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

European Journal of Clinical Nutrition (2024)Cite this article

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Abstract

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.

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Fig. 1: Metabolic, inflammatory, and symptom responses to dietary fiber fermentation.
Fig. 2: Mean total dietary fiber intake of children and adolescents based on age and sex in the United States and Canada.
Fig. 3: Approaches to attenuate gastrointestinal symptoms associated with high-fiber intake.

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Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

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Funding

We thank our funders, The Weston Family Microbiome Initiative for their continued support for our research. We thank our donors Invovo Biologic Inc. (RES0056385) and the Alberta Diabetes Foundation: Defeating Diabetes (RES0059938) for their generous funding and ongoing support for our research. NB was a recipient of the Alberta Diabetes Institute Graduate Studentship from 2022-2023 and the 2023 TD Bank Financial Group Grant for Health Sciences Interdisciplinary Research Fund Award.

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Author notes

  1. These authors contributed equally: Nandini Basuray, Edward C. Deehan.

Authors and Affiliations

  1. Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada

    Nandini Basuray, Flávio T. Vieira, Catherine J. Field & Andrea M. Haqq

  2. Department of Food Science and Technology, University of Nebraska, Lincoln, NE, USA

    Edward C. Deehan

  3. Nebraska Food for Health Center, Lincoln, NE, USA

    Edward C. Deehan

  4. Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

    Flávio T. Vieira, Hayford M. Avedzi, Reena L. Duke, Eytan Wine & Andrea M. Haqq

  5. School of Sport Sciences, Universidad Anahuac Mexico, Huixquilucan, Mexico

    Eloisa Colín-Ramírez

  6. JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China

    Hein M. Tun

  7. College of Ocean Food and Biological Engineering, Jimei University, Xiamen, Fujian, China

    Zhengxiao Zhang

  8. Department of Medicine, University of Alberta, Edmonton, AB, Canada

    Karen L. Madsen

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Contributions

NB and ECD have contributed equally to writing the manuscript. FTV, HMA, ECR, RLD, HMT, ZZ, EW, KLM, CJF, and AMH revised the manuscript and approve the final version.

Corresponding author

Correspondence to Andrea M. Haqq.

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Competing interests

AMH is on advisory boards for Rhythm Pharmaceuticals, Novo Nordisk Canada, and Pfizer Canada. She is a clinical trial investigator for Rhythm Pharmaceuticals, Levo Therapeutics, and Eli Lilly. NB, ECD, FTV, HMA, ECR, RLD, HMT, ZZ, EW, KLM, and CJF – no conflicts of interest.

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Basuray, N., Deehan, E.C., Vieira, F.T. et al. Dichotomous effect of dietary fiber in pediatrics: a narrative review of the health benefits and tolerance of fiber. Eur J Clin Nutr (2024). https://doi.org/10.1038/s41430-024-01429-5

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