Nutritional Status and Diarrheal Illness as Independent Risk Factors for Alveolar Pneumonia

• Published in: American journal of epidemiology Vol. 162; no. 10; pp. 999 - 1007
• Main Authors: Coles, Christian L., Fraser, Drora, Givon-Lavi, Noga, Greenberg, David, Gorodischer, Raphael, Bar-Ziv, Jacob, Dagan, Ron
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 15-11-2005; Oxford Publishing Limited (England)
• Subjects: adjusted odds ratio; Analysis. Health state; anemia; Anemia - epidemiology; Anemias. Hemoglobinopathies; AOR; Arabs - statistics & numerical data; Biological and medical sciences; CAAP; Case-Control Studies; Child, Preschool; community-acquired alveolar pneumonia; Community-Acquired Infections - epidemiology; Comorbidity; confidence interval; Diarrhea; Diarrhea - epidemiology; Diseases of red blood cells; Epidemiology; Female; Follow-Up Studies; General aspects; Growth Disorders - epidemiology; Hematologic and hematopoietic diseases; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Israel - epidemiology; Logistic Models; Male; Medical sciences; micronutrients; Multivariate Analysis; Nutrition; Nutrition Surveys; Nutritional Status; Pneumonia; Pneumonia - blood; Pneumonia - epidemiology; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Socioeconomic Factors; Vitamin A - blood; Asia; Israel; Human; Lung disease; Pneumonia; risk factors; Respiratory disease; Anemia; Diarrhea; Hemopathy; Epidemiology; Ethnic group; Feeding; Micronutrient; Statistical model; Risk factor; Digestive diseases; Intestinal disease; micronutrients; Child; Nutritional status
• ISSN: 0002-9262; 1476-6256
• DOI: 10.1093/aje/kwi312

Community-acquired alveolar pneumonia (CAAP) is typically associated with bacterial infections and is especially prevalent in vulnerable populations worldwide. The authors studied nutritional status and diarrheal history as risk factors for CAAP in Bedouin children <5 years of age living in Israel. In this prospective case-control study (2001–2002), 334 children with radiographically confirmed CAAP were compared with 529 controls without pneumonia with regard to nutritional status and diarrhea history. Controls were frequency matched to cases on age and enrollment month. Logistic regression models were used to evaluate associations of CAAP with nutritional status and recent diarrhea experience. Anemia (adjusted odds ratio (AOR) = 3.32, 95% confidence interval (CI): 2.24, 4.94; p < 0.001), low birth weight (AOR = 2.16, 95% CI: 1.32, 3.54; p = 0.002), stunting (AOR = 2.22, 95% CI: 1.31, 3.78; p = 0.004), serum retinol concentration (AOR = 1.03 per μg/dl, 95% CI: 1.02, 1.05; p < 0.001), and having ≥1 diarrhea episodes within 31 days prior to enrollment (AOR = 2.30, 95% CI: 1.26, 4.19; p = 0.007) were identified as risk factors for CAAP. Results suggest that improving antenatal care and the nutritional status of infants may reduce the risk of CAAP in Bedouin children. Furthermore, they suggest that vaccines developed to prevent diarrhea may also lower the risk of CAAP.