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Dietary fiber and growth, iron status and bowel function in children 0-5 years old: a systematic review.
Dierkes, J, Nwaru, BI, Ramel, A, Arnesen, EK, Thorisdottir, B, Lamberg-Allardt, C, Spielau, U, Söderlund, F, Bärebring, L, Åkesson, A
Food & nutrition research. 2023;67
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Emerging evidence shows that high fibre intake has beneficial effects on bowel function, cardiometabolic risk factors and cardiometabolic risk in adults, while the benefits are less clear in children. The aim of this study was to identify, critically appraise and synthesize evidence from studies on the role of high fibre intake on growth and development, iron status and bowel function in small children living in affluent countries. This study was a systematic review of fours studies of which two were randomised controlled trials and the other two were observational studies. Results show that there are no robust associations between high intake of fibre and growth in healthy infants and preschool children. Increased dietary fibre increased stool production in the randomised controlled trials, but higher fibre intake was not associated with constipation in the observational study. Authors conclude that there is a lack of studies on high fibre intake and iron status in well-nourished infants and children. Thus, further studies are needed both to determine desirable levels of fibre intake in small children and to clarify the role of dietary fibre in infancy and childhood for normal bowel function, growth and nutritional status.
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.
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Dietary Fiber Intake (Supplemental or Dietary Pattern Rich in Fiber) and Diabetic Kidney Disease: A Systematic Review of Clinical Trials.
Carvalho, CM, Gross, LA, de Azevedo, MJ, Viana, LV
Nutrients. 2019;11(2)
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Most of the financial burden of diabetes mellitus is related to management of its complications, and chronic kidney disease is the most expensive and debilitating. The aim of the study was to evaluate the effect of dietary fibre (supplemental or dietary pattern rich in fibre) on diabetic kidney disease. The study is a systemic review that included seven interventional clinical trials that comprised 161 patients with diabetes with an age range of 20 to 74 years. The mean fibre intake in the intervention was 24 g/day and 16 g/day in the control group. Results indicate that only the vegetarian dietary pattern was associated with beneficial kidney outcomes in both type 1 and type 2 diabetes mellitus. There were no other dietary patterns that had favourable effects on kidney outcomes. Authors conclude that a vegetarian dietary pattern may have a beneficial effects on renal outcomes.
Abstract
Fiber intake is associated with better glycemic control being an important nonpharmacologicaltreatment for diabetes (DM). We hypothesize that a dietary fiber intake can bringbenefits to diabetic kidney disease (DKD), improving renal outcomes. This systematic review aimedto evaluate the effect of dietary fiber (supplemental or dietary pattern rich in fiber) on DKD. Wesearched six databases to identify clinical trials that reported fiber intake and renal outcomes(albuminuria, proteinuria, estimated glomerular filtration rate (eGFR) dialysis) in patients with DM.From 1814 studies, 48 papers were fully evaluated. In the end, seven trials (161 patients, aged 58.3years, 49% females) were included. The studies were organized into three categories (vegetarian,Dietary Approaches to Stop Hypertension (DASH) diet, and fiber supplement), two evaluatedsupplements and five dietary patterns. Vegetarian diet reduced albuminuria in three trials, two inpatients with type 1 DM and one in patients with type 2 DM; and one study demonstrated a change inthe eGFR in type 1 DM. The individual quality of the studies was low/uncertain. A vegetarian dietarypattern may have a beneficial effect on these renal outcomes. However, the individual effect of theintake of fiber on DKD not was possible to be evaluated.