic gastrointestinal diseases. The aim of this narrative review was to analyse the role of the Mediterranean diet in several gastrointestinal diseases, so as to give a useful overview on its effectiveness in the prevention and management of these disorders.

Mediterranean Diet in Developmental Age: A Narrative Review of Current Evidences and Research Gaps

Numerous studies in recent decades have shown that Mediterranean diet (MD) can reduce the risk of developing obesity in pediatric patients. The current narrative review summarizes recent evidence regarding the impact of MD across the different stages of child development, starting from fetal development, analyzing breastfeeding and weaning, through childhood up to adolescence, highlighting the gaps in knowledge for each age group. A literature search covering evidence published between 1 January 2000 and 1 March 2022 and concerning children only was conducted using multiple keywords and standardized terminology in PubMed database. A lack of scientific evidence about MD adherence concerns the age group undergoing weaning, thus between 6 months and one year of life. In the other age groups, adherence to MD and its beneficial effects in terms of obesity prevention has been extensively investigated, however, there are still few studies that correlate this dietary style with the incidence of non-communicable diseases. Furthermore, research on multi-intervention strategy should be implemented, especially regarding the role of education of children and families in taking up this healthy dietary style.

Diet and Pediatric Functional Gastrointestinal Disorders in Mediterranean Countries

Background: The increased intake of FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyol) rich foods has been suggested as a possible trigger of functional gastrointestinal disorders (FGIDs). Despite the high FODMAP content, the Mediterranean diet (MD) appears to have beneficial effects on health. Our aim was to evaluate whether the prevalence of FGIDs in different Mediterranean countries may be influenced by FODMAP consumption and adherence to the MD. Methods: A school-based, cross-sectional, multicenter study was performed in six countries in the Mediterranean area: Croatia, Greece, Israel, Italy, Macedonia, and Serbia. Subjects 4-18 years were examined in relation to their eating habits and the presence of FGIDs, using Rome IV criteria, 3-day food diaries and Mediterranean Diet Quality Index in Children and Adolescents (KIDMED) questionnaires. Results: We enrolled 1972 subjects between 4 and 9 years old (Group A), and 2450 subjects between 10 and 18 years old (Group B). The overall prevalence of FGIDs was 16% in Group A and 26% in Group B. FODMAP intake was significantly different among countries for both age groups. In both groups, no significant association was found between FGIDs and FODMAPs. Adherence to the MD in all countries was intermediate, except for Serbia, where it was low. In both groups, we found a statistically significant association between FGIDs and the KIDMED score (Group A: OR = 0.83, p < 0.001; Group B: OR = 0.93, p = 0.005). Moreover, a significant association was found between the KIDMED score and functional constipation (Group A: OR = 0.89, p = 0.008; Group B: OR = 0.93, p = 0.010) and postprandial distress syndrome (Group A: OR = 0.86, p = 0.027; Group B: OR = 0.88, p = 0.004). Conclusions: Our data suggest that the prevalence of FGIDs in the Mediterranean area is not related to FODMAP consumption, whereas adherence to the MD seems to have a protective effect.

Evidence-Based and Emerging Dietary Approaches to Upper Disorders of Gut-Brain Interaction

Food ingestion is a major symptom trigger in functional esophageal and gastroduodenal disorders and gastroparesis. This review summarizes current knowledge and identifies areas of research on the role of food factors and the opportunities for dietary intervention in these disorders. While many patients experiencing functional esophageal and gastroduodenal disorders identify specific food items as symptom triggers, available data do not allow the identification of specific nutrient groups that are more likely to induce symptoms. In functional dyspepsia (FD), recent studies have shown the potential efficacy of a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, although the underlying mechanism of action is unclear. Reports of favorable responses to gluten elimination in patients with FD are confounded by the concomitant benefit of reduced intake of fructans, fermentable oligosaccharides, disaccharides, monosaccharides, and polyols present in wheat. Emerging data based on a 6-food elimination diet and confocal laser endomicroscopic evaluation of mucosal responses to food proteins suggest a role for duodenal allergic reactions in FD symptom generation. In patients with gastroparesis, a low-residue diet has been shown to improve symptoms. Novel dietary approaches under evaluation are the Mediterranean diet and the heating/cooling diet approach.

Pediatric Functional Abdominal Pain Disorders following COVID-19

BACKGROUND

Functional abdominal pain disorders (FAPD) are a group of functional gastrointestinal disorders with multifactorial etiology and are subclassified using Rome IV criteria into a series of clinically distinct entities represented by irritable bowel syndrome, functional dyspepsia, abdominal migraine and functional abdominal pain that is not otherwise specified. Digestive functional disorders associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may be mediated by the involvement of complex pathogenic mechanisms, which have been under investigation in children since the beginning of the coronavirus disease pandemic (COVID-19).

METHODS

In this retrospective, observational descriptive and analytical study, we investigated the presence of chronical functional abdominal pain in preschool children (4-6 years old) from the south-west of Romania in the pre-pandemic (18 cases) and COVID-19 pandemic period (34 cases), as well as the association with the COVID-19 positive and COVID-19 negative statuses, gender, environment origin, and viral infection-associated symptoms. Age-specific Rome IV criteria were used to diagnose functional abdominal pain. We performed an integrated statistical analysis of the results utilizing an electronic database in which we compared the data in order to assess the impact of COVID-19 on the clinical-epidemiological parameters analyzed.

RESULTS

In the pre-pandemic group, irritable bowel syndrome predominated (77.8%), followed by functional dyspepsia (22.2%), the other types of functional abdominal pain being absent, while for the pandemic group, irritable bowel syndrome was the most common (79.4%), followed by abdominal migraine (11.8%), abdominal dyspepsia (5.9%) and functional abdominal pain not otherwise specified (2.9%). We found a female/male ratio difference of 0.84 and an urban/rural ratio of 1.83 in favor of the pandemic group. These discrepancies were mainly caused by the differences between the COVID-19 positive and negative pandemic groups, where we observed statistical association of the positive pandemic group with IBS and urban environment, and a tendency of FAPDs diagnostic mainly with males. The predominant symptoms associated with COVID-19 positive cases were digestive (60.9%) or respiratory (39.1%).

CONCLUSIONS

Our study demonstrates viral-mediated sensitivity of the gastrointestinal tract in preschool children, considering different clinical-epidemiological profiles related to the prevalence of FAPD and according to gender and environment origin, while the contribution of the pandemic context remains to be demonstrated in larger studies.

Constipation: Prevalence in the Portuguese community using Rome IV-Associated factors, toilet behaviours and healthcare seeking

Background

Chronic constipation (CC) is a major public health condition and CC management remains challenging.

Objective

We aimed to evaluate the CC (and subtypes) prevalence in a Southern Europe Mediterranean country using Rome IV criteria, and to assess related factors, toilet and healthcare seeking behaviours.

Methods

Cross‐sectional epidemiological survey, conducted in general community and representing the Portuguese population according to sex and age. The questionnaire covered bowel habits, factors potentially associated with CC (demographic, health/lifestyle, toilet behaviours) and data regarding healthcare seeking.

Results

From the study data of 1950 individuals were analyzed. The answer rate was 68% and 1335 questionnaires were available for calculation. The CC prevalence was 17.8%, with respectively 9.3% of Functional Constipation (FC) and 8.5% of Irritable Bowel Syndrome – subtype constipation (IBS‐C). The likelihood of constipation was significantly higher in younger (OR 1.01; 95% confidence interval [CI], 1.007–1.031), solo (OR 2.48; 95% CI, 1.7–3.47) and low‐income (OR 2.40; 95% CI, 1.77–3.47) individuals. Constipated individuals spent more time at defecation, longer than 5 min (p = 0.001), and had particular toilet behaviours (absence of a morning pattern [p = 0.008], the use of triggers [p = 0.001] and reading/technological material [p = 0.006]) to facilitate the evacuation. Only 39% of affected individuals sought medical advice, mainly IBS‐C patients (p = 0.018).

Conclusion

Chronic constipation seems to impact 1 in each 5 Portuguese. Constipated patients are younger, solo, less active and with low income. They develop a clear toilet behaviour profile. FC and IBS‐C patients assume particular behaviours.

Is there an association between necrotizing enterocolitis in premature neonates and functional gastrointestinal disorders later in childhood?

BACKGROUND

Stressful events during infancy may predispose to the development of functional gastrointestinal disorders (FGIDs) in childhood.

AIMS

To evaluate the association of necrotizing enterocolitis (NEC) with childhood FGIDs.

METHODS

We conducted a study, comparing 29 children of eight to ten years with a history of NEC with 58 children with no history of NEC. Subjects were assessed for FGIDs, based on Rome-III criteria.

RESULTS

Among 29 subjects with NEC, 17 had surgical and 12 conservative NEC. Subjects with surgically, or conservatively managed NEC developed FGIDs at a significantly higher proportion, as compared to children with no history of NEC, later in childhood (41%, 33%, and 13% respectively, p = 0.033). Functional constipation was the most frequently identified disorder (35%, 33%, and 7% respectively). A significant association was detected between FGIDs and the history of perinatal stress (p = 0.049), NEC (p = 0.011), and the surgical management of NEC (p = 0.015).

CONCLUSIONS

Our study suggests that there is a potential association between NEC and FGIDs later in childhood with functional constipation being the most frequently identified disorder.

Adherence to the Mediterranean Diet Improved Clinical Scores and Inflammatory Markers in Children with Active Inflammatory Bowel Disease: A Randomized Trial

Objective

Methods

Results

Conclusion

Digital Therapeutics Care Utilizing Genetic and Gut Microbiome Signals for the Management of Functional Gastrointestinal Disorders: Results From a Preliminary Retrospective Study

Diet and lifestyle-related illnesses including functional gastrointestinal disorders (FGIDs) and obesity are rapidly emerging health issues worldwide. Research has focused on addressing FGIDs via in-person cognitive-behavioral therapies, diet modulation and pharmaceutical intervention. Yet, there is paucity of research reporting on digital therapeutics care delivering weight loss and reduction of FGID symptom severity, and on modeling FGID status and symptom severity reduction including personalized genomic SNPs and gut microbiome signals. Our aim for this study was to assess how effective a digital therapeutics intervention personalized on genomic SNPs and gut microbiome signals was at reducing symptomatology of FGIDs on individuals that successfully lost body weight. We also aimed at modeling FGID status and FGID symptom severity reduction using demographics, genomic SNPs, and gut microbiome variables. This study sought to train a logistic regression model to differentiate the FGID status of subjects enrolled in a digital therapeutics care program using demographic, genetic, and baseline microbiome data. We also trained linear regression models to ascertain changes in FGID symptom severity of subjects at the time of achieving 5% or more of body weight loss compared to baseline. For this we utilized a cohort of 177 adults who reached 5% or more weight loss on the Digbi Health personalized digital care program, who were retrospectively surveyed about changes in symptom severity of their FGIDs and other comorbidities before and after the program. Gut microbiome taxa and demographics were the strongest predictors of FGID status. The digital therapeutics program implemented, reduced the summative severity of symptoms for 89.42% (93/104) of users who reported FGIDs. Reduction in summative FGID symptom severity and IBS symptom severity were best modeled by a mixture of genomic and microbiome predictors, whereas reduction in diarrhea and constipation symptom severity were best modeled by microbiome predictors only. This preliminary retrospective study generated diagnostic models for FGID status as well as therapeutic models for reduction of FGID symptom severity. Moreover, these therapeutic models generate testable hypotheses for associations of a number of biomarkers in the prognosis of FGIDs symptomatology.

Early nutritional influences of cardiovascular health

INTRODUCTION

Increasing evidence shows that nutritional choices during children's formative years, including prenatally, impacts the development of adult onset cardiovascular diseases (CVDs), such as hypertension, myocardial infarction, or stroke.

AREAS COVERED

This literature review aims to synthesize the current body of evidence on nutritional factors, from conception through adolescence, which may influence a person's risk factors for future development of CVD.

EXPERT OPINION

Given the escalating healthcare costs associated with CVD, it is imperative that medical professionals and scientists remain steadfast in prioritizing and promoting early CVD prevention, even within the first few years of life. Though not the only contributing risk factor, diet is a modifiable risk factor and has been shown to have a profound impact on the reduction of cardiovascular morbidity and mortality in adult literature. Nutritional choices should be targeted on multiple levels: prenatally with the mother, individually with the patient, in conjunction with their family unit, and also within the broader community wherein they reside. Healthcare providers can play a key advocacy role for local and national food environment policy changes.

Dietary habits in Greek children with functional constipation based on Rome III criteria: a school-based, cross-sectional multivariate analysis

Background

Functional constipation (FC) is the most common gastrointestinal disorder of childhood and has a multifactorial etiology. We aimed to assess dietary habits in Greek children with FC compared to the general population (control group, CG).

Methods

This was a subgroup analysis of a school-based, cross-sectional study carried out in children 6-18 years of age, between January and June 2014, using the Rome III criteria for the diagnosis of FC. Dietary parameters, as well as socioeconomic and demographic data and their association with the likelihood of FC, were analyzed through multivariate logistic regression analysis and expressed as odds ratios (OR).

Results

A total of 1439 children (1218 CG, 221 FC) were included in the analysis. The final model showed that consumption of was the only dietary parameter significantly related to FC; higher frequency of consumption was inversely related to the likelihood of FC (OR: 0.98, 95% CI: 0.96, 0.99, P=0.048). Significant socioeconomic confounders with a positive association with FC were: parental educational level, victimization, physical activity and number of adults at home.

Conclusions

Increased frequency of fiber consumption is significantly associated with higher odds of FC irrespective of socioeconomic background and lifestyle parameters. Interventional studies are required to validate these cross-sectional observations.

Global Dietary Patterns and Functional Gastrointestinal Disorders

Functional Gastrointestinal Disorders (FGIDs) are common. In the United States alone, approximately 25 million Americans are estimated to have at least one FGID. Nonpharmacological treatment options include psychological/behavioral approaches, and dietary interventions that can vary across countries. The aim of this review is to evaluate the available evidence for dietary interventions for the treatment of childhood FGIDs amongst various cultures and regions of the world. This review includes clinical trials of dietary therapies for the treatment of FGIDs in children posted on or before 13 July 2020 in PubMed. Overall, the consensus view suggests that the westernization of diets is linked to the development of FGIDs, and diets low in Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAPs) may reduce abdominal symptoms. However, more work is needed to confirm these findings.

Prevalence of Functional Gastrointestinal Disorders in European Infants and Toddlers

OBJECTIVE

To assess the prevalence of functional gastrointestinal disorders (FGIDs) in young children in a cross-sectional, multicenter study in Belgium, Italy, and The Netherlands.

STUDY DESIGN

Children were enrolled if they were age 0-48 months, attending a general pediatrician (Belgium, Italy) or a well-baby clinic (The Netherlands) for routine follow-up. Separate questionnaires were developed for infants age 0-12 months and for toddlers age 13-48 months. Questionnaires evaluated the clinical history, symptoms, sociodemographic information on the family, and exposure to stressful life events. FGIDs were defined according to Rome IV criteria.

RESULTS

In total 2751 children were included: 1698 infants age 0-12 months and 1053 children age 13-48 months. The prevalence of any FGID in infants age 0-12 months and 13-48 months was 24.7% and 11.3%, respectively. The most common disorders were infant regurgitation (13.8%) in infants and functional constipation (9.6%) in toddlers. Multivariable regression analyses demonstrated that younger age (P = .030) and formula feeding (P = .045) were associated with the prevalence of any FGID among infants. Country (Italy) (P = .033) and parents subjected to domestic violence (P = .035) were associated with the prevalence of any FGID in toddlers age 13-48 months.

CONCLUSIONS

FGIDs are common in a community sample of Western European infants and toddlers. Regurgitation is most prevalent in infants and functional constipation is most common in toddlers. Younger age, formula feeding, and domestic violence to parents are associated with the prevalence of FGIDs.