The Children’s Faecal Matter Structure Is Built by Their Parents

Introduction: Humans have gone through physical changes over the last 4 million years. The mouth, however, has not changed teeth quantity or quality. Eight incisors for fruits, vegetables and tubers; four little canines for little animals; eight premolars and twelve flat molars are used for crushing these foods, especially whole grains and legumes. The teeth crushing foods are the first step in the building of faecal matter. Foods are selected mostly according to cultural guidelines than to biological needs. The patterns of consumption are induced by the publicity of industrialized or processed foods. Material and Methods: This study design was observational, analytical, correlational, transversal and prospective. One thousand children (0 12 years old) were questioned in order to learn about the relationship between Weekly Eating Frequency (WEF) and Faecal Matter (FM) characteristics. The FM was classified as soft, normal or hard and the outcome was expressed as Dry Faecal Residue (DFR). The WEF and Weekly Bowel Movement Frequency (WBMF) were determined and tabulated according to times per week. Environmental factors, parents’ education level and children’s birth order were examined. Results: There was a strong association between DFR, WBMF and WEF. Environment and education level did not play a key role although birth order did matter. Conclusions: Fibre-free foods (dairies, meats, flours and sweeties or sodas) increased DFR. Foods containing fibre from vegetables decreased DFR, which in turn contributed to the WBMF. Lowest DFR was observed in children under Exclusive Breastfeeding (EB). Distant last-born children had higher DFR. Comments: Daily examples support these results How to cite this paper: Cueto Rua, E., Wright, R., Zubiri, C., Guzmán, L., Losada, C., Urrutia, M.I., Gonzalez, M.T., Drut, R., Espósito, M., Recalde, N., Fiad, J., Goñi, I., Belén, N. and Arregui, M.C. (2019) The Children’s Faecal Matter Structure Is Built by Their Parents. Open Journal of Epidemiology, 9, 64-74. https://doi.org/10.4236/ojepi.2019.91006 Received: December 3, 2018 Accepted: January 21, 2019 Published: January 24, 2019 Copyright © 2019 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access


Introduction
Primates have eyes in one plane, an opponent finger and clavicles.These allowed the versatility of arms and, together with the standing, remark the difference [1].
Since Ardipithecus all species had teeth similar in quality and number to that of modern man.Our mouth has had for millions of years, eight incisors to eat fruits, vegetables and tubers; four canines, which are similar in size to the incisors, to eat little animal; eight premolars and twelve flat molars, which crush all, particularly grains and legumes [2] [3] [4].
Actual feeding left variety to be a "universal" and routine habit [5].
Children left chewing fruits for just "swallowing" soft, sweet and flavored desserts.The word milk has replaced the words breakfast and snack.
We then asked ourselves if foods are related to the teeth of to the advertisements.
The aim of present paper is to understand the relationships between ingested food and the characteristics, consistency and frequency of depositions in children between 0 and 12 years of age.We made 1000 surveys.

Material and Methods
The surveys were done in the year 2012, in pediatric doctor's offices, schools, and kinder gardens at La Plata city (51.5%)Mar del Plata city (24.2%) and Dolores city (10.1%).Other were done at Berisso city, Ensenada city, Etcheverry city, Roque Pérez city and Lobos city, these representing 14.2% of the sample.
The study was observational, analytic, correlational, transversal y prospective.

Sample
Confidence level was 95% (α = 0.05).The probabilistic evaluation of the size of the sample showed a minimal number of 664 children (15,625.084inhabitants) [6].The whole study included a total of 1000 children in order to produce a larger reliability to the results.To include the children in this study it was taken in consideration that they come to a periodic clinical control, or assist to kindergarten or schools in the Buenos Aires Province, and that they did not present any acute or chronic condition.Children out of these situations were excluded.

Instruments for Data Collection
We used a structured inquiry with closed answers containing:

Personal Data
First letter of name and surname, sex, age in years or in months when less than one year of age.Once the healthy child coming to clinical control was identified the objective was to establish the consistence of the faecal matter and the frequency of depositions.

Breastfeeding
This item was performed to breastfeeders with exclusive maternal (EM) or mixed, complemented with cow milk (CM), being it "formula" or common one, at least once a day.

Feeding Habits (FH)
An inquiry of FH of 7 days was used.This presented a numeric scale defined as: 0, never; 1, once; 4, four times; 7, seven times per weeks and 14, twice a day.The analyzed foods included: CM; yogurt or desserts; cheeses; meats (cow, bird, fish, pork or lamb); starchs (flours, pasta, rice, potato or sweet potato); sodas or juices; candies (caramel cookie, chocolates or candies); carotenes (pumpkin o carrots); green leaves vegetables; vegetables and fruits.

Consistency of the Faecal Matter (FM)
The categories of FM consistency in DFR was proposed by one of the AA due to his experience while doing his doctoral thesis [7], and due to the fact of having done 5000 Van de Kamer and chemical-functional analysis as diagnostic tool in the malabsorption syndrome The consistency was reported by the parents.For this the inquirer used the raw meat (RM) consistency as a reference tool.This was taken as that of normal FM or Bristol 3 -4.The RM and the normal FM have dry residue similar to that of water [8].Beginning with this premise, parents were asked if it was softer or harder than that of RM [9] [10].
If the answer was softer (pasty-amorphous or Bristol 5 -6), the register for DFR was 10%.
If the answer was harder (difficult to deform or Bristol 1 -2), the register for DFR was 30%.

Weekly Evacuation Frequency (WEF)
The WEF established as 0, 1, 2, 4, 7 and 14 times per week, 0 being an evacuation in more than 7 days, and 14 belonging to those evacuating more than once per day.
As to the ambient aspects, the water was categorized as 1-drinking water.

Time of Birth
The time of birth as related to the brothers and sisters was established as first, middle last, one and only, and "last but distant" (the child distant 6 years or more from the precedent).We know that these kids get a special treatment [11] [12].
Once that faecal matter consistency and evacuation frequency were established the objective was to determine the "quality" and "frequency" of foods.The inquiry was simple to understand and easy to fill by the clinicians as well as by the nutritionists doing it (see Adnexa).

Data Analysis
The results were registered in an Epi6 base and analised through descriptive and inferencial statistic methods.Particularly, the mean value of each parameter in the different groups was statistically analised by the Varianza Analysis (ANOVA).
When differences between the compared means were found the analysis was continued with a Minimal significant differences (m.s.d.) test and the Tukey test was used.
The process of data observation followed the analysis of FM consistency as related to WEF, EM, weekly food frequency (WFF) and mixed; and some cultural aspects.
We decided to use the quantified data of the FM consistency and not the adjective of soft, normal or hard, or the Bristol equivalents.
The weekly food frequency WFF of the following was evaluated: CM, yogurt, meats, starches (flours), sodas, candies, carotenes, vegetables of green leaves, vegetables and fruits; and at the same time the frequency of EM and the consistency of depositions.

Population
From the whole population submitted to the inquiry 76.9% was in clinical control, 20.2% was in the healthy child consulting room, and 2.9% in the school and kinder garden; 50.3% were girls, with a mean age of 3.85 ± 3.26 years, while 49.7% were boys with a mean age of 4.15 ± 3.41 years.While comparing the mean age by sex we found a "t" = −1.422(P = 0.155).

Fecal Dry Residue
When evaluating together the FDR and FES it clearly appears the close relationship between the two variables Chi 2 = 395.44(P ≤ 0.001).When the FDR increased the WEF decreased significantly, and vice versa.While observing the extreme values it appears that with a FDR of 28.27%, (hard FM) the evacuation are twice per week while with a FDR of 16.02%, (soft FM) the evacuations are twice per day.
FES was arranged in 4 categories according to the weekly frequency and when comparing the means of FDR for each of these categories the ANOVA resulted with an F = 134.79(P = 0.00000), a highly significant difference.When WEF increased there appears an important decreasing of FDR values.

FDR and LME
If the group with breast feeding only EM was compared with that receiving mixed milk feeding it appeared that the FDR increased from 11.09 (±3.15) to 16.64 (±7.06), respectively, the differences being highly significant ("t" = −5.580(P ≤ 0.001)).

Dry Residue and Feeding Frequency
The analysis of the different frequencies of feeding showed a sequence of 14, 7, 4 y once a week.As presented in Table 1 foods without fibers in the frequencies of 14 and 7 are mainly milky, producing a high FDR, therefore inducing constipation.On the contrary, products with vegetable fibers given with the same frequency generate a los FDR, and so a soft FM.To be particularly highlighted are foods offered to children in frequency 4 (every second day) which produced a normal and homogeneous FDR, clearly seen by a non-significant difference.Foods given with a frequency once a week produced the expected effect: If scant fibers the FDR tends to be high and if scant milky products the FDR tends to be low.
In the analysis of consumed foods decreasing FDR it appears flours, meats and fruits, followed by yogurt and in the last three positions natural foods with fibers (Table 2).

Weekly Evacuation Frequency (WEF)
The WEF analysis showed that 89.2% of the children evacuated once every 2 days, daily and twice per day was, while only 10.3% evacuated every three days and the only evacuating once in more than 7 days was a child the with EM.
Table 3 shows that children with soft FM evacuated a mean of 10.32 times/week while those with normal FM did it daily and those with hard FM did it 4.15 times/week, the differences being highly significant (ANOVA, F = 153.35(P = 0.00000)).The higher the FDR the lower the WEF.
As related to the WFF and the EM and the mixed, it was observed that the former evacuated 10.4 times per week while the latter did so 8.68 times.Comparing the means of both groups showed a Student "t" = 2.36 (P = 0.019), indicating a significant difference between the WFF and the EM and mixed.
The analysis of the different WEF and the WFF showed a strong association between both (Table 4).

Cultural Variables and FDR
Mothers' instruction level was 11.28 ± 4.30 and that of the fathers 11.03 ± 4.27, (4˚ year at the secondary school).If this instruction level is related to the FDR this did not modified significantly.Although the FDR increased with the instruction level the ANOVA test with a value of F = 2.46 (P = 0.06) resulted in a non-significant number.
The analysis of the DFR as related to the birth order showed different means.
The "last" category presented the lower DFR, most probably due to the EM.This contrasted with the category "last but distant" which showed the higher DFR (Table 5).
This Table shows all the DFR in normal values but according to our experience we believe there is a difference in de FM of brothers as a whole (1 -2 -3: FDR = 20.43 ± 6.28) when compared with one only (4) and "last but distant" (34).
The ANOVA analysis of these means showed a value of F = 3.71 (P = 0.025), supporting our presumption.This difference is related to the "last but distant" son with the other two groups, these not presenting differences between them.The sanitary environment seemed not to influence DFR.Different water sources and residues elimination maintained a normal DFR (Table 6).When comparing the three means with the ANOVA the result was F = 1.21 (P = 0.321) indicating a non-significant difference in the DFR.So then, it is evident that the environment in this sample did not influence in DFR.It should be noted that there are "private neighborhoods" that have water pump and waterhole wells, but with a strict sanitary control.

FDR
It is known that the WEF is related to the FDR as well as to cultural guidelines.
In order to perform this investigation we considered more truthfully the FDR-consistency than the WEF, since although related, the first seems to depend exclusively on the food culture and the second adds the social guidelines."Not always that you want you can (large) and not always that you want and may, you should (visits)".
Notice that the area for FM and urine evacuations is referred as "bath rooms".
To demonstrate that the FDR and the WEF condition themselves mutually we recurred to a peculiar example.There are scientific papers referring people carrying packs (and hard) of drugs in the rectum [13] [14] and travel without evacuation emergencies.On the contrary an enema generates this urgency.

Foods
The most consumed foods were: flours, meats fruits and yogurts.Vegetables were absent in 44.6% of the responses even the bible mandate [15] and the work of Daniel, without double blind but with a control group [16].
As seen, the flours, excluding lactating children, were consumed by 99.8% of the children.Citing the chronicler Facundo Sonatti: "In the morning toasts, the pastas of noon and the crackers in the afternoon the wheat are present every day in the Argentine menu… The flours consumption was 94 kilograms per capita in 2012, according to data from the Federación Argentina de la Industria Molinera" [17].As related to meat we transcribe a journalist note of year 2013: "What is certain is that in Argentina never was eaten so large quantity of meat as now, 116.6 kilograms per year and per capita… All according to the Ministry of Agriculture" [18].
Water represents 75% of faecal matter weight and is related to food.A mixed nutritional regimen eliminates 60 to 250 grams/day, a vegetarian one 370 g and a meat-centered one between 54.5 g and 64 g [19].
The yogurt which is related by the present work as well as by our experience in the increasing of FDR, was present, excluding on EM, in the 94.5% of children.Hard FM is the first step to a painful deposition [20] and was present in 23.8% of the children, particularly in those consuming scant fiber and many milky products.

Weekly Evacuation Frequency
In 1775, Alexander Cumming designed and patented the toilet.This structure previously "away from" began to be integrated to home [21].However, cultural features keep on considering bowel evacuation as highly private and a bit shaming.Our work is to demystify this function which is with us since the origin of life itself.

Cultures
The order of the birth of the sons according appears as a risk factor to be taken into consideration.To the last but distant son occasionally is referred as a "sky present".With this child the parents' behavior frequently is permissive.In this study the last but distant was besides the main soda consumer.It seems that because it was not searched for parents feel enabled to make of him/her an obese, constipated and dental caries suffering child [22].In our experience is also the one who more transgress the celiac diet [23].
There are many other variables which might be crossed.Among them, selection of fruits and vegetables "once" a week compared with yogurt and cow milk "twice a day", there were only 9 children and all of them had hard FM.We all know that cheese constipates and that there is no aleatory, double blind and controlled scientific research saying that water calms thirst but indeed it calms the thirst.Not always the experience requires evidences.

Table 1 .
Dry faecal residue and weekly feeding frequency.

Table 2 .
Ranking of the more consumed foods.

Table 3 .
Weekly Evacuation Frequency (WEF) as related to the Faecal Dry Residue (FDR).

Table 4 .
Weekly evacuation frequency and weekly feeding frequency.

Table 5 .
Sons order and faecal dry residue.

Table 6 .
Relationship between faecal dry residue and sanitary categories.