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Controversies on the relationship between increased body mass index and treatment-resistant chronic constipation in
Sudipta Misra1,2, Andrew Liaw1
1Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, UIC College of Medicine at Peoria and Children's Hospital Of Illinois at OSF St Francis Medical Center, Peoria, Illinois, USA.
Insights
Children with increased body mass index (BMI) are not at higher risk for constipation. However, those with constipation and increased BMI are more likely to need specialist referral, suggesting treatment-resistant constipation.
Area of Science:
- Pediatric Gastroenterology
- Public Health
- Obesity Research
Background:
- Conflicting reports exist regarding the link between elevated body mass index (BMI) and constipation in children.
- This study addresses the controversy using a retrospective chart review in a primary care setting.
Purpose of the Study:
- To investigate the association between increased BMI and constipation in pediatric patients.
- To determine if children with increased BMI and constipation are more likely to be referred to subspecialty care.
Main Methods:
- Retrospective chart review of two groups of children from a primary care clinic.
- Group 1: Assessed BMI and constipation incidence in general pediatric care patients.
- Group 2: Reviewed charts of children diagnosed with constipation for BMI prevalence and subspecialty referral rates.
Main Results:
- Increased BMI did not correlate with a higher prevalence of constipation in the general pediatric population.
- Children with constipation and increased BMI were three times more likely to be referred to pediatric gastroenterology (p = 0.04).
- Prevalence of increased BMI was similar between the general pediatric group (33.4%) and the constipation group (30.3%).
Conclusions:
- Children with increased BMI are not at increased risk for developing constipation.
- Children with both increased BMI and constipation show a higher likelihood of treatment resistance, indicated by increased subspecialty referrals.
Background:
There are conflicting reports on the association between children with increased body mass index (BMI), and constipation. This retrospective chart review of two groups of children from a primary care clinic was designed to address the controversy.
Methods:
Group-1: Charts of all children seen in a year for general pediatric care were reviewed for incidences of increased BMI (>85th percentile) and constipation as well as overweight recognition in the final diagnosis; Group-2: Children diagnosed with constipation at the same primary care setting for 5 years were identified by ICD-9 code. These charts were reviewed for prevalence of increased BMI and incidences of referral to subspecialty clinic.
Results:
Group-1: Three hundred nineteen (33.4%) of the 955 children had increased BMI and 28 (2.93%) had constipation. The prevalence of constipation was not increased among children with increased BMI. Group-2: 24 of the 66 children with constipation were referred to the pediatric gastroenterology clinic. children with increased BMI were three times more likely to be referred (n = 20, p = 0.04). The two groups had a similar prevalence of children with increased BMI (Group 1 = 33.4%; Group 2 = 30.3%).
Conclusion:
In the general pediatric population, children with an increased BMI were not at an increased risk of developing constipation. However, children with increased BMI and constipation were three times more likely to be referred, presumably for treatment failure, to the pediatric gastroenterology clinic .Hence children with increased BMI were more likely to develop treatment resistant constipation.
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