Fibre fortification to increase stool frequency in children with a history of constipation

Constipation is a serious problem in the pediatric population and often requires medical management with laxatives and enemas. Participants (2-10 years of age, n=13) with a history of mild constipation were assigned randomly to a fibre treatment or placebo group. After three weeks, subjects were crossed over to the other treatment. Pea hull fibre (4.0-7.6 g/day = 3.6-6.8 g/day of dietary fibre) was added to snack foods and an inulin supplement (5.0 g/day = 4.5 g/day of dietary fibre) was given, whereas the placebos were non-fortified snacks and maltodextrin (5.0 g/day). Subjects or their parents documented stool frequency, stool consistency, occurrence of abdominal pain and intake of snack foods and the supplement. Over the final two weeks, there was a trend towards an increase in the mean number of daily bowel movements in the fibre treatment group compared to the placebo group (n=11, 0.68 ± 0.18 vs. 0.59 ± 0.26, p=0.064). Exclusion of one subject with diarrhea-type stools led to a significant difference between groups (n=10, 0.54 ± 0.18 vs. 0.67 ± 0.22, p=0.002). Stool consistency, using the Bristol Stool Form Rating Scale, showed no significant differences in stool consistency between groups (p=0.379) nor was there a difference in the incidences of abdominal pain (p=0.129). Not all subjects experienced abdominal pain. The inulin supplement (91% compliance rate; 1 serving per day) was consumed more consistently than were the snack foods fortified with pea hull fibre (77% compliance rate; 2 servings per day). There were no significant differences in the intake of the snacks or supplement when the placebo and treatment groups were compared. Energy intake was significantly lower during the fibre treatment period compared to placebo (n=12, 1307 ± 296 kcal/day vs. 1441 ± 285 kcal/day, p=0.035). The addition of pea hull fibre to typical snack foods and an inulin supplement to beverages were well accepted by children and no adverse effects were reported. Fibre fortification of snack foods with pea hull fibre and fibre supplementation of beverages with inulin may provide an alternative means to treat pediatric constipation.