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83 Functional defecation disorders and overweight 3 TABLE 4. Prevalence of overweight, obesity and functional defecation disorders in pediatric population-based studies. Study Country Population (P) Definition FC and measurement n (%) FC n (%) FI Definition OW/OB and measurement n (%) OW n (%) OB Conclusion Comments Phatak et al . 2014 USA, pediatric and adolescent clinic and private pediatric practice Primary care centers n=450 4-18 years ♂ :45% Rome III criteria Assessed using questionnaire (interview) P: 80/450 (18%) NW: 36/259 (14%) OW/OB: 44/191 (23%) n/a OW: BMI 85-95 th percentile OB: BMI>95 th percentile Weight and height were measured Standard data from the Center for Disease control and Prevention were used as reference P: 68/450 (15%) FC: n/a non-FC: n/a P: 123/450 (27%) FC: n/a non-FC: n/a Probability of having FC in OW/OB population 23% vs 14% in normal weight population (OR=1.83, p=0.01) In the text of the article by Phatak et al., 13% of NW children are mentioned to have FC, in the table of this same article this number is reported to be 13.9% (the latter number is adopted in this systematic review). Costa et al . 2011 Brazil, cross- sectional survey conducted at schools n=1,077 10-18 years ♂ : 46% Modified Rome III criteria, combination of pediatric and adult criteria: ≥2 of the following: 2 or fewer defecations in the toilet per week, a history of painful or hard bowel movements, hard stools that resembled a sausage but have cracks on their surface or separate hard lumps, a sensation of incomplete evacuation, a history of large diameter stools that may obstruct the toilet and a history of fecal incontinence. Assessed using validated questionnaire P: 196/1,077 (18%) NW: 168/933 (18%) OW: 28/144 (19%) P: 25/1,077 (2%) -FNRFI: 3/1,077 (0%) FC: 22/196 (11%) FC + FI: -OW: 8/28 (29%) -non-OW: 14/168 (8%) FNRFI: -OW: n/a -non-OW: n/a OW: BMI ≥85 th percentile OB: n/a Weight and height assessed using questionnaire Standard data from the Center for Disease control and Prevention were used as reference P: 144/1,077 (14%) FC: 28/196 (14%) non-FC: 116/881 (13%) FI: n/a non-FI: n/a n/a No significant difference between BMI of adolescents with/without FC (medians: 19.4 vs 19.3 kg/m 2 , p=0.941). There was a significant association between FC-associated FI and OW (OR 4.40, p=0.005). According to the table, the number of children with OW in the study population is 144 (and not 145 as mentioned in the article). 8/28 children with FC and FI were OW, the authors reported that this was 37%, but according to our calculations this should be 29%. Authors state that the questionnaire is validated, but do not provide a reference. Koppen et al . 2016 Colombia, cross- sectional study conducted at schools n=2,820 8 -18 years ♂ : 52% Rome III criteria Assessed using a Spanish translation of the Questionnaire on Pediatric Gastrointestional Symptoms-Rome III Version (QPGS-RIII) P: 368 (13%) NW: 269/2,090 (13%) OW: 71/542 (13%) OB: 28/188 (15%) n/a OW: BMI z score between +1 and +2 OB: BMI z score > +2 Weight and height were measured WHO reference values were used P: 542 (19%) FC: 71/368 (19%) non-FC: 471/2,452 (19%) P: 188 (7%) FC: 28/368 (8%) non-FC: 160/2,452 (7%) No association between FC and OW/ OB was found C, control group; FI, fecal incontinence; NA, not applicable; NW, normal weight; OB, obesity; OW, overweight.