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Fluid intake and urinary osmolality in pediatric patients with functional constipation

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A Correction to this article was published on 13 October 2021

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Abstract

Purpose

This study aimed to evaluate fluid intake and urinary osmolality in pediatric patients with functional constipation.

Methods

This was a cross-sectional, case–control study that prospectively included two groups: 36 pediatric patients older than 4 years with functional constipation (Rome III criteria) who were consecutively admitted in a public tertiary pediatric gastroenterology outpatient clinic and 93 controls with normal bowel habits. The control group was recruited from a public school and did not have any of the characteristics of the Rome III criteria. Fluid and food intakes were assessed using a daily diet inquiry and 24 h recording method. Hypohydration was defined as osmolality greater than 800 mOsm/kg H2O in a spot urine sample.

Results

The age of the functional constipation group (median, 8.9 years; range 7.3–10.0 years) and the control group (8.8 years) was similar (p = 0.51). The proportion of boys in the functional constipation group (76.6%; 25/36) was higher (p = 0.01) than that in the control group (45.2%; 41/93). The total water intake of the functional constipation group (median 1566 mL) was lower (p < 0.001) than that of the control group (median 2177 mL). Urinary osmolality was higher (p = 0.039) in the functional constipation group (median 859 mOsm/kg H2O) than in the control group (median 775 mOsm/kg H2O). The association between hypohydration and functional constipation did not reach statistical significance (Odds ratio 2.06; 95% confidence interval 0.93–4.55; p = 0.073).

Conclusion

Compared to the control group, patients with functional constipation have lower fluid intake and higher urinary osmolality.

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Data availability

Available for the authors.

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References

  1. Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A et al (2006) Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 130(5):1527–1537. https://doi.org/10.1053/j.gastro.2005.08.063

    Article  PubMed  Google Scholar 

  2. Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, Van Tilburg M (2016) Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 150(6):1456-1468.e2. https://doi.org/10.1053/j.gastro.2016.02.015

    Article  Google Scholar 

  3. Tabbers MM, Dilorenzo C, Berger MY, Faure C, Langendam MW, Nurko S et al (2014) Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 58(2):258–274. https://doi.org/10.1097/MPG.0000000000000266

    Article  PubMed  CAS  Google Scholar 

  4. Liem O, Harman J, Benninga M, Kelleher K, Mousa H, Di Lorenzo C (2009) Health utilization and cost impact of childhood constipation in the United States. J Pediatr 154:258–262. https://doi.org/10.1016/j.jpeds.2008.07.060

    Article  PubMed  Google Scholar 

  5. Rajindrajith S, Devanarayana NM, Crispus Perera BJ, Benninga MA (2016) Childhood constipation as an emerging public health problem. World J Gastroenterol 22:6864–6875. https://doi.org/10.3748/wjg.v22.i30.6864

    Article  PubMed  PubMed Central  Google Scholar 

  6. National Collaborating Centre for Women’s and Children’s Health (UK) (2010) Constipation in children and young people: diagnosis and management of idiopathic childhood constipation in primary and secondary care. London: RCOG Press; 2010. PMID: 22220325. www.nice.org.uk/guidance/cg99

  7. Lindberg G, Hamid SS, Malfertheiner P, Thomsen OO, Fernandez B, Garisch JJ et al (2011) (2011) World gastroenterology organisation global guideline: constipation—a global perspective. J Clin Gastroenterol 45(6):483–487. https://doi.org/10.1097/MCG.0b013e31820fb914

    Article  PubMed  Google Scholar 

  8. Arnaud MJ (2003) (2003) Mild dehydration: a risk factor of constipation? Eur J Clin Nutr 57(May):S88-95. https://doi.org/10.1038/sj.ejcn.1601907

    Article  PubMed  Google Scholar 

  9. Boilesen SN, Tahan S, Dias FC, Melli LCFL, de Morais MB (2017) Water and fluid intake in the prevention and treatment of functional constipation in children and adolescents: is there evidence? J Pediatr (Rio J) 93:320–327. https://doi.org/10.1016/j.jped.2017.01.005 (Epub 2017 Apr 25 PMID: 28450053)

    Article  Google Scholar 

  10. Suh HG, Kavouras SA (2019) Water intake and hydration state in children. Eur J Nutr 58:475–496. https://doi.org/10.1007/s00394-018-1869-9

    Article  PubMed  Google Scholar 

  11. Dias FC, Boilesen SN, Tahan S, Melli LC, Morais MB (2019) Prevalence of voluntary dehydration according to urine osmolarity in elementary school students in the metropolitan region of São Paulo, Brazil. Clinics (Sao Paulo) 74:e903. https://doi.org/10.6061/clinics/2019/e903

    Article  Google Scholar 

  12. El-Sharkawy AM, Sahota O, Lobo DN (2015) Acute and chronic effects of hydration status on health. Nutr Rev 73:97–109. https://doi.org/10.1093/nutrit/nuv038

    Article  PubMed  Google Scholar 

  13. Popkin BM, D’Anci KE, Rosenberg IH (2010) Water, hydration, and health. Nutr Rev 68(8):439–458. https://doi.org/10.1111/j.1753-4887.2010.00304.x

    Article  PubMed  Google Scholar 

  14. Armstrong LE, Johnson EC (2018) Water intake, water balance, and the elusive daily water requirement. Nutrients 10(12):1–25. https://doi.org/10.3390/nu10121928

    Article  CAS  Google Scholar 

  15. Baron S, Courbebaisse M, Lepicard EM, Friedlander G (2015) Assessment of hydration status in a large population. Br J Nutr 113(1):147–158. https://doi.org/10.1017/S0007114514003213

    Article  PubMed  CAS  Google Scholar 

  16. Sangalli CN, Dos Santos LP, De Morais MB, Vitolo MR (2010) Infant feeding practices and the effect in reducing functional constipation 6 years later: a randomized field trial. J Pediatr Gastroenterol Nutr 67(5):660–665. https://doi.org/10.1097/MPG.0000000000002075

    Article  Google Scholar 

  17. Macêdo MIP, de Albuquerque MFM, Tahan S, de Morais MB (2020) Is there any association between overweight, physical activity, fat and fiber intake with functional constipation in adolescents? Scand J Gastroenterol 55(4):414–420. https://doi.org/10.1080/00365521.2020.1749878

    Article  PubMed  Google Scholar 

  18. De Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J (2007) Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 85(9):660–667. https://doi.org/10.2471/blt.07.043497

    Article  PubMed  PubMed Central  Google Scholar 

  19. Freudenheim JL (1993) A review of study designs and methods of dietary assessment in nutritional epidemiology of chronic disease. J Nutr 123:401–405. https://doi.org/10.1093/jn/123.suppl_2.401

    Article  PubMed  CAS  Google Scholar 

  20. Muckelbauer R, Libuda L, Clausen K, Toschke AM, Reinehr T, Kersting M (2009) Promotion and provision of drinking water in schools for overweight prevention: randomized, controlled cluster trial. Pediatrics. https://doi.org/10.1542/peds.2008-2186

    Article  PubMed  Google Scholar 

  21. Núcleo de Estudos e Pesquisas em Alimentação–NEPA (2011) Tabela Brasileira de Composição de Alimentos–TACO. Universidade Estadual de Campinas (UNICAMP), Campinas. https://www.cfn.org.br/wp-content/uploads/2017/03/taco_4_edicao_ampliada_e_revisada.pdf

  22. Institute of Medicine (2005) Dietary reference intakes for water, potassium, sodium, chloride, and sulfate. The National Academies Press, Washington, DC. https://doi.org/10.17226/10925

  23. Williams CL, Bollella M, Wynder EL (1995) A new recommendation for dietary fiber in childhood. Pediatrics 96(5 Pt2):985–988

    PubMed  CAS  Google Scholar 

  24. Medeiros LCDS, De Morais MB, Tahan S, Fukushima É, Motta MEFA, Fagundes-Neto U (2007) Características clínicas de pacientes pediátricos com constipação crônica de acordo com o grupo etário. Arq Gastroenterol 44(4):340–344. https://doi.org/10.1590/S0004-28032007000400011

    Article  PubMed  Google Scholar 

  25. Soares ACF, Tahan S (2009) De Morais MB (2109) Effects of conventional treatment of chronic functional constipation on total and segmental colonic and orocecal transit times. J Pediatr (Rio J) 85(4):322–328. https://doi.org/10.1590/S0021-75572009000400009

    Article  Google Scholar 

  26. Gomes RC, Maranhão HS (2003) Pedrosa L de FC, Morais MB (2003) Consumo de fibra alimentar e de macronutrientes por crianças com constipação crônica funcional. Arq Gastroenterol 40(3):181–187. https://doi.org/10.1590/S0004-28032003000300009

    Article  PubMed  Google Scholar 

  27. Speridião PGL, Tahan S, Fagundes-Neto U, Morais MB (2003) Dietary fiber, energy intake and nutritional status during the treatment of children with chronic constipation. Braz J Med Biol Res 36(6):753–759. https://doi.org/10.1590/S0100-879X2003000600011

    Article  PubMed  Google Scholar 

  28. Fernandes VPI, Lima MCL, Camargo EE, Collares EF, Bustorff-Silva JM, Lomazi EA (2013) Gastric emptying of water in children with severe functional fecal retention. Braz J Med Biol Res 46(3):293–298. https://doi.org/10.1590/1414-431X20132448

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Soares ACF, Lederamn HM, Fagunes-Neto U, Morais MB (2005) Breath hydrogen test after a bean meal demonstrates delayed oro-cecal transit time in children with chronic constipation. J Pediatr Gastroenterol Nutr 41(2):221–224. https://doi.org/10.1097/01.mpg.0000167499.40074.d7

    Article  PubMed  Google Scholar 

  30. Tjeerdsma HC, Smout AJ, Akkermans LM (1993) Voluntary suppression of defecation delays gastric emptying. Dig Dis Sci 38:832–836. https://doi.org/10.1007/BF01295908

    Article  PubMed  CAS  Google Scholar 

  31. Tambucci R, Quitadamo P, Ambrosi M, De Angelis P, Angelino G, Stagi S et al (2019) Association between obesity/overweight and functional gastrointestinal disorders in children. J Pediatr Gastroenterol Nutr 68(4):517–520. https://doi.org/10.1097/MPG.0000000000002208

    Article  PubMed  Google Scholar 

  32. Mora-Rodriguez R, Ortega JF, Fernandez-Elias VE, Kapsokefalou M, Malisova O, Athanasatou A, Husemann M, Domnik K, Braun H (2016) Influence of physical activity and ambient temperature on hydration: the European hydration research study (EHRS). Nutrients 8(5):252. https://doi.org/10.3390/nu8050252

    Article  PubMed Central  CAS  Google Scholar 

  33. Ebner A, Manz F (2002) Sex difference of urinary osmolality in German children. Am J Nephrol 22(4):352–355. https://doi.org/10.1159/000065226

    Article  PubMed  Google Scholar 

  34. Padrão P, Neto M, Oliveira AC, Moreira A, Moreira P (2016) Urinary hydration biomarkers and dietary intake in children. Nutr Hosp 33(2):35–40. https://doi.org/10.20960/nh.314

    Article  Google Scholar 

  35. Dupont C, Hébert G (2020) Magnesium sulfate-rich natural mineral waters in the treatment of functional constipation—a review. Nutrients 12(7):1–14. https://doi.org/10.3390/nu12072052

    Article  Google Scholar 

  36. Feferbaum R, de Abreu LC, Leone C (2012) Fluid intake patterns: an epidemiological study among children and adolescents in Brazil. BMC Public Health 12(1):1005. https://doi.org/10.1186/1471-2458-12-1005

    Article  PubMed  PubMed Central  Google Scholar 

  37. Adams JD, Kavouras SA, Johnson EC, Jansen LT, Capitan-Jimenez C, Robillard JI, Mauromoustakos A (2017) The effect of storing temperature and duration on urinary hydration markers. Int J Sport Nutr Exerc Metab 27(1):18–24. https://doi.org/10.1123/ijsnem.2016-0098

    Article  PubMed  CAS  Google Scholar 

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Funding

CNPq-Conselho Nacional de Desenvolvimento Científico e Tecnológico (The National Council for Scientific and Technological Development, Brazil).

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Authors and Affiliations

  1. Division of Pediatric Gastroenterology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo, 781-12 Andar, São Paulo, SP, 04039-032, Brazil

    Sabine Nunes Boilesen, Francine C. Dias, Soraia Tahan, Lígia C. F. L. Melli & Mauro Batista de Morais

Authors
  1. Sabine Nunes Boilesen
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  2. Francine C. Dias
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  3. Soraia Tahan
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  4. Lígia C. F. L. Melli
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  5. Mauro Batista de Morais
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Contributions

All authors contributed to the accomplishment of the article with significant intellectual contributions. All authors have approved the final version of the manuscript and assume responsibility for the content.

Corresponding author

Correspondence to Mauro Batista de Morais.

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Not to declare.

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Approved by the Research Ethics Committee of the Universidade Federal de São Paulo (CEP 859.533).

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Participants signed the informed consent and assent forms.

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Boilesen, S.N., Dias, F.C., Tahan, S. et al. Fluid intake and urinary osmolality in pediatric patients with functional constipation. Eur J Nutr 60, 4647–4655 (2021). https://doi.org/10.1007/s00394-021-02657-2

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  • DOI: https://doi.org/10.1007/s00394-021-02657-2

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