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Cortisol Diurnal Rhythm and Stress Reactivity in Constipation and Abdominal Pain: The Generation R Study

Kiefte-de Jong, Jessica C.*; Saridjan, Nathalie S.*; Escher, Johanna C.; Jaddoe, Vincent W.V.*; Hofman, Albert; Tiemeier, Henning‡,§; Moll, Henriette A.||

Journal of Pediatric Gastroenterology & Nutrition: October 2011 - Volume 53 - Issue 4 - p 394–400
doi: 10.1097/MPG.0b013e31821e73cf
Original Articles: Gastroenterology

Objectives: The aim of this study was to assess whether diurnal cortisol rhythm and cortisol stress reactivity were associated with functional constipation and abdominal pain in infancy.

Patients and Methods: This study was embedded in a subset of the Generation R Study, a prospective cohort study from fetal life onward in Rotterdam, the Netherlands. Data of infants between 14 and 24 months of age (N = 483) were used. Salivary cortisol diurnal rhythm and salivary cortisol stress reactivity after a Strange Situation Procedure were assessed at age 14 months. Data on functional constipation were available according to the Rome II criteria, and data on abdominal pain on the basis of the Abdominal Pain Index were available from questionnaire data at 24 months.

Results: In the second year of life, 13% of the infants had functional constipation and 17% had abdominal pain. Only 4% had symptoms of both functional constipation and abdominal pain. Diurnal cortisol rhythm did not differ significantly between children with and children without functional constipation and abdominal pain. Cortisol stress reactivity was slightly higher in infants with abdominal pain than in those without it, but this was not statistically significant (odds ratio 1.41; 95% confidence interval 0.46–4.31). No association was found between the cortisol stress reactivity and functional constipation.

Conclusions: Our results suggest that cortisol as a marker for stress does not play a major role in functional constipation or abdominal pain in infancy.

*The Generation R Study Group

Department of Pediatric Gastroenterology

Department of Epidemiology

§Department of Child and Adolescent Psychiatry

||Department of Pediatrics, Erasmus University Medical Centre, Rotterdam, The Netherlands.

Address correspondence and reprint requests to Prof Henriëtte A. Moll, MD PhD, Department of Pediatrics, Erasmus University Medical Centre, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands (e-mail:

Received 11 February, 2011

Accepted 3 April, 2011

This phase of the Generation R Study was supported by the Erasmus Medical Center, the Erasmus University Rotterdam, the Netherlands Organization for Health Research and Development (Zon Mw), and Europe Container Terminals B.V. The Generation R Study is conducted by the Erasmus Medical Center in close collaboration with the School of Law and Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Service–Rotterdam Metropolitan Area, the Rotterdam Homecare Foundation, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond.

The authors report no conflicts of interest.

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Copyright 2011 by ESPGHAN and NASPGHAN