Functional Bowel Disorders and Obesity in Children: State of the Problem

REVIEW
Anna Pogodina, Anastasia Romanitsa, Lyubov Rychkova

 
International Journal of Biomedicine. 2020;10(4):316-323.
DOI: 10.21103/Article10(4)_RA2
Originally published December 10, 2020

Abstract: 

Obesity and functional bowel disorders (FBDs) are often observed in children and have common risk factors. The present review aimed to summarize the published data on the association between obesity and FBDs in children and a discussion of possible pathophysiological mechanisms that may be involved. Published data indicates that obesity and FBDs could be associated conditions. There is substantial evidence that obesity in children is associated with constipation. However, it should be noted that there were few studies in this direction, and those studies were heterogeneous in both the composition of participants and studied diagnostic criteria, and in the majority of cases, they were not adjusted for potential confounders. The association between obesity and FBDs can be explored through diet, peculiarities of eating behavior, and psychological factors. The most promising direction in the study could be the study of the GM, the changes in which can contribute to the development of immune dysfunctions of the bowel, chronic low-grade inflammation, increased colonic permeability, motility disturbances, and visceral hypersensitivity. The studies in this area can provide important data for developing a strategy of treatment and prevention of both groups of diseases.

Keywords: 
irritable bowel syndrome • functional constipation • adolescents
References: 
  1. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014 Aug 30;384(9945):766-81. doi: 10.1016/S0140-6736(14)60460-8.
  2. Tutelyan VA, Baturin AK, Kon IY, Martinchik AN, Uglickih AK, Korosteleva MM, et al. [Prevalence of overweight and obesity in child population of Russia: multicenter study]. Pediatria. Journal named after G.N. Speransky. 2014;93(5):28-31. doi:10.24110/0031-403X-2014-93-5-28-31. [Article in Russian].
  3. GBD 2015 Obesity Collaborators; Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27. doi: 10.1056/NEJMoa1614362
  4. Corazziari E. Definition and epidemiology of functional gastrointestinal disorders. Best Pract Res Clin Gastroenterol. 2004;18:613–631 doi: 10.1016/j.bpg.2004.04.012.
  5. Nurko S, Di Lorenzo C. Functional abdominal pain: time to get together and move forward. J Pediatr Gastroenterol Nutr. 2008;47:679–680. doi: 10.1097 / MPG.0b013e31818936d1
  6. Koppen IJ, Nurko S, Saps M, Di Lorenzo C, Benninga MA. The pediatric Rome IV criteria: what's new? Expert Rev Gastroenterol Hepatol. 2017 Mar;11(3):193-201. doi: 10.1080/17474124.2017.1282820. Epub 2017 Jan 24.
  7. Chumpitazi BP, Shulman RJ. Underlying molecular and cellular mechanisms in childhood irritable bowel syndrome. Mol Cell Pediatr. 2016;3(1):1-9. doi: 10.1186/s40348-016-0036-8.
  8. Giannetti E, de'Angelis G, Turco R, Campanozzi A, Pensabene L, Salvatore S et al. Subtypes of irritable bowel syndrome in children: prevalence at diagnosis and at follow-up. J Pediatr. 2014;164(5):1099–1103. doi: 10.1016/j.jpeds.2013.12.043.
  9. Belmer SV, Khavkin AI, Pechkurov DV. [Functional constipation in children (Look through the Rome consensus IV)]. Lechaschi Vrach. 2017;2:54-58.[Article in Russian].
  10. Teitelbaum JE, Sinha P, Micale M, Yeung S, Jaeger J. Obesity is related to multiple functional abdominal diseases. J Pediatr. 2009;154(3):444-446. doi: 10.1016/j.jpeds.2008.09.053.
  11. Galai T, Moran-Lev H, Cohen S, Ben-Tov A, Levy D, Weintraub Y et al. Higher prevalence of obesity among children with functional abdominal pain disorders. BMC Pediatr. 2020;20(1):1-6. doi: 10.1186/s12887-020-02106-9.
  12. Pawłowska K, Umławska W, Iwańczak B. A link between nutritional and growth states in pediatric patients with functional gastrointestinal disorders. J Pediatr. 2018;199:171-177. doi: 10.1016/j.jpeds.2018.02.069.
  13. Tambucci R, Quitadamo P, Ambrosi M, De Angelis P, Angelino G, Stagi S. et al. Association between obesity/overweight and functional gastrointestinal disorders in children. J Pediatr Gastroenterol Nutr. 2019;68(4):517-520. doi: 10.1097/MPG.0000000000002208.
  14. Phatak UP, Pashankar DS. Prevalence of functional gastrointestinal disorders in obese and overweight children. Int J Obes (Lond). 2014;38(10):1324-1327. doi: 10.1038/ijo.2014.67. 
  15. 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. 2004;145:253–254. doi: 10.1016/j.jpeds.2004.04.022
  16. Pashankar DS, Loening-Baucke V. Increased prevalence of obesity in children with functional constipation evaluated in an academic medical center. Pediatrics. 2005;116(3):e377-e380. doi: 10.1542/peds.2005-0490.
  17. Misra S, Lee A, Gensel K. Chronic constipation in overweight children. J Parenter Enteral Nutr. 2006;30(2):81-84. doi: 10.1177/014860710603000281.
  18. vd Baan-Slootweg OH, Liem O, Bekkali N, van Aalderen WMC, Pels TH et al. Constipation and colonic transit times in children with morbid obesity. J Pediatr Gastroenterol Nutr. 2011;52(4):442-445. doi: 10.1097/MPG.0b013e3181ef8e3c.
  19. Rybochkina AV, Dmitrieva TG, Innokentieva NN. [Pathology of digestive organs in children with obesity in Sakha Republic (Yakutia)]. Vestnik of North-Eastern Federal University. Medical sciences. 2017;4(9):85-88. [Article in Russian].
  20. Çağan Appak Y, Karakoyun M, Koru T, Baran M. Dietary properties and anthropometric findings of children with functional constipation: a cross-sectional study. Arch Argent Pediatr. 2019;117(3):e224-e231. doi: 10.5546/aap.2019.eng.e224.
  21. Kelishadi R, Ardalan G, Gheiratmand R,  Majdzadeh R, Hosseini M, Gouya MM et al. Thinness, overweight and obesity in a national sample of Iranian children and adolescents: CASPIAN Study. Child Care Health Dev. 2008;34(1):44–54. doi: 10.1111/j.1365-2214.2007.00744.x.
  22. Costa ML, Oliveira JN, Tahan S, Morais MB. Overweight and constipation in adolescents. BMC Gastroenterol. 2011;17;11:40. doi: 10.1186/1471-230X-11-40.
  23. Koppen IJ, Velasco-Benítez CA, Benninga MA, Di Lorenzo C, Saps M. Is there an association between functional constipation and excessive bodyweight in children? J Pediatr. 2016;171:178-182.e1. doi: 10.1016/j.jpeds.2015.12.033.
  24.  Macêdo MIP, Albuquerque MDFM, Tahan S, de Morais MB. Is there any association between overweight, physical activity, fat and fiber intake with functional constipation in adolescents? Scand J Gastroenterol. 2020;55(4):414-420. doi: 10.1080/00365521.2020.1749878.
  25. Kiefte‐de Jong JC, de Vries JH, Escher JC, Jaddoe VWV, Hofman A, Raat H et al. Role of dietary patterns, sedentary behaviour and overweight on the longitudinal development of childhood constipation: the Generation R study. Matern Child Nutr. 2013;9(4):511-23. doi: 10.1111/j.1740-8709.2011.00395.x.
  26. Chien LY, Liou YM, Chang P. Low defaecation frequency in Taiwanese adolescents: association with dietary intake, physical activity and sedentary behaviour. J Paediatr Child Health. 2011;47(6):381-6. doi: 10.1111/j.1440-1754.2010.01990.x.
  27. Ho W, Spiegel BM. The relationship between obesity and functional gastrointestinal disorders: causation, association, or neither? Gastroenterol Hepatol (N Y). 2008 Aug;4(8):572-8. 
  28. Gurova MM, Novikova VP, Khavkin AI. The state of gut microbiota and clinical-metabolic features in children with overweight and obesity. Russian journal of evidence-based gastroenterology. 2018;7(3):4-10
  29. Bonilla S, Wang D, Saps M. Obesity predicts persistence of pain in children with functional gastrointestinal disorders. Int J Obes (Lond). 2011;35:517–21. doi: 10.1038/ijo.2010.245.
  30. Koppen IJ, Kuizenga-Wessel S, Saps M, Di Lorenzo C, Benninga MA, van Etten-Jamaludin FS et al. Functional defecation disorders and excessive body weight: a systematic review. Pediatrics. 2016;138:pii:e20161417. doi: 10.1542/peds.2016-1417.
  31. Malaty H, Abudayyeh S, Fraley K, Graham DY, Gilger MA, Hollier DR. Recurrent abdominal pain in school children: effect of obesity and diet. Acta Paediatr. 2007;96:572–576. doi: 10.1111/j.1651-2227.2007.00230.x.
  32.   Pickett-Blakely O. Obesity and irritable bowel syndrome: a comprehensive review. Gastroenterol Hepatol (N Y). 2014;10(7):411-416.
  33. Pavlovskaya EV, Strokova TV, Surkov AG. Et al. Dietary characteristics in children with overweight and obesity. Vopr Pitan. 2015;84(S5):58.
  34.  Schnabel L, Buscail C, Sabate, Bouchoucha JMM, Kesse-Guyot E, Allès B. et al. Association between ultra-processed food consumption and functional gastrointestinal disorders: results from the French NutriNet-Santé cohort. Am J Gastroenterol . 2018;113(8):1217-1228.  doi: 10.1038/s41395-018-0137-1.
  35. Barrett JS, Gibson PR. Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and nonallergic food intolerance: FODMAPs or food chemicals? Ther Adv Gastroenterol. 2012;5:261–268. doi: 10.1177/1756283X11436241.
  36. Ozaki RKF, Speridião PDGL, Soares ACF, de Morais MB. Intestinal fructose malabsorption is associated with increased lactulose fermentation in the intestinal lumen. J Pediatr (Rio J). 2018;94(6):609-615. doi: 10.1016/j.jped.2017.08.006.
  37. Fodor I, Man SC, Dumitrascu DL. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet in children. World J Clin Cases. 2019;7(18):2666. doi: 10.12998/wjcc.v7.i18.2666.
  38. Nalyotov AV, Vunichenko YS. The using of low-FODMAP diet is an important step in the treatment of children with irritable bowel syndrome. Pediatrician (St. Petersburg). 2017;8(6):94-98. doi: 10.17816/PED8694-98
  39. Feinle-Bisset C, Azpiroz F. Dietary lipids and functional gastrointestinal disorders. Am. J. Gastroenterol. 2013;108:737–747. doi: 10.1038/ajg.2013.76.
  40. Accarino AM, Azpiroz F, Malagelada JR. Modification of small bowel mechanosensitivity by intestinal fat. Gut. 2001;48:690–695. doi: 10.1136/gut.48.5.690.
  41. Levy RL, Linde JA, Feld KA, Crowell MD, Jeffery RW et al. The association of gastrointestinal symptoms with weight, diet, and exercise in weight-loss program participants. Clin Gastroenterol Hepatol. 2005;3(10):992-996. doi: 10.1016/s1542-3565(05)00696-8.
  42. Piccoli de Mello P, Eifer DA, Daniel de Mello E. Use of fibers in childhood constipation treatment: Systematic review with meta-analysis. J. Pediatr. 2018;94:460–470. doi: 10.1016/j.jped.2017.10.014.
  43. Khavkin AI, Fayzullina RA, Belmer SV, Gorelov AV, Zakharova IN, Zvyagin AA et al. Diagnosis and tactics of treatment of children with functional constipation (recommendations of the Society of Paediatric Gastroenterologists). Pediatric Nutrition. 2014;12(4):49–63.
  44.  He J, Cai Z, Fan, X. Prevalence of binge and loss of control eating among children and adolescents with overweight and obesity: An exploratory meta‐analysis. Int J Eat Disord. 2017;50(2):91-103. doi:10.1002/eat.22661.
  45. Decaluwe V, Braet C, Fairburn CG. Binge eating in obese children and adolescents. Int J Eat Disord 2003;33:78–84. doi: 10.1038/sj.ijo.0802233.
  46. Moayyedi P. The epidemiology of obesity and gastrointestinal and other diseases: an overview. Dig Dis Sci. 2008;53:2293–2299. doi: 10.1007/s10620-008-0410-z.
  47. Rankin J, Matthews L, Cobley S, Han A, Sanders R, Wiltshire HD et al. Psychological consequences of childhood obesity: psychiatric comorbidity and prevention. Adolesc Health Med Ther. 2016;7:125-146. doi: 10.2147/AHMT.S101631.
  48. Larina NG. Food behaviour, lifestyle, and psychological status of adolescents with obesity and autonomic dysfunction. Vestnik NovSU. 2017;8(106):58-61.
  49. Yacob D, Di Lorenzo C, Bridge JA, Rosenstein PF, Onorato M, Bravender T et al. Prevalence of pain-predominant functional gastrointestinal disorders and somatic symptoms in patients with anxiety or depressive disorders. J Pediatr 2016;163:767–770. doi: 10.1016/j.jpeds.2013.02.033.
  50. Wouters MM, Boeckxstaens GE. Is there a causal link between psychological disorders and functional gastrointestinal disorders? Expert Rev Gastroenterol Hepatol 2016;10:5–8. doi: 10.1586/17474124.2016.1109446.
  51. Vu J, Kushnir V, Cassell B, Gyawali CP, Sayuk GS. The impact of psychiatric and extraintestinal comorbidity on quality of life and bowel symptom burden in functional gastrointestinal disorders. Neurogastroenterol Motil 2014;26:1323-1332. doi: 10.1111/nmo.12396.
  52. Koloski NA, Jones M, Kalantar J, Weltman M, Zaguirre J, Talley NJ. The brain–gut pathway in functional gastrointestinal disorders is bidirectional: a 12-year prospective population-based study. Gut. 2012;61(9):1284–1290. doi: 10.1136/gutjnl-2011-300474.
  53.  Dinan TG, Quigley EM, Ahmed SM, Scully P, O'Brien S, O'Mahony L et al. Hypothalamic-pituitary-gut axis dysregulation in irritable bowel syndrome: plasma cytokines as a potential biomarker? Gastroenterology 2006;130:304–311. doi: 10.1053/j.gastro.2005.11.033.
  54. Iovino P, Tremolaterra F, Boccia G, Miele E, Ruju FM, Staiano A. Irritable bowel syndrome in childhood: visceral hypersensitivity and psychosocial aspects. Neurogastroenterol Motil. 2009;21(9):940-e974. doi: 10.1111/j.1365-2982.2009.01303.x.
  55. Schneck AS, Anty R, Tran A, Hastier A, Amor IB, Gugenheim J et al. Increased prevalence of irritable bowel syndrome in a cohort of French morbidly obese patients candidate for bariatric surgery. Obes Surg. 2016;26(7),1525-1530. doi: 10.1007/s11695-015-1907-0.
  56. Delgado-Aros S, Camilleri M, Garcia MA, Burton D, Busciglio I. High body mass alters colonic sensory-motor function and transit in humans. Am J Physiol Gastrointest Liver Physiol. 2008;295:G382-8. doi: 10.1152/ajpgi.90286.2008.
  57. Bouchoucha M, Fysekidis M, Rompteaux P, Airinei G, Sabate JM, Benamouzig R. Influence of age and body mass index on total and segmental colonic transit times in constipated subjects. J Neurogastroenterol Motil. 2019;25(2):258-266. doi: 10.5056/jnm18167.
  58. Gomez-Pinilla PJ, Gibbons SJ, Sarr MG, Kendrick ML, Shen KR, Cima RR et al. Changes in interstitial cells of Cajal with age in the human stomach and colon. Neurogastroenterol Motil. 2011;23(1):36-44. doi: 10.1111/j.1365-2982.2010.01590.x.
  59. Talley NJ, Howell S, Poulton R. Obesity and chronic gastrointestinal tract symptoms in young adults: a birth cohort study. Am J Gastroenterol. 2004;99(9):1807-1814. doi: 10.1111/j.1572-0241.2004.30388.x.
  60. Drapkina OM, Korneeva ON. [Gut microbiota and obesity: Pathogenetic relationships and ways to normalize the intestinal microflora]. Ter Arkh. 2016;88(9):135-142. doi: 10.17116/terarkh2016889135-142. [Article in Russian].
  61. Da Silva CC, Monteil MA, Davis EM. Overweight and obesity in children are associated with an abundance of Firmicutes and reduction of Bifidobacterium in their gastrointestinal microbiota. Child Obes. 2020;16(3):204-210. doi: 10.1089/chi.2019.0280.
  62. Belkova NL, Nemchenko UM, Pogodina AV, Feranchuk SI, Romanitsa AI, Novikova EA et al. Composition and structure of gut microbiome in adolescents with obesity and different breastfeeding duration. Bull Exp Biol Med. 2019;167(6):759-762. doi: 10.1007/s10517-019-04617-7.
  63. Rajilic-Stojanovic  M, Biagi E, Heilig HG, Kekkonen RA, Tims S, de Vos WM. Global and deep molecular analysis of microbiota signatures in fecal samples from patients with irritable bowel syndrome. Gastroenterology. 2011;141:1792–1801. doi:10.1053/j.gastro.2011.07.043.
  64. Saulnier DM, Riehle K, Mistretta TA, Diaz MA, Mandal D, Raza S et al. Gastrointestinal microbiome signatures of pediatric patients with irritable bowel syndrome. J Gastroenterology. 2011;141(5):1782-1791. doi: 10.1053/j.gastro.2011.06.072.
  65. Horvath A, Dziechciarz P, Szajewska H. Meta-analysis: Lactobacillus rhamnosus GG for abdominal pain-related functional gastrointestinal disorders in childhood. Aliment Pharmacol Ther. 2011;33(12):1302–1310. doi: 10.1111/j.1365-2036.2011.04665.x.
  66. Guandalini S, Magazzu G, Chiaro A, La Balestra V, Di Nardo G, Gopalan S et al. VSL#3 improves symptoms in children with irritable bowel syndrome: a multicenter, randomized, placebo-controlled, double-blind, crossover study. J Pediatr Gastroenterol Nutr 2010;51:24–30. doi: 10.1097/MPG.0b013e3181ca4d95.
  67. Giannetti E, Maglione M, Alessandrella A, Strisciuglio C, De Giovanni D, Campanozzi A et al. A mixture of 3 Bifidobacteria decreases abdominal pain and improves the quality of life in children with irritable bowel syndrome: a multicenter, randomized, double-blind, placebo-controlled, crossover trial. J Clin Gastroenterol 2017;51:e5–e10. doi: 10.1097/MCG.0000000000000528.
  68. de Meij TGJ, de Groot EFJ, Eck A, Budding AE, Kneepkens CM, Benninga MA et al. Characterization of microbiota in children with chronic functional constipation. PLoS ONE. 2016;11(10):e0164731. doi: 10.1371/journal.pone.0164731.
  69. Zhu L, Liu W, Alkhouri R, Baker RD, Bard JE, Quigley EM et al. Structural changes in the gut microbiome of constipated patients. Physiol Genomics. 2014;46:679–686. doi: 10.1152/physiolgenomics.00082.2014.
  70. Zoppi G, Cinquetti M, Luciano A, Benini A, Muner A, Bertazzoni Minelli E.. The intestinal ecosystem in chronic functional constipation. Acta Paediatr. 1998;87:836–841. doi: 10.1080/080352598750013590.
  71. Wojtyniak K., Szajewska H. Systematic review: probiotics for functional constipation in children. Eur J Pediatr. 2017;176(9):1155-1162. doi: 10.1007/s00431-017-2972-2.

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Received September 4, 2020.
Accepted October 17, 2020.
©2020 International Medical Research and Development Corporation.