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Smiliotopoulos T, Zampelas A, Houliaras G, Sgouros SN, Michas G, Bamias G, Panagiotakos D, Cholopoulos N, Chrousos GP, Roma E, Magriplis E. Association of fructose consumption with prevalence of functional gastrointestinal disorders manifestations: results from Hellenic National Nutrition and Health Survey (HNNHS). Br J Nutr 2023; 130:1961-1972. [PMID: 37197939 PMCID: PMC10630147 DOI: 10.1017/s0007114523001198] [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: 11/22/2022] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Abstract
The study aimed to assess the total prevalence of functional gastrointestinal disorders (FGID), and separately, irritable bowel syndrome (IBS) among adults and to determine their potential association with fructose consumption. Data from the Hellenic National Nutrition and Health Survey were included (3798 adults; 58·9 % females). Information regarding FGID symptomatology was assessed using self-reported physician diagnosis questionnaires the reliability of which were screened using the ROME III, in a sample of the population. Fructose intake was estimated from 24 h recalls, and the MedDiet score was used to assess adherence to the Mediterranean diet. The prevalence of FGID symptomatology was 20·2 %, while 8·2 % had IBS (representing 40·2 % of total FGID). The likelihood of FGID was 28 % higher (95 %CI: 1·03-1·6) and of IBS 49 % (95 %CI: 1·08-2·05) in individuals with higher fructose intake than with lower intake (3rd tertile compared with 1st). When area of residence was accounted for, individuals residing in the Greek islands had a significantly lower probability of FGID and IBS compared with those residing in Mainland and the main Metropolitan areas, with Islanders also achieving a higher MedDiet score and lower added sugar intake, comparatively to inhabitants of the main metropolitan areas. FGID and IBS symptomatology was most prominent among individuals with higher fructose consumption, and this was most conspicuous in areas with a lower Mediterranean diet adherence, suggesting that the dietary source of fructose rather than total fructose should be examined in relation to FGID.
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Affiliation(s)
- Theodoros Smiliotopoulos
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, 11855Athens, Greece
| | - Antonis Zampelas
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, 11855Athens, Greece
| | - George Houliaras
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, 11527Athens, Greece
| | - Spiros N. Sgouros
- Department of Gastroenterology, Athens Naval Hospital, 7011528Athens, Greece
| | - George Michas
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, 11855Athens, Greece
| | - George Bamias
- Department of Gastroenterology, Athens Naval Hospital, 7011528Athens, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education Harokopio University, 17676Athens, Greece
| | - Nikolaos Cholopoulos
- Department of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124Thessaloniki, Greece
| | - George P. Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair on Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, 11527Athens, Greece
| | - Eleftheria Roma
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, 11527Athens, Greece
| | - Emmanuella Magriplis
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, 11855Athens, Greece
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Cordeiro Santos ML, da Silva Júnior RT, de Brito BB, França da Silva FA, Santos Marques H, Lima de Souza Gonçalves V, Costa dos Santos T, Ladeia Cirne C, Silva NOE, Oliveira MV, de Melo FF. Non-pharmacological management of pediatric functional abdominal pain disorders: Current evidence and future perspectives. World J Clin Pediatr 2022; 11:105-119. [PMID: 35433299 PMCID: PMC8985495 DOI: 10.5409/wjcp.v11.i2.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/19/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
Functional abdominal pain disorders (FAPDs) are an important and prevalent cause of functional gastrointestinal disorders among children, encompassing the diagnoses of functional dyspepsia, irritable bowel syndrome, abdominal migraine, and the one not previously present in Rome III, functional abdominal pain not otherwise specified. In the absence of sufficiently effective and safe pharmacological treatments for this public problem, non-pharmacological therapies emerge as a viable means of treating these patients, avoiding not only possible side effects, but also unnecessary prescription, since many of the pharmacological treatments prescribed do not have good efficacy when compared to placebo. Thus, the present study provides a review of current and relevant evidence on non-pharmacological management of FAPDs, covering the most commonly indicated treatments, from cognitive behavioral therapy to meditation, acupuncture, yoga, massage, spinal manipulation, moxibustion, and physical activities. In addition, this article also analyzes the quality of publications in the area, assessing whether it is possible to state if non-pharmacological therapies are viable, safe, and sufficiently well-based for an appropriate and effective prescription of these treatments. Finally, it is possible to observe an increase not only in the number of publications on the non-pharmacological treatments for FAPDs in recent years, but also an increase in the quality of these publications. Finally, the sample selection of satisfactory age groups in these studies enables the formulation of specific guidelines for this age group, thus avoiding the need for adaptation of prescriptions initially made for adults, but for children use.
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Affiliation(s)
- Maria Luísa Cordeiro Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Breno Bittencourt de Brito
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Hanna Santos Marques
- Campus Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45083-900, Bahia, Brazil
| | | | - Talita Costa dos Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Carolina Ladeia Cirne
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Natália Oliveira e Silva
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Márcio Vasconcelos Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
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Rallis D, Saliakellis E, Kaselas C, Malakozi M, Spyridakis I, Fotoulaki M, Diamanti E, Tsakalidis C. Is there an association between necrotizing enterocolitis in premature neonates and functional gastrointestinal disorders later in childhood? Neurogastroenterol Motil 2022; 34:e14222. [PMID: 34468064 DOI: 10.1111/nmo.14222] [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] [Received: 04/14/2021] [Revised: 06/15/2021] [Accepted: 07/07/2021] [Indexed: 02/08/2023]
Abstract
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.
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Affiliation(s)
- Dimitrios Rallis
- 2nd Neonatal Intensive Care Unit and Neonatology Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efstratios Saliakellis
- Department of Paediatrics and Paediatric Gastroenterology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Kaselas
- Department of Paediatric Surgery, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marina Malakozi
- 2nd Neonatal Intensive Care Unit and Neonatology Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Spyridakis
- Department of Paediatric Surgery, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Fotoulaki
- Department of Paediatrics and Paediatric Gastroenterology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elisavet Diamanti
- 2nd Neonatal Intensive Care Unit and Neonatology Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Tsakalidis
- 2nd Neonatal Intensive Care Unit and Neonatology Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Chouliaras GL, Krepis P, Bouzios I, Zellos A, Chrousos G, Roma-Giannikou E. Dietary habits in Greek children with functional constipation based on Rome III criteria: a school-based, cross-sectional multivariate analysis. Ann Gastroenterol 2021; 34:528-534. [PMID: 34276192 PMCID: PMC8276364 DOI: 10.20524/aog.2021.0626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/09/2021] [Indexed: 11/11/2022] Open
Abstract
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.
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Affiliation(s)
- Giorgos L Chouliaras
- 2nd Department of Pediatrics, University of Athens, "P & Ag. Kyriakou" Children's Hospital (Giorgos L. Chouliaras, Panagiotis Krepis)
| | - Panagiotis Krepis
- 2nd Department of Pediatrics, University of Athens, "P & Ag. Kyriakou" Children's Hospital (Giorgos L. Chouliaras, Panagiotis Krepis)
| | - Ilias Bouzios
- 1st Department of Pediatrics, University of Athens, "Aghia Sophia" Children's Hospital (Ilias Bouzios, Aglaia Zellos, George Chrousos, Eleftheria Roma-Giannikou), Athens, Greece
| | - Aglaia Zellos
- 1st Department of Pediatrics, University of Athens, "Aghia Sophia" Children's Hospital (Ilias Bouzios, Aglaia Zellos, George Chrousos, Eleftheria Roma-Giannikou), Athens, Greece
| | - George Chrousos
- 1st Department of Pediatrics, University of Athens, "Aghia Sophia" Children's Hospital (Ilias Bouzios, Aglaia Zellos, George Chrousos, Eleftheria Roma-Giannikou), Athens, Greece
| | - Eleftheria Roma-Giannikou
- 1st Department of Pediatrics, University of Athens, "Aghia Sophia" Children's Hospital (Ilias Bouzios, Aglaia Zellos, George Chrousos, Eleftheria Roma-Giannikou), Athens, Greece
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Goyal O, Nohria S, Dhaliwal AS, Goyal P, Soni RK, Chhina RS, Sood A. Prevalence, overlap, and risk factors for Rome IV functional gastrointestinal disorders among college students in northern India. Indian J Gastroenterol 2021; 40:144-153. [PMID: 33226570 DOI: 10.1007/s12664-020-01106-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND/PURPOSE There is scarcity of data on prevalence, overlap, and risk factors for functional gastrointestinal disorders (FGID) by Rome IV criteria. We evaluated these factors among medical, nursing, and humanities students. METHODS Rome IV Diagnostic Questionnaire (for all FGIDs), Rome III questionnaire (for irritable bowel syndrome [IBS], functional diarrhea [FDr], and functional constipation [FC]), and questionnaires assessing demography, physical activity, anxiety, and depression were used. RESULTS A total of 1309 college students were included (medical 425, nursing 390, humanities 494; mean age 20.5 ± 2.1 years; 36.5% males). Prevalence of Rome IV FGIDs was 26.9% (n = 352), significantly higher among females compared with males (32.3% vs. 17.6%; p < 0.001) and significantly higher among medical (34.4%) and nursing students (29.2%) compared with humanities students (18.6%) (p < 0.05). Most common FGIDs were functional dyspepsia (FD) (15.2%), IBS (6.2%), reflux hypersensitivity (3.5%), FDr (2.9%), FC (2.1%), and unspecified functional bowel disorder (2.1%). FGID overlap was present in 9.3%, most common being FD-IBS overlap (4.4%). With Rome III criteria, prevalence of IBS was higher (9.5%), while that of FDr (0.92%) and of FC (1.3%) were lower. On multivariate analysis, independent predictors for FGIDs were female gender, medical student, non-vegetarian diet, junk food, tea/coffee, poor physical activity, anxiety, and insomnia. CONCLUSION Rome IV FGIDs were present among one-fourth of college students with preponderance among females and medical students. FD, IBS, and reflux hypersensitivity were the most common FGIDs. Rome IV criteria led to a reduction in IBS prevalence and increase in FDr and FC prevalence. Dietary factors, physical activity, anxiety, and insomnia affected FGID prevalence.
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Affiliation(s)
- Omesh Goyal
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India.
| | - Sahil Nohria
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Armaan Singh Dhaliwal
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Prerna Goyal
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Ravinder Kumar Soni
- Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Rajoo Singh Chhina
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Ajit Sood
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
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Axelrod CH, Saps M. Global Dietary Patterns and Functional Gastrointestinal Disorders. CHILDREN-BASEL 2020; 7:children7100152. [PMID: 32992448 PMCID: PMC7601251 DOI: 10.3390/children7100152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 12/01/2022]
Abstract
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.
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Ayonrinde OT, Sanfilippo FM, O'Sullivan TA, Adams LA, Ayonrinde OA, Robinson M, Oddy WH, Olynyk JK. Bowel patterns, gastrointestinal symptoms, and emotional well-being in adolescents: A cohort study. J Gastroenterol Hepatol 2019; 34:1946-1954. [PMID: 31059144 DOI: 10.1111/jgh.14699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/12/2019] [Accepted: 04/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Bowel patterns are varied in the general population. Gastrointestinal symptoms are common reasons for clinical visits. We aimed to examine the usual bowel pattern and the prevalence and significance of gastrointestinal symptoms in a population-based cohort of Australian adolescents. METHODS Seventeen-year-old adolescents (n = 1279) in the Western Australian Pregnancy Cohort (Raine) Study participated in a cross-sectional assessment, involving health questionnaires. Questions included medical history, diet, bowel patterns, and gastrointestinal symptoms. Data were analyzed to identify patterns of bowel motions, gastrointestinal symptoms, and factors associated with these in adolescents. Multivariate logistic regression analysis was used to determine predictors of poorer self-rated health status. RESULTS The dominant pattern of bowel motions was passage of stool that was "not too hard and not too soft" (Bristol stool types 3 and 4) in 90% and occurring between three and seven times per week in 74%. The most prevalent gastrointestinal symptoms included abdominal bloating (72%), abdominal pain (36%), nausea (25%), and constipation (20%). A "Western" dietary pattern was associated with abdominal bloating, constipation, and nausea (P < 0.05). Apart from diarrhea, gastrointestinal symptoms were more prevalent in female adolescents than male adolescents (P < 0.05 for all). Female sex (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.16-3.02, P = 0.01), nausea (OR 3.18, 95% CI 2.03-4.98, P < 0.001), and depression (OR 6.68, 95% CI 3.65-12.22, P = 0.03) were independently associated with poorer self-rated health status, after adjusting for other gastrointestinal symptoms. CONCLUSIONS In adolescents, bowel patterns and gastrointestinal symptoms are diverse and show sex differences. Nausea, depression, and female sex are significant factors for poorer self-rated health.
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Affiliation(s)
- Oyekoya T Ayonrinde
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Perth, Western Australia, Australia.,Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Faculty of Health Sciences, Curtin University, Bentley, Western Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Therese A O'Sullivan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Leon A Adams
- Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Oyedeji A Ayonrinde
- Department of Psychiatry, Queens University, Kingston, Ontario, Canada.,Kingston Health Sciences Centre, Hotel Dieu Hospital, Kingston, Ontario, Canada
| | - Monique Robinson
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Wendy H Oddy
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - John K Olynyk
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Perth, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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