Dietary fiber and growth, iron status and bowel function in children 0–5 years old: a systematic review

Jutta Dierkes; Bright I. Nwaru; Alfons Ramel; Erik Kristoffer Arnesen; Birna Thorisdottir; Christel Lamberg-Allardt; Ulrike Spielau; Fredrik Söderlund; Linnea Bärebring; Agneta Åkesson

doi:10.29219/fnr.v67.9011

Jutta Dierkes Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Laboratory Medicine and Pathology, Haukeland University Hospital, Bergen, Norway
Bright I. Nwaru Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
Alfons Ramel Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
Erik Kristoffer Arnesen Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
Birna Thorisdottir Faculty of Sociology, Anthropology and Folkloristics & Health Science Institute, University of Iceland, Reykjavik, Iceland
Christel Lamberg-Allardt Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
Ulrike Spielau
Fredrik Söderlund Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
Linnea Bärebring Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Agneta Åkesson Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

DOI: https://doi.org/10.29219/fnr.v67.9011

Keywords: Dietary fiber and growth, systematic review, Nordic Nutrition Recommendations, iron status, children

Abstract

Background: While dietary fiber intake is low in many children, the current trend to plant-based diets is associated with higher fiber intake in children raised on these diets. As older reports indicate that diets providing high fiber intake in children 0–5 years may affect growth, iron status and bowel function, we summarized the available evidence in this systematic review.

Objective: To identify, critically appraise, and synthesize evidence on the effect of high fiber intake on growth, iron and bowel function in children 0–5 years, with relevance to the Nordic and Baltic countries.

Methods: Following a pre-registered protocol, we searched MEDLINE, EMBASE, Cochrane Central of Controlled Trials, and Scopus for clinical trials and prospective cohort studies published until November 2021. Two reviewers independently screened retrieved literature, extracted relevant data, and performed risk of bias assessment. Outcomes were growth, iron metabolism and bowel function in children 0–5 years. We narratively described findings from studies that met inclusion criteria.

Results: From 5,644 identified records, five articles met the inclusion criteria. Two RCTs had an overall moderate risk of bias, while the three observational studies had serious risk. Overall, we found no robust association between high intake of dietary fiber and growth. In the RCTs, higher intake of fiber had a positive effect on bowel movements and constipation. No studies on fiber intake and iron status were identified.

The certainty of the overall evidence was inconclusive for growth and bowel function, while no assessment was made for iron status.

Conclusion: We found no clear association between high intake of dietary fiber and growth or bowel function in young children living in affluent countries, albeit with only a limited number of studies. There is a lack of studies investigating health effects of high fiber intake in small children.

Downloads

Download data is not yet available.

References

1.
European Food Safety Authority. Scientific opinion on dietary reference values for carbohydrates and dietary fibre. EFSA J 2010; 8: 1–77. doi: 10.2903/j.efsa.2010.1462

2.
Stephen AM, Champ MM, Cloran SJ, Fleith M, van Lieshout L, Mejborn H, Burley VJ. Dietary fibre in Europe: current state of knowledge on definitions, sources, recommendations, intakes and relationships to health. Nutr Res Rev. 2017 Dec;30(2):149–190.

3.
Mikkilä V, Räsänen L, Raitakari OT, Pietinen P, Viikari J. Consistent dietary patterns identified from childhood to adulthood: the cardiovascular risk in young finns study. Br J Nutr 2005; 93: 923–31. doi: 10.1079/BJN20051418

4.
Edwards CA, Parrett AM. Dietary fibre in infancy and childhood. Proc Nutr Soc 2003; 62: 17–23. doi: 10.1079/PNS2002231

5.
Schürmann S, Kersting M, Alexy U. Vegetarian diets in children: a systematic review. Eur J Nutr 2017; 56: 1797–817. doi: 10.1007/s00394-017-1416-0

6.
Desmond MA, Sobiecki JG, Jaworski M, Płudowski P, Antoniewicz J, Shirley MK, et al. Growth, body composition, and cardiovascular and nutritional risk of 5- to 10-y-old children consuming vegetarian, vegan, or omnivore diets. Am J Clin Nutr. 2021 Jun 1;113(6):1565-1577.

7.
Roberts I, West R, Ogilvie D, Dillon M. Malnutrition in infants receiving cult diets: a form of child abuse. Br Med J 1979; 1: 296–8. doi: 10.1136/bmj.1.6159.296

8.
Dwyer JT, Andrew EM, Berkey C, Valadian I, Reed RB. Growth in ‘new’ vegetarian preschool children using the Jenns-Bayley curve fitting technique. Am J Clin Nutr 1983; 37: 815–27. doi: 10.1093/ajcn/37.5.815

9.
Dagnelie PC, Vergote FJ, van Staveren WA, van den Berg H, Dingjan PG, Hautvast JG. High prevalence of rickets in infants on macrobiotic diets. Am J Clin Nutr. 1990 Feb;51(2):202–8.

10.
Sanders TAB. Growth and development of British vegan children. Am J Clin Nutr 1988; 48: 822–5. doi: 10.1093/ajcn/48.3.822

11.
Williams CL, Bollella M. Is a high-fiber diet safe for children? Pediatrics 1995; 96: 1014–19. doi: 10.1542/peds.96.5.1014

12.
Reynolds AN, Diep Pham HT, Montez J, Mann J. Dietary fibre intake in childhood or adolescence and subsequent health outcomes: a systematic review of prospective observational studies. Diabetes Obes Metab 2020; 22: 2460–7. doi: 10.1111/dom.14176

13.
Nordic Council of Ministers (editor) Nord 2014:002 ISBN 978–92–893–2670–4. doi: 10.6027/Nord2014-002

14.
Christensen JJ, Arnesen EK, Andersen R, Eneroth H, Erkkola M, Høyer A, et al. The Nordic Nutrition Recommendations 2022 - principles and methodologies. Food Nutr Res. 2020 Jun 18;64. doi: 10.29219/fnr.v64.4402.

15.
Høyer A, Christensen JJ, Arnesen EK, Andersen R, Eneroth H, Erkkola M, Lemming EW, Meltzer HM, Halldórsson ÞI, Þórsdóttir I, Schwab U, Trolle E, Blomhoff R. The Nordic Nutrition Recommendations 2022 - prioritisation of topics for de novo systematic reviews. Food Nutr Res. 2021 Oct 8;65. doi: 10.29219/fnr.v65.7828.

16.
Arnesen EK, Christensen JJ, Andersen R, Eneroth H, Erkkola M, Høyer A, et al. The Nordic Nutrition Recommendations 2022 - structure and rationale of qualified systematic reviews. Food Nutr Res. 2020 Jun 18;64. doi: 10.29219/fnr.v64.4403.

17.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71. doi: 10.1136/bmj.n71

18.
Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 2021; 372: n160. doi: 10.1136/bmj.n160

19.
Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; 355: 4–10. doi: 10.1136/bmj.i4919

20.
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: 1–8. doi: 10.1136/bmj.l4898

21.
Morton SC, Murad MH, O’Connor E, Lee CS, Booth M, Vandermeer BW, et al. Quantitative synthesis – An update. Methods guide for effectiveness and comparative effectiveness reviews. AHRQ methods for effective health care. Rockville, MD: AHRQ; 2018.

22.
Deeks J, Higgins JP, Altman DG. Analysing data and undertaking meta-analyses. In: Cochrane handbook for systematic reviews of interventions version 6.3 (updated February 2022). Cochrane; 2022. availabe from: www.training.cochrane.org/handbook.

23.
Moore N, Chao C, Yang LP, Storm H, Oliva-Hemker M, Saavedra JM. Effects of fructo-oligosaccharide-supplemented infant cereal: a double-blind, randomized trial. Br J Nutr 2003; 90: 581–7. doi: 10.1079/BJN2003950

24.
Williams CL, Bollella MC, Campanaro L, Strobino BA, Boccia L. Plant stanol ester and bran fiber in childhood: effects on lipids, stool weight and stool frequency in preschool children. J Am Coll Nutr 1999; 18: 572–81. doi: 10.1080/07315724.1999.10718891

25.
Kiefte-de Jong JC, de Vries JH, Escher JC, Jaddoe VW, Hofman A, Raat H, et al. Role of dietary patterns, sedentary behaviour and overweight on the longitudinal development of childhood constipation: the generation R study. Matern Child Nutr 2013; 9: 511–23. doi: 10.1111/j.1740-8709.2011.00395.x

26.
van Gijssel RMA, Braun KV, Kiefte-de Jong JC, Jaddoe VW, Franco OH, Voortman T. Associations between dietary fiber intake in infancy and cardiometabolic health at school age: the generation R study. Nutrients 2016; 8: 531. doi: 10.3390/nu8090531

27.
Ruottinen S, Lagström HK, Niinikoski H, Rönnemaa T, Saarinen M, Pahkala et al. Dietary fiber does not displace energy but is associated with decreased serum cholesterol concentrations in healthy children. Am J Clin Nutr 2010; 91: 651–61. doi: 10.3945/ajcn.2009.28461

28.
Kranz S, Brauchla M, Slavin JL, Miller KB. What do we know about dietary fiber intake in children and health? The effects of fiber intake on constipation, obesity, and diabetes in children. Adv Nutr 2012; 3: 47–53. doi: 10.3945/an.111.001362

29.
Alexy U, Kersting M, Sichert-Hellert W. Evaluation of dietary fibre intake from infancy to adolescence against various references – results of the DONALD study. Eur J Clin Nutr 2006; 60: 909–14. doi: 10.1038/sj.ejcn.1602400

30.
Taylor CM, Northstone K, Wernimont SM, Emmett PM. Picky eating in preschool children: associations with dietary fibre intakes and stool hardness. Appetite 2016; 100: 263–71. doi: 10.1016/j.appet.2016.02.021

31.
Øverby NC, Kristiansen AL, Andersen LF, Lande B. Spedkost – 12 måneder. Landsomfattende kostholdsundersøkelse blant 12 måneder gamle barn. Spedkost 2006–2007. 2009. S-1635, p 1–107 vailable from: https://www.helsedirektoratet.no/rapporter/spedkost-og-smabarnskost-landsomfattende-kostholdsundersokelser/Spedkost12måneder–landsomfattendekostholdundersøkelse2007-2008.pdf/

32.
Kristiansen AL, Andersen LF, Lande B. Småbarnskost – 2 år Landsomfattende kostholdsundersøkelse blant 2 år gamle barn. IS-1731, 1–94, 2009.

33.
Barbieri HE, Pearson M, Becker W. Riksmaten – barn 2003: Livsmedles- och näringsintag bland barn i Sverige. Uppsala: Livsmedelsverket; 2003.

34.
van den Berg MM, Benninga MD, Di Lorenzo C. Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol 2006; 101: 2401–9. doi: 10.1111/j.1572-0241.2006.00771.x

35.
Morais MB, Vitolo MR, Aguirre AN, Fagundes-Neto U. Measurement of low dietary fiber intake as a risk factor for chronic constipation in children. J Pediatr Gastroenterol Nutr 1999; 29: 132–5. doi: 10.1097/00005176-199908000-00007

36.
Institute of Medicine. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, DC: The National Academies Press; 2005.

Dietary fiber and growth, iron status and bowel function in children 0–5 years old: a systematic review

Abstract

Downloads

References

Most read articles by the same author(s)