title: Bidirectional associations between fussy eating and functional constipation in preschool children.
abstract: OBJECTIVE
  To examine bidirectional associations between a child's fussy eating behavior and functional constipation.
  
  
  METHODS
  Participants were 4823 children enrolled in a prospective cohort study from pregnancy onward. We assessed fussy eating at age 4 years with the Child Eating Behavior Questionnaire, and assessed functional constipation using ROME II and III criteria with parental questionnaires at age 2, 3, 4, and 6 years.
  
  
  RESULTS
  Higher food fussiness at age 4 years was associated with a greater risk of functional constipation at both 4 years (OR, 1.30; 95% CI, 1.20-1.42; P < .001 per 1 SD increase) and 6 years (OR, 1.12; 95% CI, 1.03-1.23; P < .05 per 1 SD increase). The converse was also observed; previous constipation predicted a greater risk of being a fussy eater at age 4 years (constipation at 2 years: OR, 2.05; 95% CI 1.43-2.94; P < .001; constipation at 3 years: OR, 1.72; 95% CI, 1.26-2.35, P < .001). Path analyses confirmed that the association between fussy eating and functional constipation was indeed bidirectional, showing that functional constipation at age 3 years predicted fussy eater classification at age 4 years (β = 0.06; P < .001), which in turn predicted functional constipation at age 6 years (β = 0.08: P < .001) independent of each other.
  
  
  CONCLUSIONS
  A vicious cycle might develop in which children with functional constipation develop unhealthy eating behavior, which in turn increases the risk of functional gastrointestinal disease.
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands. Electronic address: a.tharner@erasmusmc.nl.
authors.forename: Anne
authors.initials: A
authors.lastname: Tharner
authors.affiliation: Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands; Institute of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Pauline W
authors.initials: PW
authors.lastname: Jansen
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Kiefte-de Jong
authors.affiliation: Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Henriette A
authors.initials: HA
authors.lastname: Moll
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands; Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands; Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Vincent W V
authors.initials: VW
authors.lastname: Jaddoe
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands; Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Henning
authors.initials: H
authors.lastname: Tiemeier
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands; Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
mesh_terms: D002652:Child Behavior / Q000502:physiology; D002675:Child, Preschool; D015331:Cohort Studies; D003248:Constipation / Q000503:physiopathology*; D005247:Feeding Behavior / Q000502:physiology; D005260:Female; D005518:Food Preferences; D006801:Humans; D008297:Male; D009426:Netherlands; D011446:Prospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires