14781-koppen

88 Chapter 3 This is the first systematic review evaluating the association between FDDs and overweight/ obesity in children. Because both FDDs and overweight/obesity are such significant pediatric health care problems, it is of key importance to investigate a potential association between them to improve pediatric health care worldwide. However, there are some limitations to this systematic review. First of all, the included studies have adopted a variance of definitions for FDDs and overweight/obesity and are conducted in different settings using different study designs; therefore, it is difficult to draw firm conclusions. Moreover, we were unable to perform a quantitative analysis due to the heterogeneity of the data. By including only articles written in English, this systematic review is at risk for some level of selection bias. However, we consider this risk to be very low, because most relevant literature is likely published in English. Finally, there is a potential risk of publication bias, although negative studies were identified and included in this systematic review, we may potentially have been unable to identify unpublished negative data. CONCLUSIONS Although several studies have reported on the potential association between FDDs and excessive body weight in children, the results from studies included in this systematic review are conflicting. Moreover, only one study was rated to be of good quality on the basis of an assessment of the internal validity and risk of bias, whereas most studies were rated to be of fair or poor quality. Therefore, we cannot draw firm conclusions. There is a need for high quality prospective cohort studies using uniform definitions and well-defined inclusion and exclusion criteria according to accepted guidelines. Future studies assessing the association between FDDs and overweight in children should aim to further investigate the role of factors such as dietary factors, physical exercise, and psychological factors. Furthermore, the differences in study results between developed and developing countries warrant further investigation into the role of social economic status and the indirect consequences thereof. In addition, the potential risk of pelvic floor dysfunction in obese children needs to be sought out further. Finally, the field of microbiome studies is relatively young, but very promising and future studies investigating the potential role of the gut microbiota would seem to be of much interest.