DOI QR코드

DOI QR Code

The Magnesium-Rich Formula for Functional Constipation in Infants: a Randomized Comparator-Controlled Study

  • Benninga, Marc A. (Department of Pediatric Gastroenterology, Emma Children's Hospital, Academic Medical Center) ;
  • MENA Infant Constipation Study Group (KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel) ;
  • Vandenplas, Yvan (KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel)
  • 투고 : 2018.09.13
  • 심사 : 2018.11.24
  • 발행 : 2019.05.15

초록

Purpose: To compare the effectiveness of the magnesium (Mg)-enriched formula vs. control formula in constipated infants. Methods: An open-label, interventional, and the comparator-controlled study was conducted to evaluate the effectiveness of the Mg-enriched formula in formula-fed infants ${\leq}6$ months old presenting with functional constipation according to modified Rome IV criteria. Infants were randomized 1:1 to intervention or control formula for 30 days. Parents recorded stool consistency (hard, normal, or watery) and frequency on days 1-7 and 23-29. Physicians recorded patient baseline characteristics and performed the clinical examination at the time of three patient visits (baseline, day 8, and 30). Results: Of the 286 recruited infants, 143 received the Mg-rich formula and 142 received the control formula. After 7 days, significantly more infants had stools with normal consistency with the Mg-rich formula compared to the infants fed with the control formula (81.8% vs. 41.1%; p<0.001). The number of infants passing one or more stools per day was increased at day 7 in the Mg-rich formula group (86.7% vs. 68.2%; p<0.001). At days 7 and 29, >25% of infants responded completely to the Mg-rich formula compared to <5% of infants fed with the control formula (p<0.001). Parents of infants in the Mg-rich formula group were very satisfied with the treatment (80.8% vs. 10.2%), with the majority willing to continue treatment after 30 days (97.9% vs. 52.6%; p<0.001). Conclusion: The Mg-rich formula significantly improved stool consistency and frequency compared to the control formula in constipated infants.

키워드

참고문헌

  1. Baker SS, Liptak GS, Colletti RB, Croffie JM, Di Lorenzo C, Ector W, et al. Constipation in infants and children: evaluation and treatment. A medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr 1999;29:612-26. https://doi.org/10.1097/00005176-199911000-00029
  2. van den Berg MM, Benninga MA, Di Lorenzo C. Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol 2006;101:2401-9. https://doi.org/10.1111/j.1572-0241.2006.00771.x
  3. Vandenplas Y, Abkari A, Bellaiche M, Benninga M, Chouraqui JP, Cokura F, et al. Prevalence and health outcomes of functional gastrointestinal symptoms in infants from birth to 12 months of age. J Pediatr Gastroenterol Nutr 2015;61:531-7. https://doi.org/10.1097/MPG.0000000000000949
  4. Tabbers MM, DiLorenzo C, Berger MY, Faure C, Langendam MW, Nurko S, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014;58:258-74. https://doi.org/10.1097/MPG.0000000000000266
  5. Biggs WS, Dery WH. Evaluation and treatment of constipation in infants and children. Am Fam Physician 2006;73:469-77.
  6. Rubin G, Dale A. Chronic constipation in children. BMJ 2006;333:1051-5. https://doi.org/10.1136/bmj.39007.760174.47
  7. Iacono G, Merolla R, D'Amico D, Bonci E, Cavataio F, Di Prima L, et al. Gastrointestinal symptoms in infancy: a population-based prospective study. Dig Liver Dis 2005;37:432-8. https://doi.org/10.1016/j.dld.2005.01.009
  8. Tunc VT, Camurdan AD, Ilhan MN, Sahin F, Beyazova U. Factors associated with defecation patterns in 0-24-month-old children. Eur J Pediatr 2008;167:1357-62. https://doi.org/10.1007/s00431-008-0669-2
  9. Camurdan AD, Beyazova U, Ozkan S, Tunc VT. Defecation patterns of the infants mainly breastfed from birth till the 12th month: prospective cohort study. Turk J Gastroenterol 2014;25 Suppl 1:1-5. https://doi.org/10.5152/tjg.2014.0001
  10. Zanardo V, Gamba P, Menti C, Trevisanuto D. Induction of meconium evacuation and stooling habit development in premature infants: role of gestational age. Minerva Pediatr 2010;62:545-9.
  11. Stewart ML, Schroeder NM. Dietary treatments for childhood constipation: efficacy of dietary fiber and whole grains. Nutr Rev 2013;71:98-109. https://doi.org/10.1111/nure.12010
  12. Loening-Baucke V, Miele E, Staiano A. Fiber (glucomannan) is beneficial in the treatment of childhood constipation. Pediatrics 2004;113:e259-64. https://doi.org/10.1542/peds.113.3.e259
  13. Tabbers MM, Benninga MA. Constipation in children: fibre and probiotics. BMJ Clin Evid 2015;2015:0303.
  14. Wegh CA, Schoterman MH, Vaughan EE, Belzer C, Benninga MA. The effect of fiber and prebiotics on children's gastrointestinal disorders and microbiome. Expert Rev Gastroenterol Hepatol 2017;11:1031-45. https://doi.org/10.1080/17474124.2017.1359539
  15. Vandenplas Y, Alarcon P, Alliet P, De Greef E, De Ronne N, Hoffman I, et al. Algorithms for managing infant constipation, colic, regurgitation and cow's milk allergy in formula-fed infants. Acta Paediatr 2015;104:449-57. https://doi.org/10.1111/apa.12962
  16. Mouterde O. Constipation in infants and children: how should it be treated? Arch Pediatr 2016;23:664-7. https://doi.org/10.1016/j.arcped.2016.03.003
  17. Dupont C, Campagne A, Constant F. Efficacy and safety of a magnesium sulfate-rich natural mineral water for patients with functional constipation. Clin Gastroenterol Hepatol 2014;12:1280-7. https://doi.org/10.1016/j.cgh.2013.12.005
  18. Kinnunen O, Salokannel J. Constipation in elderly long-stay patients: its treatment by magnesium hydroxide and bulk-laxative. Ann Clin Res 1987;19:321-3.
  19. Murakami K, Sasaki S, Okubo H, Takahashi Y, Hosoi Y, Itabashi M, et al. Association between dietary fiber, water and magnesium intake and functional constipation among young Japanese women. Eur J Clin Nutr 2007;61:616-22. https://doi.org/10.1038/sj.ejcn.1602573
  20. Loening-Baucke VA, Younoszai MK. Effect of treatment on rectal and sigmoid motility in chronically constipated children. Pediatrics 1984;73:199-205.
  21. Loening-Baucke V, Pashankar DS. A randomized, prospective, comparison study of polyethylene glycol 3350 without electrolytes and milk of magnesia for children with constipation and fecal incontinence. Pediatrics 2006;118:528-35. https://doi.org/10.1542/peds.2006-0220
  22. Ikarashi N, Ushiki T, Mochizuki T, Toda T, Kudo T, Baba K, et al. Effects of magnesium sulphate administration on aquaporin 3 in rat gastrointestinal tract. Biol Pharm Bull 2011;34:238-42. https://doi.org/10.1248/bpb.34.238
  23. Lee WT, Ip KS, Chan JS, Lui NW, Young BW. Increased prevalence of constipation in pre-school children is attributable to under-consumption of plant foods: a community-based study. J Paediatr Child Health 2008;44:170-5. https://doi.org/10.1111/j.1440-1754.2007.01212.x
  24. Chao HC, Vandenplas Y. Therapeutic effect of Novalac-IT in infants with constipation. Nutrition 2007;23:469-73. https://doi.org/10.1016/j.nut.2007.03.006
  25. Infante Pina D, Badia Llach X, Arino-Armengol B, Villegas Iglesias V. Prevalence and dietetic management of mild gastrointestinal disorders in milk-fed infants. World J Gastroenterol 2008;14:248-54. https://doi.org/10.3748/wjg.14.248
  26. Infante DD, Segarra OO, Redecillas SS, Alvarez MM, Miserachs MM. Modification of stool's water content in constipated infants: management with an adapted infant formula. Nutr J 2011;10:55. https://doi.org/10.1186/1475-2891-10-55
  27. Bongers ME, de Lorijn F, Reitsma JB, Groeneweg M, Taminiau JA, Benninga MA. The clinical effect of a new infant formula in term infants with constipation: a double-blind, randomized cross-over trial. Nutr J 2007;6:8. https://doi.org/10.1186/1475-2891-6-8
  28. Moro G, Minoli I, Mosca M, Fanaro S, Jelinek J, Stahl B, et al. Dosage-related bifidogenic effects of galacto- and fructooligosaccharides in formula-fed term infants. J Pediatr Gastroenterol Nutr 2002;34:291-5. https://doi.org/10.1097/00005176-200203000-00014
  29. Nowacki J, Lee HC, Lien R, Cheng SW, Li ST, Yao M, et al. Stool fatty acid soaps, stool consistency and gastrointestinal tolerance in term infants fed infant formulas containing high sn-2 palmitate with or without oligofructose: a double-blind, randomized clinical trial. Nutr J 2014;13:105. https://doi.org/10.1186/1475-2891-13-105
  30. Scholtens PA, Goossens DA, Staiano A. Stool characteristics of infants receiving short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides: a review. World J Gastroenterol 2014;20:13446-52. https://doi.org/10.3748/wjg.v20.i37.13446
  31. Piemontese P, Gianni ML, Braegger CP, Chirico G, Gruber C, Riedler J, et al. Tolerance and safety evaluation in a large cohort of healthy infants fed an innovative prebiotic formula: a randomized controlled trial. PLoS One 2011;6:e28010. https://doi.org/10.1371/journal.pone.0028010
  32. Closa-Monasterolo R, Gispert-Llaurado M, Luque V, Ferre N, Rubio-Torrents C, Zaragoza-Jordana M, et al. Safety and efficacy of inulin and oligofructose supplementation in infant formula: results from a randomized clinical trial. Clin Nutr 2013;32:918-27. https://doi.org/10.1016/j.clnu.2013.02.009
  33. Sierra C, Bernal MJ, Blasco J, Martinez R, Dalmau J, Ortuno I, et al. Prebiotic effect during the first year of life in healthy infants fed formula containing GOS as the only prebiotic: a multicentre, randomised, double-blind and placebo-controlled trial. Eur J Nutr 2015;54:89-99. https://doi.org/10.1007/s00394-014-0689-9
  34. Stiverson J, Williams T, Chen J, Adams S, Hustead D, Price P, et al. Prebiotic oligosaccharides: comparative evaluation using in vitro cultures of infants' fecal microbiomes. Appl Environ Microbiol 2014;80:7388-97. https://doi.org/10.1128/AEM.02200-14
  35. Coccorullo P, Strisciuglio C, Martinelli M, Miele E, Greco L, Staiano A. Lactobacillus reuteri (DSM 17938) in infants with functional chronic constipation: a double-blind, randomized, placebo-controlled study. J Pediatr 2010;157:598-602. https://doi.org/10.1016/j.jpeds.2010.04.066
  36. Hyams JS, Treem WR, Etienne NL, Weinerman H, MacGilpin D, Hine P, et al. Effect of infant formula on stool characteristics of young infants. Pediatrics 1995;95:50-4.
  37. Salvatore S, Abkari A, Cai W, Catto-Smith A, Cruchet S, Gottrand F, et al. Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants. Acta Paediatr 2018;107:1512-20. https://doi.org/10.1111/apa.14378

피인용 문헌

  1. An Observational Real-Life Study with a New Infant Formula in Infants with Functional Gastro-Intestinal Disorders vol.13, pp.10, 2019, https://doi.org/10.3390/nu13103336