Pediatric Nutrition in Practice

48 Hojsak

the risk of nutrient deficiency and significantly
increase energy intake. The best evidence exists
for sugar-sweetened beverages, due to the lower
satiety potential of energy supplied in liquid com-
pared with solid form [7]. Moreover, there is evi-
dence that energy-dense food consumption can
also influence insulin resistance, but there is no
clear answer to whether this is caused solely by
energy-rich food or influenced by overweight and
increased fat mass [8].
Most paediatric authorities recommend limit-
ing sugar-containing foods for infants and chil-
dren in order to reduce the likelihood of high
consumption later in life [1, 9]. Children should
receive healthy food rich in slowly absorbed car-
bohydrates and with a limited amount of rapidly
absorbed carbohydrates and simple sugars [9].
Frequent consumption of sugar-containing foods
can also increase the risk of dental caries, espe-
cially when oral hygiene and fluoride prophylax-
is are insufficient. Therefore, avoidance of fre-
quent consumption of juices or other sugar-con-
taining drinks and ‘sleeping with a bottle’ should
be recommended, as wel l as ma intena nce of good
oral hygiene [10].
In recent years there has been a growing inter-
est in the role of fructose in obesity and metabolic
disease. Fructose ingestion induces significantly
more lipogenesis than isocaloric glucose inges-
tion, which could have an effect on obesity, the
metabolic syndrome and non-alcoholic steatohep-
atitis [11]. Sugar-sweetened beverages and other
sources of dietary fructose have been suggested to
promote an increase in serum lipids and their de-
position mainly in the liver, but not all published
studies were able to confirm this association [7].

Non-Digestible (Resistant) Carbohydrates

Dietary Fibres
Dietary fibres are non-digestible carbohydrates
mostly derived from plant sources that reach the
colon nearly intact. These compounds can be fur-

ther classified into soluble types of fibre, like pec-

tins, and insoluble components such as cellulose.

Fibres that are added to the food and have benefi-

cial physiological effects on humans are called

‘functional fibres’.

It is not completely accurate to name fibres as

non-digestible, because bacteria in the large in-

testine ferment mostly soluble fibres. Fermented

products include gases (carbon dioxide and

methane), oligofructoses as well as SCFA includ-

ing acetic acid, butyric acid and propionic acid.

These fermentation products derive energy for

certain colonic bacteria and colonic epithelial

cells which use butyrate as an energy source, even

when competing substrates such as glucose are

available [1 2]. SCFA are absorbed into the blood

stream, where they can also be used as an energy

source; some, like acetate, can be metabolized in

brain cells, muscles and tissues, and others, like

propionate, are used in the liver and can interfere

with cholesterol synthesis [1 2].

Fibres: Clinical Importance

The effect of dietary fibres on chronic diseases has

been explored mostly in adults. The importance

of fibres to children’s health remains poorly in-

vestigated. Their most significant and widely

studied role is in influencing bowel movement:

fibres, especially insoluble ones, increase stool

mass and improve its consistency; lack of dietary

fibres, on the other hand, is associated with con-

stipation and diverticulosis in adults. Yet, the ex-

act fibre type and amount needed to elicit a posi-

tive effect have not been determined [13, 14].

Importantly, increasing dietary fibres up to the

recommended levels has not been associated with

any adverse events in children, and there is suffi-

cient evidence that fibres could help in the pre-

vention and treatment of constipation [14].

Other positive effects of increased intake of

dietary fibres include body weight control and

diabetes risk reduction [1 2]. However, the evi-

dence is mostly limited to studies on adults, and

data on children are scarce and conf licting, with

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 46–50

DOI: 10.1159/000360316