Dysbiosis of gut microbiota in children with functional constipation and damp-heat constitution: a cross-sectional multi-omics analysis

Functional constipation (FC), a prevalent gastrointestinal disorder in early childhood associated with gut microbial dysbiosis, shows significant connections with specific constitutional types in Traditional Chinese Medicine (TCM). While TCM's nine constitutional classifications identify damp-heat constitution as a potential risk factor for FC, pediatric-specific evidence remains scarce regarding this correlation. Using the Constitutional Medicine Questionnaire, 49 children under 2 years were stratified into two groups: 18 children with damp-heat constitution who suffered from constipation (DHC) and 31 children with balanced constitution who did not suffer from constipation (BC). Clinical assessments (Bristol Stool Scale, symptom profiles), gut microbial profiling (16 S rRNA sequencing), and urinary metabolomics (UPLC-Q-TOF/MS) revealed marked intergroup differences. DHC subjects demonstrated reduced stool consistency scores, heightened symptom severity, distinct microbial communities, and altered sphingolipid-related metabolic pathways. A diagnostic panel combining six microbial markers and six metabolites achieved effective discrimination. This multi-omics investigation delineates the pathophysiological characteristics of FC in DHC children, proposing novel therapeutic targets through TCM constitution-based microbial-metabolite interactions.