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Dietary interventions for functional abdominal pain disorders in children: a systematic review and meta-analysis
Clara Ma de Bruijn1,2,3, Robyn Rexwinkel1,2,3, Morris Gordon4
1Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Insights
Dietary fiber may improve treatment success for children with functional abdominal pain disorders (FAPDs). However, more high-quality research is needed to confirm the effectiveness of various dietary interventions for pediatric FAPDs.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Evidence-Based Medicine
Background:
- Functional abdominal pain disorders (FAPDs) significantly impact children's quality of life and school attendance.
- Dietary interventions are frequently considered for managing pediatric FAPDs.
- This review evaluates the efficacy and safety of dietary approaches for FAPDs in children.
Purpose of the Study:
- To systematically review the evidence on dietary interventions for pediatric FAPDs.
- To assess the efficacy and safety of various diets in improving FAPD symptoms.
- To determine the quality of evidence for different dietary strategies.
Main Methods:
- Systematic review of systematic reviews and randomized controlled trials (RCTs) from inception to October 2021.
- Included studies involved children aged 4-18 with FAPDs receiving dietary interventions.
- Outcomes included treatment success, pain intensity/frequency, and adverse events, assessed using the GRADE system.
Main Results:
- Twelve articles, encompassing 819 patients, were analyzed.
- Investigated interventions included fibers, FODMAP diet, fructans, fructose-restricted diet, prebiotics, and vitamin D.
- Very low-certainty evidence suggests fiber supplementation improves treatment success (NNT=5).
Conclusions:
- Fiber supplementation may be a viable option for discussion in clinical practice for pediatric FAPDs.
- High-quality intervention trials are essential to validate other dietary interventions.
- Further research is needed to establish effective dietary treatments for pediatric FAPDs.
Background:
Functional abdominal pain disorders (FAPDs) are common among children and are associated with decreased quality of life and school attendance. Several dietary interventions have been suggested to improve symptoms of FAPDs. This systematic review assessed the efficacy and safety of dietary interventions for pediatric FAPDs.
Design And Methods:
Electronic databases were searched (inception-October 2021). Systematic reviews or RCTs were included if children (4-18 years) with FAPDs were treated with dietary interventions and compared to placebo, no diet or any other diet. Data extraction and assessment of quality of evidence based on GRADE system was independently performed by two review authors. Outcomes were treatment success, pain intensity and frequency, and withdrawal due to adverse events.
Results:
Twelve articles were included, representing data of 819 pediatric FAPD patients. Trials investigating fibers, FODMAP diet, fructans, fructose-restricted diet, prebiotic (inulin), serum-derived bovine immunoglobulin, and vitamin D supplementation were included. We found very low-certainty evidence that the use of fibers leads to higher treatment success (NNT = 5).
Conclusion:
Based on current evidence, the use of fibers can be discussed in daily practice. High-quality intervention trials are highly needed to investigate if other dietary interventions are effective in the treatment of pediatric FAPD.
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