Use of fibers in childhood constipation treatment: systematic review with meta-analysis

Mello, Patrícia Piccoli de; Eifer, Diego André; Mello, Elza Daniel de

doi:10.1016/j.jped.2017.10.014

Cited by 39 publications

(24 citation statements)

References 28 publications

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“…The European and North American Societies for Paediatric Gastroenterology Hepatology and Nutrition consensuses recommend a normal fibre intake for children and adolescents with constipation 27. A 2018 systematic review and meta-analysis that included five of the six trials reported by NICE8–10 12 13 and four additional trials28–31 concluded ‘ there is no scientific evidence to corroborate the prescription of fiber supplementation in the diet of constipated children as part of the treatment of this condition ’ 32. If a low-fibre diet caused childhood constipation, then a diet high in fibre or added fibre should effectively treat constipation, rather than having ‘ no or little effect ’ 4…”

Section: Discussionmentioning

confidence: 99%

Challenging the view that lack of fibre causes childhood constipation

et al. 2020

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ObjectivesTo assess evidence supporting the view that ‘low fibre causes childhood constipation’.DesignTriangulation integrated three approaches: a systematic review NICE guideline CG99 examining effectiveness of increasing fibre; a cohort study, Avon Longitudinal Study of Parents and Children (ALSPAC), to assess if constipation (or hard stools) can precede fibre intake at weaning; and a literature search for twin studies to calculate heredity.SettingCG99 examined the literature regarding the effectiveness of increasing fibre. ALSPAC asked parents about: hard stools at 4 weeks, 6 months and 2.5 years and constipation at age 4–10 years, as well as fibre intake at 2 years. Twin studies and data from ALSPAC were pooled to calculate concordance of constipation comparing monozygotic and dizygous twin pairs.ParticipantsCG99 reported six randomised controlled trials (RCTs). ALSPAC hard stool data from 6796 children at 4 weeks, 9828 at 6 months and 9452 at 2.5 years plus constipation data on 8401 at 4–10 years were compared with fibre intake at 2 years. Twin studies had 338 and 93 twin pairs and ALSPAC added a further 45.ResultsIncreasing fibre did not effectively treat constipation. Hard stools at 4 weeks predated fibre and at 6 months predicted lower fibre intake at 2 years (p=0.003). Heredity explained 59% of constipation.ConclusionsRCTs indicate that increasing fibre is not an effective treatment for constipation in children. Hard stools can precede and predict later fibre intake. Genetic inheritance explains most childhood constipation. Extended treatment with stool softeners may improve fibre intake and limit long-term damaging sequelae of constipation.

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Section: Discussionmentioning

confidence: 99%

Challenging the view that lack of fibre causes childhood constipation

et al. 2020

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“…Through a random sample of US children, it was determined that most toddlers and preschoolers consume a low-intake of dietary fiber [ 52 ]. Anecdotal evidence suggests that children who do not consume enough fiber experience more constipation, but the role of supplemental fiber in treating FC, remains controversial [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

The Role of Fiber in the Treatment of Functional Gastrointestinal Disorders in Children

Axelrod

Saps

2018

Nutrients

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We reviewed the available evidence on the role of fiber in the treatment of Functional Constipation (FC) and Irritable Bowel Syndrome (IBS) in children. The vast majority of toddlers and preschoolers do not consume enough fiber. Two of the most common reasons for consultation to a pediatric gastroenterology practice include FC and IBS. The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines state that the evidence does not support the use of fiber supplements in the treatment of FC in children, and the Rome IV criteria do not recommend an increase in fiber consumption, in children with IBS. Despite this, in general practice, it is commonly recommended that children who experience constipation and IBS to increase their fiber intake. We conducted a systematic review of the available evidence on the role of fiber in the treatment of FC and IBS in children. Thirteen full-text articles with a total of seven hundred and twenty-three pediatric participants were included in this review. Three clinical trials found positive effects of dietary fiber for the management of IBS. Nine out of ten trials found fiber to be either more effective than placebo, or just as effective as laxative treatment. Most studies on the use of fiber for the treatment of FC and IBS have shown its benefit. However, due to the heterogeneity in study design, length of treatment, outcome measures, and amount and type of fiber, we were unable to make a definitive recommendation supporting the use of fiber for the treatment of FC and IBS in children.

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“…Disappointingly, however, no significant benefit has been demonstrated in terms of reduction in laxative use or increased stool frequency associated with additional fiber intake in children. Moreover, a recent systematic review including 680 children with FC showed no significant improvement after additional fiber intake with respect to defecation parameters, fecal incontinence episodes, abdominal pain, and treatment success [35]. The studies were of low quality and the methods used varied considerably with different definitions of constipation, different fibers, and different outcome measures.…”

Section: Fibersmentioning

confidence: 99%

Controversies in the Management of Functional Constipation in Children

Mill

Koppen

Benninga

2019

Curr Gastroenterol Rep

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Purpose of review Functional constipation (FC) in children is a common health problem with reported worldwide prevalence rates up to 32.2%. The majority of children with constipation respond to oral laxative treatment. After 5 years of intensive treatment, however, approximately 50% of children remain symptomatic. To discuss the evidence for new treatments in these children, including pre-and probiotics, pelvic physiotherapy, prucalopride, sacral nerve stimulation, and surgery, and to highlight the controversies surrounding them. Recent findings Pre-and probiotics and prucalopride are not effective in the treatment of childhood constipation. Pelvic physiotherapy and sacral nerve stimulation are promising treatment options but larger trials are needed. Surgery for pediatric constipation is the treatment of last resort. Summary Large, well-designed placebo-controlled trials with proper outcome measures, as suggested by the Rome foundation pediatric subcommittee on clinical trials, are necessary to provide more insight regarding the efficacy of new treatments in childhood constipation.

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Use of fibers in childhood constipation treatment: systematic review with meta-analysis

Cited by 39 publications

References 28 publications

Challenging the view that lack of fibre causes childhood constipation

Challenging the view that lack of fibre causes childhood constipation

The Role of Fiber in the Treatment of Functional Gastrointestinal Disorders in Children

Controversies in the Management of Functional Constipation in Children

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