Department of the Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.
Am J Gastroenterol. 2010 Apr;105(4):940-5. doi: 10.1038/ajg.2010.96. Epub 2010 Mar 2.
Food allergy and celiac disease may lead to childhood constipation. Early introduction of food allergens and gluten in the first year of life has been suggested to have a function in these food intolerances, but it is unclear whether this also holds true for development of childhood constipation. The aim of this study was to assess the association between the timing of introduction of food allergens and gluten early in life and functional constipation in childhood.
This study was embedded in the Generation R study, a population-based prospective cohort study from fetal life until young adulthood. Functional constipation at 24 months of age was defined in 4,651 children according to the Rome II criteria of defecation frequency <3 times a week or the presence of mainly hard feces for at least 2 weeks.
At the age of 24 months, 12% of the children had functional constipation. Children with functional constipation got introduced to gluten more often before or at the age of 6 months than children without functional constipation (37% and 27%, respectively). After adjustment for birth weight, gestational age, gender, ethnicity, maternal education, and family history of atopy and chronic intestinal disorders, functional constipation was significantly associated with early gluten introduction (odds ratio (OR): 1.35; 95% confidence interval (CI): 1.10-1.65). No association was found between timing of introduction of cow's milk, hen's egg, soy, peanuts, and tree nuts with functional constipation. A history of cow's milk allergy in the first year of life was significantly associated with functional constipation in childhood (OR: 1.57; 95% CI: 1.04-2.36).
These results suggest that early gluten introduction in the first year of life provide a trigger for functional constipation in a subset of children. In case of functional constipation, there also might be a role for cow's milk allergy initiated in the first year of life.
食物过敏和乳糜泻可能导致儿童便秘。有研究表明，在生命的第一年早期引入食物过敏原和麸质可能与这些食物不耐受有关，但这是否也适用于儿童便秘的发展尚不清楚。本研究旨在评估生命早期引入食物过敏原和麸质的时间与儿童功能性便秘之间的关系。
本研究嵌入了“Generation R 研究”，这是一项从胎儿期到成年早期的基于人群的前瞻性队列研究。根据排便频率<每周 3 次或至少 2 周内主要为硬粪便的罗马 II 标准，在 4651 名儿童中定义了 24 个月时的功能性便秘。
在 24 个月时，12%的儿童患有功能性便秘。有功能性便秘的儿童比没有功能性便秘的儿童更早（<6 个月）或同时引入麸质（分别为 37%和 27%）。在调整出生体重、胎龄、性别、种族、母亲教育以及特应性和慢性肠道疾病家族史后，功能性便秘与早期引入麸质显著相关（比值比（OR）：1.35；95%置信区间（CI）：1.10-1.65）。引入牛奶、鸡蛋、大豆、花生和坚果与功能性便秘之间无关联。生命第一年的牛奶过敏史与儿童期功能性便秘显著相关（OR：1.57；95% CI：1.04-2.36）。
这些结果表明，生命第一年早期引入麸质可能会引发一部分儿童的功能性便秘。在功能性便秘的情况下，生命第一年引发的牛奶过敏也可能起作用。
