countries and its relation with constipation.

Transcription

1 Fibre intake in children from 5 European countries and its relation with constipation. Veronica Luque on behalf to URV Team 18th November 2012 Milano, 10th Bi-annual Nutrimenthe meeting WG on Anthropometry and Physical Activity

2 Background: definition of functional constipation ROME III criteria ia Infants up to 4 years of age have to fulfil at least 2 of the following criteria for at least 1 month: 1. Two or fewer defecations per week 2. At least 1 episode per week of incontinence after the acquisition of toileting skills 3. History of excessive stool retention 4. History of painful or hard bowel movements 5. Presence of a large faecal mass in the rectum 6. History of large-diameter stools that may obstruct the toilet Hyman et al 2006

3 Background: definitions of fibre Dietary fibre = the indigestible portion of plant foods having two main components Soluble Insoluble Readily fermented in the colon, water absorption Gases & physiologically active products, faeces bulk, fat & sugar absorption Softer stools, CHOL and glucose levels regulation Fermented in the intestine, water absorption faeces bulk, cleaning effect Constipation prevention

4 Background: sources of fibre of Soluble fibre is found in varying quantities in all plant foods, including: Cereals Legumes Fruits and fruit juices Certain vegetables: broccoli, carrots, artichokes, roots, onions. nuts and seeds of insoluble fibre include: Cereals Legumes Fruits and fruit juices nuts and seeds Potato skin Certain vegetables: green beans, cauliflower, zucchini, celery Some fruits: avocado, and unripe bananas. Skins of some fruits including kiwi and tomato

5 Background National surveys of the diets of children in Europe and North America show a decrease in NDC intake Fulgoni VL, Mackey MA. Total dietary fiber in childrenʼs diets. Ann N Y Acad Sci 1991;623: Saldanha LG. Fiber in the diet of US children: results of national surveys. Pediatrics 1995;96: Gregory J, Collins D, Davies P, et al. National diet survey. Report of Diet and Nutrition Survey. London: HMSO; Reduction in fibre intake can be associated with increased intakes of fat- and energy-dense foods and with the prevalence of childhood obesity Nicklas TA, Myers LPH, Berenson GS. Dietary fiber intake of children: the Bogalusa heart study. Pediatrics 1995;96: Kimm SYS. The role of dietary fiber in the development and treatment of childhood obesity. Pediatrics 1995;96: Chinn S, Rona RJ. Prevalence and trends in overweight and obesity in three cross sectional studies of British children BMJ 2001;322:24 6

6 Background: fibre & constipation in children Objective: to evaluate the intake of fibre as a risk factor for chronic constipation. Methods: case-control control study. N= 52 (mean age of 6.8+/-3.2 years) who had chronic constipation + age and gender matched with 52 children with normal intestinal habits. Fibre content of the diet was evaluated with a 24-hour dietary recall. Results: The intake of fibre was less than the minimum recommendation (age + 5 g) and statistically associated (p = 0.001) with the constipation group (75.0%) in comparison with the controls (42.5%). The odds ratio was 4.1 (95% confidence limits, ). Conclusion: Intake of fibre below the minimum recommendation is a risk factor for chronic constipation in children. Morais MB et al. JPGN 1

7 Background Objective: To evaluate dietary fibre intake in children with recurrent abdominal pain. Methods: Cross-sectional study with control group. 41 patients with recurrent abdominal pain were evaluated and 41 children, as a control group. Results: The intake of fibre was lower than the minimum recommended value (age+5 g) and statistically associated (P=0.021) with the recurrent abdominal pain group (78%) in comparison with the control one (51.2%). The odds ratio was 3.39 (95% CI, ). Conclusion: fibre intake below the minimum recommended value is a risk factor for fibre intake below the minimum recommended value is a risk factor for recurrent abdominal pain in children. Paulo AZ et al, Eur J Clin Nutr 2

8 Background 5-8 year old children N = 135 children 76% of children had inadequate fibre content diets (3-day food diaries) 13.6% constipation in those with inadequate fibre intake 6% in those with adequate fibre intake. Glackin LM et al. Ir Med J

9 Background Evaluation of dietary fibre intake from infancy to adolescence against various references: results of the DONALD Study. Methods: day dietary records from 980 infants, children and adolescents aged 6 months to 18 years collected between 1990 and Results: Absolute dietary fibre intakes (g/day) increased with age from infancy to adolescence; dietary fibre density (g/1000 kcal) reached a maximum at 1 year and remained constant after the transition to the family diet. Expressed as g/kg body weight, dietary fibre intake increased during infancy with a maximum at 1 year, but decreased thereafter during childhood and adolescence. Conclusions: As intake of dietary fibre in our sample Alexy was U et significantly al. Eur J Clin Nutr associated with EI and fibre density remained constant after infancy,

10 Aims To describe children fibre intake in 5 European countries (0 8 years). To relate fibre intake to constipation in childhood (2 8 years) To assess the relationship fibre intake-constipation considering the current recommendations for children

11 Methods 3-days food diaries from 4 months to 8 years Constipation questionnaire: 1. Faecal frequency and consistency: Frequency times/ day days/ week Type: [Bristol scale] 2. Has the child been diagnosed of constipation during last year? No Yes If yes, was a physician who diagnosed him/her? No Yes. Please, specify treatment: t t Fibre (legumes, fruits, wholemeal foods) Enema Others Glycerine Suppository Osmotic laxative Was it effective? No Yes

12 Methods: what do we need from fibre? Total Fibre Soluble Fibre Insoluble fibre

13 Methods: what do we have in Nutrcalc? All items in BLS data base have information about soluble and insoluble fibre (g) as 2 separate variables Total fibre = soluble + insoluble fibre

14 Methods New items locally included. Food items Recipes Food item 1 Food item 2 Food item 3 Food item 4 Food items which soluble and insoluble parts are not recorded: per protocol: 1. Introduce the total amount in the insoluble fibre box 2. Introduce 1 in soluble fibre box

15 Methods: Examples of new items locally introduced 1. Locally introduced simple food items: 1.11 Commercial products 1.2 Or products from a local data base

16 Methods: Examples of new items locally introduced 2. Locally introduced recipes: 2.1 Made of only BLS food items 2.2

17 Methods: Examples of new items locally introduced 2. Locally introduced recipes: 2.1 Made of only BLS food items 2.2 Made of locally introduced food items (and BLS as well or not)

18 Methods New items locally included. 1. Simple food items which composition can be easily identified and calculated 2. Recipes which composition is correct 3. Recipes which composition is not correct, have to be identified and re-calculated

19 Methods: strategy to complete missing SOPs information 1. Locally introduced simple food items Same or similar product in BLS DB YES NO To assume the composition of the German item To assume the mean value for the food subgroup from BLS Food composition data

20 Methods: strategy to complete missing SOPs information Assumption for simple food items is made 3. Recipes which composition is not correct To apply new food composition of local simple food items to the recipes that combine local and BLS food items

21 Methods: what do we have in Nutrcalc? Are there food items which proportion of soluble / insoluble fibre was unknown? Do the BLS DB established a fixed % of soluble & insoluble fibre for some or all food items?

22 Next steps: 1. There is a paediatrician granted still for 1.5y that could carry on this work (besides the clinical practice). 2. Could Veit provide (in SPSS format): 1. List of all locally introduced food items and recipes 2. Composition of BLS simple food items 3. Composition of BLS Subgroups 3. To check all local simple food items and recipes with the help of the 5 countries dieticians i (translation, ti description of recipes and correct classification in food subgroups) 4. To protocol which composition should be applied to each food item 5. To return Veit the SPSS list of locally introduced food items with new variables completed (variables to be defined)

23 Thank you!