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Meta-Analysis
. 2015 May;36(4):245-57.
doi: 10.1002/bdd.1937. Epub 2015 Feb 12.

Does age affect gastric emptying time? A model-based meta-analysis of data from premature neonates through to adults

Jennifer J Bonner  1 , Pavan Vajjah, Khaled Abduljalil, Masoud Jamei, Amin Rostami-Hodjegan, Geoffrey T Tucker, Trevor N Johnson
Affiliations
Meta-Analysis

Does age affect gastric emptying time? A model-based meta-analysis of data from premature neonates through to adults

Jennifer J Bonner et al. Biopharm Drug Dispos. 2015 May.

Abstract

Purpose: Gastric emptying (GE) is often reported to be slower and more irregular in premature neonates than in older children and adults. The aim of this study was to investigate the impact of age and other covariates on the rate of GE.

Methods: The effect of age on the mean gastric residence times (MGRT) of liquid and solid food was assessed by analysing 49 published studies of 1457 individuals, aged from 28 weeks gestation to adults. The data were modelled using the nonlinear mixed-effects approach within NONMEM version 7.2 (ICON, Dublin, Ireland), with evaluation of postnatal age, gestational age and meal type as covariates. A double Weibull function was selected as a suitable model since it could account for the typical biphasic nature of GE.

Results: Age was not a significant covariate for GE but meal type was. Aqueous solutions were associated with the fastest emptying time (mean simulated gastric residence time of 45 min) and solid food was associated with the slowest (98 min).

Conclusions: These findings challenge the assertion that GE is different in neonates, as compared with older children and adults due to age, and they reinforce the significance of food type in modulating GE.

Keywords: gastric emptying; infant gut; neonatal gut; paediatric gastroenterology.

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Figures

Figure 1
Figure 1
Age and sex of the subjects in the study data set
Figure 2
Figure 2
Visual predictive check plots. The green lines represent 2.5th and 97.5th percentiles of model‐predicted data. The solid grey line represents the 50th percentile of model‐predicted data. The dashed black line represents the median of the observed data
Figure 3
Figure 3
Box‐whisker plots indicating a relationship between model‐based simulated mean gastric residence time and meal type: aq, aqueous solution; bm, breast milk; fm, formula; ss, semi‐solid meal; sol, solid meal
Figure 4
Figure 4
Model‐based simulation of the relationship between postnatal age and mean gastric residence time, allowing for differences in the meal type. (A) whole 0–17 age range and (B) more detailed view for the 0–25 month age range. Open circles represent meal types: black, aqueous; blue, breast milk; green, formula milk; cyan, semi‐solid; red, solid
Figure 5
Figure 5
Goodness of fit plots showing population and individual predictions, individual weighted residuals against individual predictions and weighted residuals against time. Lines are the best fit to the data
Figure 6
Figure 6
Visual predictive check (VPC) of the final model against the validation dataset in relation to meal type. Black stars are the observed data
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Comment in

References

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