Arch Dis Child. 2022 Mar 11;archdischild-2021-323571.doi: 10.1136/archdischild-2021-323571. Online ahead of print.

Iva Hojsak ¹, Marc A Benninga ², Bruno Hauser ³, Aydan Kansu ⁴, Veronica B Kelly ^5 6, Alison M Stephen ⁷, Ana Morais Lopez ⁸, Joanne Slavin ⁹, Kieran Tuohy ^10 11

Author information

¹Referral Center for Paediatric Gastroenterology & Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, Croatia ivahojsak@gmail.com.

²Department of Paediatric Gastroenterology & Nutrition, Emma Children's Hospital, Amsterdam University of Medical Centres, Amsterdam, The Netherlands.

³Department of Paediatric Gastroenterology and Nutrition, KidZ Health Castle UZ Brussel, Brussels, Belgium.

⁴Department of Pediatric Gastroenterology, Ankara University, School of Medicine, Ankara, Turkey.

⁵Pediatric Department, Children's Health Ireland, Dublin, Ireland.

⁶Paediatric Neurosciences, Evelina Children's Hospital, London, UK.

⁷Retired Professor of Public Health Nutrition, Department of Nutritional Sciences, University of Surrey, Surrey, UK.

⁸Pediatric Nutrition, Hospital Universitario La Paz, Madrid, Spain.

⁹Department of Food Science and Nutrition, University of Minnesota, St. Paul, Minnesota, USA.

¹⁰Department of Food Quality and Nutrition, Fondazione Edmund Mach Istituto Agrario di San Michele all'Adige, San Michele all'Adige, Italy.

¹¹School of Food Science & Nutrition, University of Leeds, Leeds, UK.

Abstract

Fibre is an essential nutrient in the human diet that is crucial for human health. It provides a range of functional benefits, including stool bulking, and physiological benefits through fermentation of diverse fibre types by the gut microbiome including cholesterol lowering, glycaemic control and weight control. The by-products of the fermentation of fibre in the gut confer health benefits that extend beyond the gut to the immune system and organs such as the liver, kidneys and the brain. A lack of fibre in the diet has been associated with several disorders in children including constipation, irritable bowel syndrome, allergies and immune-related disorders. In paediatric practice, concerns exist over tolerance of dietary fibre which may lead to unnecessary restrictions, especially for children receiving nutritional support. One reason for this may be the terminology which has historically been used. Fibre is often described in terms of its physico-chemical properties (solubility, viscosity), rather than its physiological effects/functionality (fermentability, bulking effects). To describe fibre in these latter terms represents more clearly the important role it plays. Most international guidelines recommend a daily quantity of fibre, failing to mention the quality aspect of the fibre required for health. Here we consider the evidence base for the current recommendations for daily fibre intakes for healthy children, those requiring nutritional support and those with functional gastrointestinal disorders. We also consider the importance of the gut microbiome and the role of fibre in maintaining gut microbial health and its role in health beyond the gut.