Komjölk och kronisk förstoppning hos barn - En systematisk översiktsartikel
Sahlgrenska Academyat University of GothenburgDepartment of Internal Medicine and Clinical NutritionAbstractTitle: Cow?s milk and chronic constipation in children ? A systematic reviewAuthor: Sara Palm & Anna SvenssonSupervisor: Frode SlindeExaminer: Anna WinkvistProgramme: Dietician study programme, 180/240 ECTSType of paper: Examination paper, 15 hpDate: May 27, 2014Background: Chronic functional constipation is common among children. Up to a third of all who seek a paediatrician suffer from constipation and it is a widespread problem for children in many countries. Lately it has been discussed if cow?s milk can be a cause of the constipation and if it should be considered a delayed hypersensitivity.Objective: The aim of this systematic review is to examine whether there is scientific evidence to recommend a cow?s milk-free diet as a potential treatment in chronically constipated children.Search strategy: The literature searches were performed in the databases Pubmed, Scopus and the Cochrane library, using the search terms cow?s milk, constipation, milk proteins, dairy products, milk hypersensitivity, cow milk and cows milk between March 17th and April 4th 2014.Selection criteria: Randomized controlled trials measuring stool frequency in chronically constipated children on a cow?s milk-free diet were included. The children should not have an allergy to cow?s milk or organic constipation. The articles should be written in English or Swedish.Data collection and analysis: Four relevant studies were reviewed individually using the SBU template for randomized controlled trials. The evidence was then summarized using an evidence form developed by the University of Gothenburg.Main results: All studies show a statistically significant effect on the removal of cow's milk from the diet and increased stool frequency. The results showed that 39-80% of the children in the studies improved and the constipation was resolved.Conclusions: There is moderate evidence (+++) that the exclusion of cow's milk from the diet should be part of the treatment of functional chronically constipated children. If there is a response to the treatment it provides relief of symptoms by increasing the stool frequency in the individual.