Hypohydration, Functional Constipation, and Physical Activity in Elementary School Students.

This school-based, cross-sectional study aimed to evaluate whether hypohydration is related to functional constipation and physical activity in school-aged children. The study included 452 students aged 6-12 years. Hypohydration, defined as urinary osmolality >800 mOsm/kg, was more prevalent ( P = 0.002) in boys (72.1%) than in girls (57.5%). The difference in the prevalence of functional constipation according to sex (20.1% in boys and 23.8% in girls) was not statistically significant ( P = 0.81). In bivariate analysis, functional constipation was associated with hypohydration in girls (odds ratio = 1.93, 95% confidence interval: 1.07-3.49), and multiple logistic regression did not reach statistical significance ( P = 0.082). Low proportions of active commuting to school in both sexes were associated with hypohydration. However, there were no associations between functional constipation, active commuting to school, and physical activity scores. In conclusion, multiple logistic regression did not demonstrate an association between hypohydration and functional constipation in school-aged children.

Overweight status, abdominal circumference, physical activity, and functional constipation in children

SUMMARY OBJECTIVE: The aim of this study was to assess the prevalence of functional constipation and its relationship with the food intake, overweight status, and physical activity of children. METHODS: This cross-sectional study included students from two public schools in the municipality of Osasco, which is located in the metropolitan area of São Paulo. Functional constipation was diagnosed if the clinical manifestations of the Rome IV criteria were present for more than 2 months. A 24-h recall survey was used to determine the daily food intake. Weight, height, abdominal circumference, and bioelectrical impedance were used to evaluate the weight status. Active commuting to school and physical activity scores were assessed using a questionnaire that has been validated in Brazil. RESULTS: A total of 452 children, aged 6-12 years, were evaluated. Functional constipation was observed in 22.3% of participants. A greater abdominal circumference was associated with functional constipation in girls (p=0.036) in the bivariate analysis but not in the logistic regression model. Boys with functional constipation consumed higher quantities of fats (p=0.041). There was no statistically significant relationship between functional constipation and overweight status (44.6 and 34.5% of children with and without constipation, respectively; p=0.083) and active commuting to school (48.5 and 56.7% of children with and without constipation, respectively; p=0.179). CONCLUSION: Functional constipation was associated with a greater abdominal circumference in girls in the bivariate analysis, however, without association in the logistic regression model. Boys with functional constipation consumed higher quantities of fat. No association was found between functional constipation, overweight status, and physical activity.

Overweight status, abdominal circumference, physical activity, and functional constipation in children.

OBJECTIVE: The aim of this study was to assess the prevalence of functional constipation and its relationship with the food intake, overweight status, and physical activity of children. METHODS: This cross-sectional study included students from two public schools in the municipality of Osasco, which is located in the metropolitan area of São Paulo. Functional constipation was diagnosed if the clinical manifestations of the Rome IV criteria were present for more than 2 months. A 24-h recall survey was used to determine the daily food intake. Weight, height, abdominal circumference, and bioelectrical impedance were used to evaluate the weight status. Active commuting to school and physical activity scores were assessed using a questionnaire that has been validated in Brazil. RESULTS: A total of 452 children, aged 6-12 years, were evaluated. Functional constipation was observed in 22.3% of participants. A greater abdominal circumference was associated with functional constipation in girls (p=0.036) in the bivariate analysis but not in the logistic regression model. Boys with functional constipation consumed higher quantities of fats (p=0.041). There was no statistically significant relationship between functional constipation and overweight status (44.6 and 34.5% of children with and without constipation, respectively; p=0.083) and active commuting to school (48.5 and 56.7% of children with and without constipation, respectively; p=0.179). CONCLUSION: Functional constipation was associated with a greater abdominal circumference in girls in the bivariate analysis, however, without association in the logistic regression model. Boys with functional constipation consumed higher quantities of fat. No association was found between functional constipation, overweight status, and physical activity.

Fluid intake and urinary osmolality in pediatric patients with functional constipation.

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.

Water and fluid intake in the prevention and treatment of functional constipation in children and adolescents: is there evidence? / Ingestão de água e líquidos na prevenção e no tratamento da constipação intestinal funcional em crianças e adolescentes: existem evidências?

Abstract Objective: To study the evidence on the role of water and fluid intake in the prevention and treatment of functional intestinal constipation in children and adolescents. Source of data: A search was carried out in the Medline database (between 1966 and 2016) for all published articles containing the following words: constipation, water, and fluids, published in Portuguese, English, and Spanish. All original articles that assessed children and adolescents were selected by title and abstract. The references of these articles were also evaluated. Synthesis of data: A total of 1040 articles were retrieved. Of these, 24 were selected for reading. The study included 11 articles that assessed children and adolescents. The articles were divided into two categories, those that evaluated water and fluid intake as a risk factor for intestinal constipation and those that evaluated their role in the treatment of intestinal constipation. Five articles were included in the first category. The criteria for assessing fluid intake and bowel rhythm were different in each study. Three studies demonstrated an association between low fluid intake and intestinal constipation. Regarding treatment, five articles with heterogeneous methodologies were found. None of them clearly identified the favorable role of fluid intake in the treatment of intestinal constipation. Conclusion: There are few articles on the association between fluid intake and intestinal constipation. Epidemiological evidence indicates an association between lower fluid intake and intestinal constipation. Further clinical trials and epidemiological studies that consider the international recommendations for fluid intake by children and adolescents are required.

Resumo Objetivo: Estudar as evidências sobre o papel do consumo de água e líquidos na prevenção e no tratamento da constipação intestinal funcional em crianças e adolescentes. Fontes de dados: Foram pesquisados na base de dados do Medline (entre 1966 e 2016) todos os artigos publicados com as seguintes palavras: constipação, água e líquidos, nos idiomas português, inglês e espanhol. Foram selecionados, pelo título e resumo, todos os artigos originais com crianças e adolescentes. As referências desses artigos também foram avaliadas. Síntese de dados: Foram encontrados 1.040 artigos. Desses, 24 foram selecionados para leitura. Foram incluídos 11 artigos que estudaram crianças e adolescentes. Os artigos foram distribuídos em duas categorias, os que avaliaram o consumo de água e líquidos como fator de risco para constipação intestinal e os que avaliaram o seu papel na terapêutica da constipação intestinal. Cinco artigos se enquadraram na primeira categoria. Os critérios para avaliar consumo de líquidos e ritmo intestinal foram diferentes em cada estudo. Três estudos demonstraram relação entre baixo consumo de líquidos e constipação intestinal. Quanto ao tratamento, foram encontrados cinco artigos com metodologias heterogêneas. Em nenhum deles foi possível identificar com clareza o papel favorável do consumo de líquidos no tratamento da constipação intestinal. Conclusão: Existem poucos artigos sobre a relação entre consumo de líquidos e constipação intestinal. Evidências epidemiológicas indicam associação entre menor consumo de líquidos com constipação intestinal. São necessários outros ensaios clínicos e estudos epidemiológicos que levem em consideração as recomendações internacionais para consumo de líquidos por crianças e adolescentes.

Water and fluid intake in the prevention and treatment of functional constipation in children and adolescents: is there evidence?

OBJECTIVE: To study the evidence on the role of water and fluid intake in the prevention and treatment of functional intestinal constipation in children and adolescents. SOURCE OF DATA: A search was carried out in the Medline database (between 1966 and 2016) for all published articles containing the following words: constipation, water, and fluids, published in Portuguese, English, and Spanish. All original articles that assessed children and adolescents were selected by title and abstract. The references of these articles were also evaluated. SYNTHESIS OF DATA: A total of 1040 articles were retrieved. Of these, 24 were selected for reading. The study included 11 articles that assessed children and adolescents. The articles were divided into two categories, those that evaluated water and fluid intake as a risk factor for intestinal constipation and those that evaluated their role in the treatment of intestinal constipation. Five articles were included in the first category. The criteria for assessing fluid intake and bowel rhythm were different in each study. Three studies demonstrated an association between low fluid intake and intestinal constipation. Regarding treatment, five articles with heterogeneous methodologies were found. None of them clearly identified the favorable role of fluid intake in the treatment of intestinal constipation. CONCLUSION: There are few articles on the association between fluid intake and intestinal constipation. Epidemiological evidence indicates an association between lower fluid intake and intestinal constipation. Further clinical trials and epidemiological studies that consider the international recommendations for fluid intake by children and adolescents are required.

Behavioural changes observed in demyelination model shares similarities with white matter abnormalities in humans.

Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating disease of the central nervous system (CNS). Further to the symptoms resulting from demyelination, new studies point to the involvement of neuroinflammation and white matter abnormalities in psychiatric disorders and neurodegenerative diseases. Cuprizone, a model of MS, produces consistent demyelination and elicits behavioural, morphological and inflammatory changes in animals that share some similarities with those observed in humans. In this study, we used the cuprizone model in Lewis rats to evaluate clinical signs triggered by the demyelination process which could be comparable with the symptoms seen in white matter abnormalities in human beings. To induce the demyelination process, 0.6% cuprizone was added to the Lewis rats' diet for 4 weeks. We proceeded with behavioural, morphological and immunological analyses. Animals fed with cuprizone exhibited behavioural changes: higher scores in the neurotoxicity test, reduced exploratory and locomotion behaviour, and also an increase of permanency in the closed arm of the elevated plus maze test, were observed. In these analyses, the animals showed motor coordination impairment and anxiety-like behaviour. Demyelination also triggered changes in discrimination of objects identified by an increase in the time spent close to a familiar object. These behavioural alterations were associated with a significant increase in the levels of TNF-alpha and corticosterone, consistent with the activation of microglia and astrocytes. Taken together, the results of this work show the cuprizone/Lewis rat model demyelination as an attractive paradigm for studying the correlation between white matter abnormalities and behaviour.