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BMJ Clinical Evidence Mar 2015Prevalence of childhood constipation has been estimated at 1% to 30% in the general population worldwide; most children have no obvious aetiological factors. One third... (Review)
Review
INTRODUCTION
Prevalence of childhood constipation has been estimated at 1% to 30% in the general population worldwide; most children have no obvious aetiological factors. One third of children with chronic constipation continue to have problems beyond puberty. Half of the children with chronic faecal impaction and faecal incontinence have experienced an episode of painful defecation, and many children with chronic constipation exhibit withholding behaviour.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of fibre for children with chronic constipation? What are the effects of probiotics for children with chronic constipation? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 12 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: fibre and probiotics.
Topics: Child; Constipation; Dietary Fiber; Humans; Probiotics; Treatment Outcome
PubMed: 25758093
DOI: No ID Found -
Applied Physiology, Nutrition, and... Jan 2014The rates of overweight and obesity are rising in Canada and worldwide, and there is a need for effective methods for weight loss and weight maintenance to empower... (Review)
Review
The rates of overweight and obesity are rising in Canada and worldwide, and there is a need for effective methods for weight loss and weight maintenance to empower individuals to make changes. The purpose of this systematic review was to examine the evidence available for successful diet strategies for weight loss and weight maintenance among adults. A search was conducted of the following databases: CAB Abstracts, Central Register of Controlled Trials, EMBASE, MEDLINE, Food Science and Technology Abstracts, and Web of Knowledge. The studies investigated had participants who were overweight or obese and between 18 and 65 years of age. A successful study was defined as one that reported an intervention that created ≥5% weight loss from baseline and a maintenance phase during which the ≥5% weight loss was maintained from baseline to 12 months. After exclusions, the search resulted in 67 papers. Overall, for significant safe weight loss, an energy deficit was required, which was commonly achieved by reduced fat intake. Increased dietary fibre was also a component of 21% of successful interventions. Physical activity was included in 88% of successful interventions, and behaviour training such as self-monitoring was part of 92% of successful interventions. The same combination of energy and fat restriction, regular physical activity, and behavioural strategies was also required for successful weight maintenance. This review confirmed previous knowledge about weight loss and weight maintenance in adults. A comprehensive approach, including reduced dietary intake, regular physical activity, and behavioural strategies, is warranted and is supported by the research evidence.
Topics: Body Weight Maintenance; Diet, Reducing; Humans; Overweight; Weight Loss
PubMed: 24383502
DOI: 10.1139/apnm-2013-0026 -
The American Journal of Clinical... Mar 2013There is evidence that reducing blood glucose concentrations, inducing weight loss, and improving the lipid profile reduces cardiovascular risk in people with type 2... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is evidence that reducing blood glucose concentrations, inducing weight loss, and improving the lipid profile reduces cardiovascular risk in people with type 2 diabetes.
OBJECTIVE
We assessed the effect of various diets on glycemic control, lipids, and weight loss.
DESIGN
We conducted searches of PubMed, Embase, and Google Scholar to August 2011. We included randomized controlled trials (RCTs) with interventions that lasted ≥6 mo that compared low-carbohydrate, vegetarian, vegan, low-glycemic index (GI), high-fiber, Mediterranean, and high-protein diets with control diets including low-fat, high-GI, American Diabetes Association, European Association for the Study of Diabetes, and low-protein diets.
RESULTS
A total of 20 RCTs were included (n = 3073 included in final analyses across 3460 randomly assigned individuals). The low-carbohydrate, low-GI, Mediterranean, and high-protein diets all led to a greater improvement in glycemic control [glycated hemoglobin reductions of -0.12% (P = 0.04), -0.14% (P = 0.008), -0.47% (P < 0.00001), and -0.28% (P < 0.00001), respectively] compared with their respective control diets, with the largest effect size seen in the Mediterranean diet. Low-carbohydrate and Mediterranean diets led to greater weight loss [-0.69 kg (P = 0.21) and -1.84 kg (P < 0.00001), respectively], with an increase in HDL seen in all diets except the high-protein diet.
CONCLUSION
Low-carbohydrate, low-GI, Mediterranean, and high-protein diets are effective in improving various markers of cardiovascular risk in people with diabetes and should be considered in the overall strategy of diabetes management.
Topics: Blood Glucose; Cardiovascular Diseases; Diabetes Mellitus, Type 2; Diet, Carbohydrate-Restricted; Diet, Fat-Restricted; Diet, Mediterranean; Diet, Protein-Restricted; Diet, Vegetarian; Dietary Carbohydrates; Dietary Fats; Dietary Fiber; Dietary Proteins; Energy Intake; Glycemic Index; Humans; Lipids; Randomized Controlled Trials as Topic; Risk Factors; Weight Loss
PubMed: 23364002
DOI: 10.3945/ajcn.112.042457 -
Nutrients Aug 2019Weight regain after a successful weight loss intervention is very common. Most studies show that, on average, the weight loss attained during a weight loss intervention... (Meta-Analysis)
Meta-Analysis
Weight regain after a successful weight loss intervention is very common. Most studies show that, on average, the weight loss attained during a weight loss intervention period is not or is not fully maintained during follow-up. We review what is currently known about dietary strategies for weight loss maintenance, focusing on nutrient composition by means of a systematic review and meta-analysis of studies and discuss other potential strategies that have not been studied so far. Twenty-one studies with 2875 participants who were overweight or obese are included in this systematic review and meta-analysis. Studies investigate increased protein intake (12 studies), lower dietary glycemic index (four studies), green tea (three studies), conjugated linoleic acid (three studies), higher fibre intake (three studies), and other miscellaneous interventions (six studies). The meta-analysis shows a significant beneficial effect of higher protein intake on the prevention of weight regain (SMD (standardized mean difference) -0.17 (95% CI -0.29, -0.05), = 2.80, = 0.005), without evidence for heterogeneity among the included studies. No significant effect of the other strategies is detected. Diets that combine higher protein intake with different other potentially beneficial strategies, such as anti-inflammatory or anti-insulinemic diets, may have more robust effects, but these have not been tested in randomized clinical trials yet.
Topics: Adolescent; Adult; Aged; Diet, Healthy; Dietary Fiber; Dietary Proteins; Dietary Supplements; Energy Intake; Female; Glycemic Index; Humans; Linoleic Acids, Conjugated; Male; Middle Aged; Nutritive Value; Obesity; Recurrence; Treatment Outcome; Weight Gain; Weight Loss; Young Adult
PubMed: 31443231
DOI: 10.3390/nu11081916 -
Nutrients May 2020Lactose intolerance (LI) is characterized by the presence of primarily gastrointestinal clinical signs resulting from colonic fermentation of lactose, the absorption of... (Meta-Analysis)
Meta-Analysis
Lactose intolerance (LI) is characterized by the presence of primarily gastrointestinal clinical signs resulting from colonic fermentation of lactose, the absorption of which is impaired due to a deficiency in the lactase enzyme. These clinical signs can be modified by several factors, including lactose dose, residual lactase expression, concurrent ingestion of other dietary components, gut-transit time, and enteric microbiome composition. In many of individuals with lactose malabsorption, clinical signs may be absent after consumption of normal amounts of milk or, in particular, dairy products (yogurt and cheese), which contain lactose partially digested by live bacteria. The intestinal microbiota can be modulated by biotic supplementation, which may alleviate the signs and symptoms of LI. This systematic review summarizes the available evidence on the influence of prebiotics and probiotics on lactase deficiency and LI. The literature search was conducted using the MEDLINE (via PUBMED) and SCOPUS databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and included randomized controlled trials. For each study selected, the risk of bias was assessed following the Cochrane Collaboration methodology. Our findings showed varying degrees of efficacy but an overall positive relationship between probiotics and LI in relation to specific strains and concentrations. Limitations regarding the wide heterogeneity between the studies included in this review should be taken into account. Only one study examined the benefits of prebiotic supplementation and LI. So further clinical trials are needed in order to gather more evidence.
Topics: Abdominal Pain; Animals; Databases, Factual; Diarrhea; Diet; Flatulence; Food, Fortified; Gastrointestinal Microbiome; Humans; Lactase; Lactose; Lactose Intolerance; Milk; Prebiotics; Probiotics; Vomiting
PubMed: 32443748
DOI: 10.3390/nu12051487 -
Nutrients Jun 2019While dietary factors are important modifiable risk factors for type 2 diabetes (T2D), the causal role of carbohydrate quality in nutrition remains controversial.... (Meta-Analysis)
Meta-Analysis
While dietary factors are important modifiable risk factors for type 2 diabetes (T2D), the causal role of carbohydrate quality in nutrition remains controversial. Dietary glycemic index (GI) and glycemic load (GL) have been examined in relation to the risk of T2D in multiple prospective cohort studies. Previous meta-analyses indicate significant relations but consideration of causality has been minimal. Here, the results of our recent meta-analyses of prospective cohort studies of 4 to 26-y follow-up are interpreted in the context of the nine Bradford-Hill criteria for causality, that is: (1) Strength of Association, (2) Consistency, (3) Specificity, (4) Temporality, (5) Biological Gradient, (6) Plausibility, (7) Experimental evidence, (8) Analogy, and (9) Coherence. These criteria necessitated referral to a body of literature wider than prospective cohort studies alone, especially in criteria 6 to 9. In this analysis, all nine of the Hill's criteria were met for GI and GL indicating that we can be confident of a role for GI and GL as causal factors contributing to incident T2D. In addition, neither dietary fiber nor cereal fiber nor wholegrain were found to be reliable or effective surrogate measures of GI or GL. Finally, our cost-benefit analysis suggests food and nutrition advice favors lower GI or GL and would produce significant potential cost savings in national healthcare budgets. The high confidence in causal associations for incident T2D is sufficient to consider inclusion of GI and GL in food and nutrient-based recommendations.
Topics: Animals; Biomarkers; Blood Glucose; Diabetes Mellitus, Type 2; Diet; Glycemic Index; Glycemic Load; Humans; Incidence; Prognosis; Risk Assessment; Risk Factors
PubMed: 31242690
DOI: 10.3390/nu11061436 -
The Journal of Pediatrics Jan 2022To evaluate the effectiveness and safety of nonpharmacologic interventions for the treatment of childhood functional constipation. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the effectiveness and safety of nonpharmacologic interventions for the treatment of childhood functional constipation.
STUDY DESIGN
Randomized controlled trials (RCTs) evaluating nonpharmacologic treatments in children with functional constipation which reported at least 1 outcome of the core outcome set for children with functional constipation.
RESULTS
We included 52 RCTs with 4668 children, aged between 2 weeks and 18 years, of whom 47% were females. Studied interventions included gut microbiome-directed interventions, other dietary interventions, oral supplements, pelvic floor-directed interventions, electrical stimulation, dry cupping, and massage therapy. An overall high risk of bias was found across the majority of studies. Meta-analyses for treatment success and/or defecation frequency, including 20 RCTs, showed abdominal electrical stimulation (n = 3), Cassia Fistula emulsion (n = 2), and a cow's milk exclusion diet (n = 2 in a subpopulation with constipation as a possible manifestation of cow's milk allergy) may be effective. Evidence from RCTs not included in the meta-analyses, indicated that some prebiotic and fiber mixtures, Chinese herbal medicine (Xiao'er Biantong granules), and abdominal massage are promising therapies. In contrast, studies showed no benefit for the use of probiotics, synbiotics, an increase in water intake, dry cupping, or additional biofeedback or behavioral therapy. We found no RCTs on physical movement or acupuncture.
CONCLUSIONS
More well-designed high quality RCTs concerning nonpharmacologic treatments for children with functional constipation are needed before changes in current guidelines are indicated.
Topics: Biofeedback, Psychology; Cognitive Behavioral Therapy; Constipation; Cryotherapy; Diet; Electric Stimulation Therapy; Exercise Therapy; Humans; Laxatives; Massage; Phytotherapy; Prebiotics
PubMed: 34536492
DOI: 10.1016/j.jpeds.2021.09.010 -
Nutrients Sep 2021Excessive consumption of ultra-processed foods (UPFs), as described by the NOVA classification system, represents a potential threat to human health. The nutritional... (Meta-Analysis)
Meta-Analysis
Excessive consumption of ultra-processed foods (UPFs), as described by the NOVA classification system, represents a potential threat to human health. The nutritional composition of UPFs may explain their observed adverse effects. The present study aimed to provide a quantitative meta-analysis of nationally representative surveys on the consumption of UPFs and the dietary/nutrient composition of respondents' diets. A systematic search for relevant studies published prior to July 2021 was conducted via electronic databases. The studies that provided the dietary/nutrient composition of foods categorized according to the NOVA classification system were selected. The association between UPFs and other dietary variables was modelled using ordinary least squares linear regression based on aggregated data extracted from the selected articles. Consumption of UPFs represented up to 80% of total caloric intake in the US and Canada, with confectionery and sugar-sweetened beverages being the most consumed items. When considered in relation to other food groups, an inverse linear relation between UPFs and less-processed foods was evident. Increased UPF intake correlated with an increase in free sugars, total fats, and saturated fats, as well as a decrease in fiber, protein, potassium, zinc, and magnesium, and vitamins A, C, D, E, B12, and niacin. In conclusion, the data indicate that increased UPF consumption negatively affects the nutritional quality of diets.
Topics: Adolescent; Adult; Child; Diet; Dietary Sugars; Energy Intake; Fast Foods; Female; Food Handling; Food Quality; Humans; Male; Nutrition Surveys; Nutritive Value; Snacks; Sugar-Sweetened Beverages
PubMed: 34684391
DOI: 10.3390/nu13103390 -
Nutrients Oct 2023Health authorities increasingly recommend sustainable and healthy diets rich in plant foods and with moderate amounts of animal foods. However, there are concerns about... (Review)
Review
Health authorities increasingly recommend sustainable and healthy diets rich in plant foods and with moderate amounts of animal foods. However, there are concerns about whether such diets can meet all nutrient requirements, especially in children and adolescents, who have relatively high nutrient needs for growth and development. Therefore, we aimed to evaluate the nutrient intake and status of children and adolescents (2-18 y) consuming plant-based (i.e., vegetarian and vegan) diets compared to those of meat-eating children following a systematic literature review of studies published between 2000 and 2022. Mean intake and status data of nutrients were calculated across studies and benchmarked to dietary reference values and cut-off values for nutrient deficiencies. A total of 30 studies were included (15 in children 2-5 y, 24 in children 6-12 y, and 11 in adolescents 13-18 y). In all diets, there were risks of inadequate intakes of vitamin D and calcium. Children consuming meat had a risk of inadequate folate and vitamin E intake; and mean fiber, SAFA, and PUFA intakes were not in line with the recommendations. Children consuming plant-based diets risked inadequate vitamin B12, iron, and zinc intakes. In contrast to vegans, vegetarian children may not meet the recommended intakes of fiber, SAFA, and possibly PUFA, but their mean intakes were more favorable than in meat-eating children. Although the data are limited and need further validation, our findings indicate that there are risks of nutritional inadequacies in all diet groups. Therefore, increasing consumption of a variety of plant-based foods, in combination with food fortification and supplementation where needed, is recommended for children and adolescents to have sustainable and nutritionally adequate diets.
Topics: Animals; Humans; Child; Adolescent; Diet; Energy Intake; Meat; Eating; Diet, Vegan; Diet, Vegetarian
PubMed: 37892416
DOI: 10.3390/nu15204341 -
PLoS Medicine Jul 2016Effects of major dietary macronutrients on glucose-insulin homeostasis remain controversial and may vary by the clinical measures examined. We aimed to assess how... (Meta-Analysis)
Meta-Analysis Review
Effects of Saturated Fat, Polyunsaturated Fat, Monounsaturated Fat, and Carbohydrate on Glucose-Insulin Homeostasis: A Systematic Review and Meta-analysis of Randomised Controlled Feeding Trials.
BACKGROUND
Effects of major dietary macronutrients on glucose-insulin homeostasis remain controversial and may vary by the clinical measures examined. We aimed to assess how saturated fat (SFA), monounsaturated fat (MUFA), polyunsaturated fat (PUFA), and carbohydrate affect key metrics of glucose-insulin homeostasis.
METHODS AND FINDINGS
We systematically searched multiple databases (PubMed, EMBASE, OVID, BIOSIS, Web-of-Knowledge, CAB, CINAHL, Cochrane Library, SIGLE, Faculty1000) for randomised controlled feeding trials published by 26 Nov 2015 that tested effects of macronutrient intake on blood glucose, insulin, HbA1c, insulin sensitivity, and insulin secretion in adults aged ≥18 years. We excluded trials with non-isocaloric comparisons and trials providing dietary advice or supplements rather than meals. Studies were reviewed and data extracted independently in duplicate. Among 6,124 abstracts, 102 trials, including 239 diet arms and 4,220 adults, met eligibility requirements. Using multiple-treatment meta-regression, we estimated dose-response effects of isocaloric replacements between SFA, MUFA, PUFA, and carbohydrate, adjusted for protein, trans fat, and dietary fibre. Replacing 5% energy from carbohydrate with SFA had no significant effect on fasting glucose (+0.02 mmol/L, 95% CI = -0.01, +0.04; n trials = 99), but lowered fasting insulin (-1.1 pmol/L; -1.7, -0.5; n = 90). Replacing carbohydrate with MUFA lowered HbA1c (-0.09%; -0.12, -0.05; n = 23), 2 h post-challenge insulin (-20.3 pmol/L; -32.2, -8.4; n = 11), and homeostasis model assessment for insulin resistance (HOMA-IR) (-2.4%; -4.6, -0.3; n = 30). Replacing carbohydrate with PUFA significantly lowered HbA1c (-0.11%; -0.17, -0.05) and fasting insulin (-1.6 pmol/L; -2.8, -0.4). Replacing SFA with PUFA significantly lowered glucose, HbA1c, C-peptide, and HOMA. Based on gold-standard acute insulin response in ten trials, PUFA significantly improved insulin secretion capacity (+0.5 pmol/L/min; 0.2, 0.8) whether replacing carbohydrate, SFA, or even MUFA. No significant effects of any macronutrient replacements were observed for 2 h post-challenge glucose or insulin sensitivity (minimal-model index). Limitations included a small number of trials for some outcomes and potential issues of blinding, compliance, generalisability, heterogeneity due to unmeasured factors, and publication bias.
CONCLUSIONS
This meta-analysis of randomised controlled feeding trials provides evidence that dietary macronutrients have diverse effects on glucose-insulin homeostasis. In comparison to carbohydrate, SFA, or MUFA, most consistent favourable effects were seen with PUFA, which was linked to improved glycaemia, insulin resistance, and insulin secretion capacity.
Topics: Adult; Blood Glucose; Dietary Carbohydrates; Fats, Unsaturated; Fatty Acids, Monounsaturated; Fatty Acids, Unsaturated; Glycated Hemoglobin; Homeostasis; Humans; Insulin; Randomized Controlled Trials as Topic
PubMed: 27434027
DOI: 10.1371/journal.pmed.1002087