title: Infant nutritional factors and functional constipation in childhood: the Generation R study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of the Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: J C
authors.initials: JC
authors.lastname: Kiefte-de Jong
authors.forename: J C
authors.initials: JC
authors.lastname: Escher
authors.forename: L R
authors.initials: LR
authors.lastname: Arends
authors.forename: V W V
authors.initials: VW
authors.lastname: Jaddoe
authors.forename: A
authors.initials: A
authors.lastname: Hofman
authors.forename: H
authors.initials: H
authors.lastname: Raat
authors.forename: H A
authors.initials: HA
authors.lastname: Moll
mesh_terms: D001942:Breast Feeding; D002446:Celiac Disease / Q000150:complications*; D016009:Chi-Square Distribution; D003248:Constipation / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005512:Food Hypersensitivity / Q000150:complications*; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D016015:Logistic Models; D008297:Male; D008390:Markov Chains; D016269:Milk Hypersensitivity / Q000150:complications; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors