Abstract
Background
Studies have reported the relationship between functional constipation and obesity in pediatric population. However, the results are contradictory. The purpose of this study is to evaluate the possible association between these two disorders in pediatric population.
Methods
Four databases including PubMed, Embase, CENTRAL, and Web of Science were searched until 30 September 2022. The review was done in accordance with PRISMA guidelines and registered in PROSPERO (CRD42022328992)
Results
Nine studies met the eligibility criteria, including 7444 participants. Studies showed the risk of obesity was significantly increased in boys with functional constipation (CI: 1.12, 3.07; P = 0.016). Such an association was also observed in girls (CI: 1.42–4.47; P = 0.00). A statistically significant association was observed between overweight/obesity and increased risk of functional constipation in children and adolescents (CI: 1.14–3.97; P = 0.02). Especially in developed countries (CI: 1.49–3.46; P = 0.00); however, no significant association was observed in developing countries (CI: 0.81–5.3; P = 0.13).
Conclusions
There is a risk of obesity in either boys or girls with functional constipation. An association exists between the risk of functional constipation and children/adolescents with obesity, especially in developed countries, but not in developing countries.
Impact
-
Our study encourages further research in this field because early detection and intervention are crucial for both functional constipation and overweight/obesity in children, to better identify its complex biology and possibly optimize the treatment approaches.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 14 print issues and online access
$259.00 per year
only $18.50 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Tabbers, M. & Benninga, M. Constipation in children: fibre and probiotics. BMJ Clin. Evid. 0303, 2015 (2015).
Chien, L.-Y., Liou, Y. M. & Chang, P. Low defaecation frequency in Taiwanese adolescents: association with dietary intake, physical activity and sedentary behaviour. J. Paediatr. Child Health 47, 381–386 (2011).
Van der Berg, M. M., Benninga, M. A. & Di Lorenzo, C. Epidemiology of childhood constipation: a systematic review. Am. J. Gastroenterol. 101, 2401–2409 (2006).
Mugie, S. M., Benninga, M. A. & Di Lorenzo, C. Epidemiology of constipation in children and adults: a systematic review. Best. Pr. Res Clin. Gastroenterol. 25, 3–18 (2011).
Koppen, I. J. N. et al. Prevalence of functional defecation disorders in children: a systematic review and meta-analysis. J. Pediatr. 198, 121–130.e6 (2018).
Van Mill, M. J., Koppen, I. J. N. & Benninga, M. A. Controversies in the management of functional constipation in children. Curr. Gastroenterol. Rep. 21, 23 (2019).
Suares, N. C. & Ford, A. C. Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis. Am. J. Gastroenterol. 106, 1582–1592 (2011).
Drossman, D. A. Functional gastrointestinal disorders: history, pathophysiology, clinical features, and Rome IV. Gastroenterology 150, 1262–1279 (2016).
Tsai, C. J., Leitzmann, M. F., Willett, W. C. & Giovannucci, E. L. Prospective study of abdominal adiposity and gallstone disease in US men. Am. J. Clin. Nutr. 80, 38–44 (2004). Jul.
GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N. Engl. J. Med. 377, 13–27 (2017).
Gibson, L. Y. et al. The psychosocial burden of childhood overweight and obesity: evidence for persisting difficulties in boys and girls. Eur. J. Pediatr. 176, 925–933 (2017).
Swinburn, B. A. et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet 378, 804–814 (2011).
Koppen, I. J. et al. Functional defecation disorders and excessive body weight: a systematic review. Pediatrics 138, e20161417 (2016).
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G. & Group, P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 6, e1000097 (2009).
Rasquin-Weber, A., Hyman, P. E. & Cucchiara, S. Childhood functional gastrointestinal disorders. Gut 45, II60–II68 (1999).
Rasquin, A. et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 130, 1527–1537 (2006).
Hyman, P. E. et al. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology 130, 1519–1526 (2006).
Hyams, J. S. et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 150, 1456–1468.e2 (2016).
Benninga, M. A. et al. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology 15, S0016-5085(16)00182-7 (2016).
de Onis, M. & Lobstein, T. Defining obesity risk status in the general childhood population: which cut-offs should we use? Int J. Pediatr. Obes. 5, 458–460 (2010).
Stang, A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur. J. Epidemiol. 25, 603–605 (2010).
Zeng, X. et al. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J. Evid. Based Med. 8, 2–10 (2015).
Hu, J. et al. Prevalence of suicide attempts among Chinese adolescents: a meta-analysis of cross-sectional studies. Compr. Psychiatry 61, 78–89 (2015).
Higgins, J. P. T. Measuring inconsistency in meta-analyses. BMJ 327, 557–560 (2003).
Begg, C. B. & Mazumdar, M. Operating characteristics of a rank correlation test for publication bias. Biometrics 50, 1088–1101 (1994).
Egger, M., Davey Smith, G., Schneider, M. & Minder, C. Bias in meta-analysis detected by a simple, graphical test. BMJ 315, 629–634 (1997).
Kavehmanesh, Z., Saburi, A. & Maavaiyan, A. Comparison of body mass index on children with functional constipation and healthy controls. J. Fam. Med. Prim. Care 2, 222–226 (2013).
Tambucci, R. et al. Association between obesity/overweight and functional gastrointestinal disorders in children. J. Pediatr. Gastroenterol. Nutr. 68, 517–520 (2019).
Teitelbaum, J. E., Sinha, P., Micale, M., Yeung, S. & Jaeger, J. Obesity is related to multiple functional abdominal diseases. J. Pediatr. 154, 444–446 (2009).
Olaru, C. et al. Some risk factors of chronic functional constipation identified in a pediatric population sample from Romania. Gastroenterol. Res Pr. 2016, 3989721 (2016).
Koppen, I. J., Velasco-Benítez, C. A., Benninga, M. A., Di Lorenzo, C. & Saps, M. Is there an association between functional constipation and excessive bodyweight in children? J. Pediatr. 171, 178–82.e1 (2016).
Chang, S. H. et al. Prevalence, clinical characteristics, and management of functional constipation at pediatric gastroenterology clinics. J. Korean Med. Sci. 28, 1356–1361 (2013).
Yuwanita, N., Sinuhaji, A. B., Sembiring, T., Supriatmo, S. & Yudiyanto, A. R. Obesity and functional constipation in children. Paediatr. Indones. 58, 1–4 (2018).
Costa, M. L., Oliveira, J. N., Tahan, S. & Morais, M. B. Overweight and constipation in adolescents. BMC Gastroenterol. 11, 40 (2011).
Phatak, U. P. & Pashankar, D. S. Prevalence of functional gastrointestinal disorders in obese and overweight children. Int J. Obes. (Lond.) 38, 1324–1327 (2014).
Pashankar, D. S. & Loening-Baucke, V. Increased prevalence of obesity in children with functional constipation evaluated in an academic medical center. Pediatrics 116, e377–e380 (2005).
Dehghani, S. M., Karamifar, H. & Imanieh, M. H. Evaluation of the growth parameters in children with chronic functional constipation. Ann. Colorectal Res 1, 55–59 (2013).
Misra, S., Lee, A. & Gensel, K. Chronic constipation in overweight children. JPEN J. Parenter. Enter. Nutr. 30, 81–84 (2006).
Pawłowska, K., Umławska, W. & Iwańczak, B. A Link between nutritional and growth states in pediatric patients with functional gastrointestinal disorders. J. Pediatr. 199, 171–177 (2018).
Chao, H. C. et al. The impact of constipation on growth in children. Pediatr. Res. 64, 308–311 (2008).
North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (2006). Evaluation and treatment of constipation in children. J. Pediatr. Gastroenterol. Nutr. 43, 405–407 (2006).
Santucci, N. R. & Hyman, P. E. Do functional gastrointestinal disorders affect growth and nutrition? J. Pediatr. 199, 9–10 (2018).
Baker, S. S. et al. Constipation in infants and children: evaluation and treatment. A medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition. J. Pediatr. Gastroenterol. Nutr. 29, 612–626 (1999).
Fishman, L., Lenders, C., Fortunato, C., Noonan, C. & Nurko, S. Increased prevalence of constipation and fecal soiling in a population of obese children. J. Pediatr. 145, 253–254 (2004).
vd Baan-Slootweg, O. H. et al. Constipation and colonic transit times in children with morbid obesity. J. Pediatr. Gastroenterol. Nutr. 52, 442–445 (2011).
Ho, W. & Spiegel, B. M. The relationship between obesity and functional gastrointestinal disorders: causation, association, or neither? Gastroenterol. Hepatol. (N. Y) 4, 572–578 (2008).
Phatak, U. P. & Pashankar, D. S. Obesity and gastrointestinal disorders in children. J. Pediatr. Gastroenterol. Nutr. 60, 441–445 (2015).
Wagner, C., Equit, M., Niemczyk, J. & von Gontard, A. Obesity, overweight, and eating problems in children with incontinence. J. Pediatr. Urol. 11, 202–207 (2015).
Taber, D. R., Chriqui, J. F., Powell, L. & Chaloupka, F. J. Association between state laws governing school meal nutrition content and student weight status: implications for new USDA school meal standards. JAMA Pediatr. 167, 513–519 (2013).
Schwimmer, J. B., Burwinkle, T. M. & Varni, J. W. Health-related quality of life of severely obese children and adolescents. JAMA 289, 1813–1819 (2003).
Russell-Mayhew, S., McVey, G., Bardick, A. & Ireland, A. Mental health, wellness, and childhood overweight/obesity. J. Obes. 2012, 281801 (2012).
Jones, M. P. et al. Mood and anxiety disorders precede development of functional gastrointestinal disorders in patients but not in the population. Clin. Gastroenterol. Hepatol. 15, 1014–1020.e4 (2017).
Mayer, E. A., Savidge, T. & Shulman, R. J. Brain-gut microbiome interactions and functional bowel disorders. Gastroenterology 146, 1500–1512 (2014).
Zhu, L. et al. Structural changes in the gut microbiome of constipated patients. Physiol. Genom. 46, 679–686 (2014).
Turnbaugh, P. J. et al. A core gut microbiome in obese and lean twins. Nature 457, 480–484 (2009).
Kalliomäki, M., Collado, M. C., Salminen, S. & Isolauri, E. Early differences in fecal microbiota composition in children may predict overweight. Am. J. Clin. Nutr. 87, 534–538 (2008).
Tilg, H. & Adolph, T. E. Influence of the human intestinal microbiome on obesity and metabolic dysfunction. Curr. Opin. Pediatr. 27, 496–501 (2015).
Devkota, S. et al. Dietary-fat-induced taurocholic acid promotes pathobiont expansion and colitis in Il10-/- mice. Nature 487, 104–108 (2012).
Barlow, S. E., Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 120, S164–S192 (2007).
Author information
Authors and Affiliations
Contributions
All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by G.N.W., K.Z., and S.L. The first draft of the manuscript was written by G.N.W. and Y.Y.X., and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Wang, G.N., Zhang, K., Xiong, Y.Y. et al. The relationship between functional constipation and overweight/obesity in children: a systematic review and meta-analysis. Pediatr Res 94, 1878–1886 (2023). https://doi.org/10.1038/s41390-023-02711-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41390-023-02711-1