Bidirectional Associations between Fussy Eating and Functional Constipation in Preschool Children - 29/10/14

Doi : 10.1016/j.jpeds.2014.09.028

Anne Tharner, PhD ^1,^2,^⁎ , Pauline W. Jansen, PhD ^2,³, Jessica C. Kiefte-de Jong, PhD ¹, Henriette A. Moll, MD, PhD ⁴, Albert Hofman, MD, PhD ¹, Vincent W.V. Jaddoe, MD, PhD ^1,^4,⁵, Henning Tiemeier, MD, PhD ^1,^2,⁵, Oscar H. Franco, MD, PhD, FESC, FFPH ^1,⁵
¹ Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
² Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
³ Institute of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands
⁴ Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
⁵ Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands

^∗Reprint requests: Dr Anne Tharner, PO Box 2040, 3000 CA Rotterdam, The Netherlands.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 29 October 2014

Abstract

Objective

To examine bidirectional associations between a child's fussy eating behavior and functional constipation.

Study design

Participants were 4823 children enrolled in a prospective cohort study from pregnancy onward. We assessed fussy eating at age 4 years with the Child Eating Behavior Questionnaire, and assessed functional constipation using ROME II and III criteria with parental questionnaires at age 2, 3, 4, and 6 years.

Results

Higher food fussiness at age 4 years was associated with a greater risk of functional constipation at both 4 years (OR, 1.30; 95% CI, 1.20-1.42; P < .001 per 1 SD increase) and 6 years (OR, 1.12; 95% CI, 1.03-1.23; P < .05 per 1 SD increase). The converse was also observed; previous constipation predicted a greater risk of being a fussy eater at age 4 years (constipation at 2 years: OR, 2.05; 95% CI 1.43-2.94; P < .001; constipation at 3 years: OR, 1.72; 95% CI, 1.26-2.35, P < .001). Path analyses confirmed that the association between fussy eating and functional constipation was indeed bidirectional, showing that functional constipation at age 3 years predicted fussy eater classification at age 4 years (β = 0.06; P < .001), which in turn predicted functional constipation at age 6 years (β = 0.08: P < .001) independent of each other.

Conclusion

A vicious cycle might develop in which children with functional constipation develop unhealthy eating behavior, which in turn increases the risk of functional gastrointestinal disease.

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Keyword : CBCL, CEBQ

Plan

Fussy Eating as a Predictor of Functional Constipation

Functional Constipation as a Predictor of Fussy Eating

Direction of the Association between Fussy Eating and Functional Constipation

Discussion

A.T., J.K.-de-J., and O.F. work at ErasmusAGE, a center funded by Nestlé Nutrition (Nestec Ltd), Metagenics Inc, and AXA. The other authors declare no conflicts of interest.