Elsevier

The Journal of Pediatrics

Volume 140, Issue 2, February 2002, Pages 210-218
The Journal of Pediatrics

Original Articles
Effects of nutritional status on diarrhea in Peruvian children,☆☆

https://doi.org/10.1067/mpd.2002.121820Get rights and content

Abstract

Objectives: We conducted a 4-year (1995-1998) field study in a Peruvian peri-urban community (pueblo joven) to examine the relation between diarrhea and nutritional status in 230 children <3 years of age. Methods: We followed the birth cohort daily for diarrhea and monthly for anthropometry. We modeled diarrheal incidence with a multivariate time-to-event regression model to account for multiple episodes per child and irregular follow-up periods and diarrheal duration with a mixed-effects gamma regression model to account for disease heterogeneity across children. Results: During 159,551 child-days of follow-up, we identified 1387 diarrheal episodes, which yielded an average incidence of 3.2 episodes per child-year. Diarrhea was seasonal, for example, infants had up to 8 diarrheal episodes during the summer; however, these variations decreased noticeably with age. Nutritional status was significantly associated with diarrheal incidence. The frequency of diarrhea increased by 15% per standard deviation decrease in height-for-age z score. Diarrheal episodes in children <6 months of age lasted significantly longer than episodes among older children. Conclusions: These results identify infants and children of poor nutritional status as priority risk groups for prevention efforts aimed at reducing the burden of acute childhood diarrhea. (J Pediatr 2002;140:210-8)

Section snippets

Material and methods

The study was conducted in Pampas de San Juan, a peri-urban community of approximately 40,000 residents. The majority of residents are immigrant families from rural areas of the Peruvian Andes. This community was established late in 1970 and was highly transitional for more than a decade. Today, it has low emigration. Pampas de San Juan is built around a cluster of sand hills located 25 km south of metropolitan Lima. The early settlers live downhill in the more established households, which are

Results

The 230 children were followed longitudinally for 159,551 child-days. During the study period we identified 1387 episodes of diarrhea, yielding a point prevalence of 2.1% and an incidence of 3.2 diarrheal episodes per child-year.

Discussion

Nutritional status was a significant predictor of diarrheal incidence in a study population with high levels of stunting but low levels of wasting. The frequency of diarrhea increased by 15% per SD decrease in the height-for-age z score after controlling for age and other variables. The association between diarrheal incidence and height-for-age remained significant even after controlling for age and environmental variables such as water supply and sanitation facilities. On the other hand,

Acknowledgements

The authors extend special thanks to Drs C. Bern and M. D. Chestnut for helpful comments and Ms J. B. Phu and Ms D. Sara for technical assistance.

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    Supported by a National Research Service Award of the National Institutes of Child Health and Development (F31-HD08488) (to W. C.), an ICTDR grant of the National Institutes of Allergy and Infectious Diseases awarded to The Johns Hopkins School of Public Health (U01-A135894), an ITREID training grant awarded to the Johns Hopkins University, and the charitable RG-ER foundation for the advancement of diarrheal disease research.

    ☆☆

    Reprint requests: William Checkley, The Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, 615 N Wolfe St, W3503, Baltimore, MD 21205.

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