Case-control study of the role of nutritional rickets in the risk of developing pneumonia in Ethiopian children

Muhe, Lulu; Lulseged, Sileshi; Mason, Karen; Simões, Eric A F

doi:10.1016/s0140-6736(96)12098-5

Cited by 317 publications

(229 citation statements)

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“…As for vitamin D status, although it is difficult to assume causality in a case-control study, it seems more likely that poor vitamin D status was a causal factor that increased severe ALRI than that ALRI induced low serum 25OHD3. Firstly, in vitro studies (Rockett et al, 1998;Cantorna, 2000;Pichler et al, 2002) and clinical studies of rickets (Lubani et al, 1989;Banajeh et al, 1997;Muhe et al, 1997) support a role for vitamin D in protecting against infectious diseases. Secondly, although 1,25-dihydroxyvitamin D3 metabolism is altered in both the acute phase response, including fever, to catch-scratch disease (Bartonella henselae; Bosch, 1998) and chronically in adults with HIV infection (Haug et al, 1998), neither of these infections induced changes in serum 25OHD3, the accepted measure of vitamin D status.…”

Section: Discussionmentioning

confidence: 99%

“…In vitro studies have shown the importance of 1,25-dihydroxyvitamin D3 for promoting and regulating immune responses (Rockett et al, 1998;Cantorna, 2000;Pichler et al, 2002) and these are also supported by studies in humans. Clinical vitamin D deficiency (rickets) was associated with 13-fold increased risk of pneumonia in Ethiopian children less than 5 y of age (Muhe et al, 1997). In Yemen, 50% of children admitted to hospital for ALRI had vitamin D deficiency rickets (Banajeh et al, 1997) and in Kuwait 43% of children with vitamin D deficiency rickets had pneumonia (Lubani et al, 1989).…”

Section: Introductionmentioning

confidence: 99%

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Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y

et al. 2004

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Objectives: To determine whether subclinical vitamin D deficiency in Indian children under 5 y of age is a risk factor for severe acute lower respiratory infection (ALRI). Design: A hospital-based case-control study. Setting: Sanjeevani Paediatrics Hospital, a private hospital in Indapur, India. Participants: A total of 150 children including 80 cases and 70 controls, aged 2-60 months, were enrolled. Case definition of severe ALRI as given by the World Health Organization was used for cases. Controls were healthy children attending outpatients' service for immunization. Main outcome measure: Association of serum 25-hydroxyvitamin D3 (25OHD3) with severe ALRI, controlling for demographic and other potential risk factors. Results: Serum 25OHD3 increased with age. Factors significantly associated with decreased risk of severe ALRI in univariate analysis were: exclusive breastfeeding in the first 4 months (cases 35/78 (45%), controls 41/64 (64%); P ¼ 0.02); introduction of other dietary liquids than milk only after 6 months (cases 46/70 (66%), controls 31/66 (47%); P ¼ 0.03); use of liquid petroleum cooking fuel (cases 32/80 (40%), controls 40/70 (57%); P ¼ 0.04); infant not covered in swaddling cloths when exposed to sunlight before crawling (cases 11/52 (21%), controls 25/54 (46%); P ¼ 0.006); and serum 25OHD3 422.5 nmol/l (cases 16/80 (20%), controls 48/70 (69%); Po0.001). In multivariate analysis, factors associated with significantly lower odds ratio for having severe ALRI were: serum 25OHD3 422.5 nmol/l (OR: 0.09; 95% CI 0.03-0.24; Po0.001) and exclusive breastfeeding in the first 4 months of life (OR 0.42; 95% CI 0.18-0.99; P ¼ 0.046) with age and height/age as significant covariates. Conclusion: Subclinical vitamin D deficiency and nonexclusive breastfeeding in the first 4 months of life were significant risk factors for severe ALRI in Indian children. (2004) 58, 563-567. doi:10.1038/sj.ejcn.1601845 Keywords: pneumonia; children; India; 25-hydroxyvitamin D3; breastfeeding European Journal of Clinical Nutrition IntroductionAcute lower respiratory infection (ALRI), primarily pneumonia, is a common cause of morbidity and mortality in children younger than 5 y of age, particularly in developing countries (United State Agency for International Development (USAID), 2002). Consequently considerable research has aimed at finding effective interventions against ALRI such as immunization (Monto & Lehmann, 1998) and casemanagement involving antibiotics (World Health Organization (WHO), 1995). Micronutrient supplementation is another potential intervention. Many trials have investigated the benefits of vitamin A supplements, but these do not significantly decrease morbidity and mortality from ALRI, other than that due to measles, in spite of decreasing overall under-5 mortality (Vitamin A and Pneumonia Working Group, 1995). Zinc supplementation lowered ALRI incidence by 41% (Zinc Investigators' Collaborative Group, 1999). Contributors: VW was involved in designing the study and collected and analysed the data. SF was...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y

et al. 2004

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“…Furthermore, vitamin D is known to play a role in the human antimicrobial response (Cannell et al, 2006;Liu et al, 2006) and pulmonary function (Black and Scragg, 2005). Vitamin D deficiency is known to cause rickets and there are a lot of studies showing the correlation between rickets and acute lower respiratory infection (ALRI) in children (Muhe et al, 1997;Najada et al, 2004). However, Wayse et al (2004) were the first to find an association of subclinical 25-hydroxy vitamin D (25(OH)D) deficiency and ALRI in nonrachitic children.…”

Section: Introductionmentioning

confidence: 99%

Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers

et al. 2007

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Background/Objectives: There are other benefits of vitamin D than those for bone health. To determine the association of serum 25-hydroxy vitamin D (25(OH)D) concentrations in newborns with acute lower respiratory infection (ALRI) and without clinical signs of rickets, and their mothers. The design comprises a hospital-based case-control study. Subjects/Methods: The study group consisted of 25 newborns with ALRI who were admitted to neonatal intensive care unit and their mothers. Controls were 15 healthy newborns of the same age as the study group and their mothers. A commercial radioimmunoassay was used to measure 25(OH)D concentrations in serum for assessing vitamin D status. Results: The two groups were similar in gestational week, birth weight, birth height, head circumference, age and gender. The mean serum 25(OH)D concentrations in the study group newborns were lower than those of the control group (9.12±8.88 ng/ml and 16.33 ± 13.42 ng/ml, respectively) (P ¼ 0.011). Also, mean serum 25(OH)D concentrations in the mothers of the study group were lower than those in the mothers of the control group (13.38±16.81 ng/ml and 22.79±16.93 ng/ml respectively) (P ¼ 0.012). In 87.5% of all newborns and 67.5% of all mothers, serum 25(OH)D concentrations were lower than 20 ng/ml. The 25(OH)D concentrations of newborns were highly correlated with mothers' serum 25(OH)D concentrations. Conclusions: Our findings suggest that newborns with subclinical vitamin D deficiency may have an increased risk of suffering from ALRI. The strong positive correlation between newborns' and mothers' 25(OH)D concentrations shows that adequate vitamin D supplementation of mothers should be emphasized during pregnancy especially in winter months.

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“…A n association between nutritional rickets and pneumonia has been reported for decades (1). In recent years there have been several reports on the associations between subclinical vitamin D deficiency and risk for respiratory infections and development of more severe disease (2)(3)(4).…”

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confidence: 99%

Vitamin D status is associated with treatment failure and duration of illness in Nepalese children with severe pneumonia

et al. 2017

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BACKGROUND: There is no consensus on optimal Vitamin D status. The objective of this study was to estimate the extent to which vitamin D status predicts illness duration and treatment failure in children with severe pneumonia by using different cutoffs for vitamin D concentration. METHODS:We measured the plasma concentration of 25(OH)D in 568 children hospitalized with World Health Organization-defined severe pneumonia. The associations between vitamin D status, using the most frequently used cutoffs for vitamin D insufficiency (25(OH)Do50 and o75 nmol/l), and risk for treatment failure and time until recovery were analyzed in multiple logistic regression and Cox proportional hazards models, respectively. RESULTS: Of the 568 children, 322 (56.7%) had plasma 25(OH) D levels ≥ 75 nmol/l, 179 (31.5%) had levels of 50-74.9 nmol/l, and 67 (%) had levels o50 nmol/l. Plasma 25(OH)D o50 nmol/l was associated with increased risk for treatment failure and longer time until recovery. CONCLUSION: Our findings indicate that low vitamin D status (25(OH)Do50 nmol/l) is an independent risk factor for treatment failure and delayed recovery from severe lower respiratory infections in children.

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Case-control study of the role of nutritional rickets in the risk of developing pneumonia in Ethiopian children

Cited by 317 publications

References 11 publications

Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y

Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y

Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers

Vitamin D status is associated with treatment failure and duration of illness in Nepalese children with severe pneumonia

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