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Nutritional factors associated with rheumatic fever
M M Zaman1, N Yoshiike, A H Chowdhury
1Tokyo Medical and Dental University, Japan.
Insights
Nutritional deficiencies increase the risk of rheumatic fever (RF) in children with group A beta-haemolytic streptococcal throat infections. Consuming eggs and soybean oil may offer protective benefits against RF development.
Area of Science:
- Pediatrics
- Infectious Diseases
- Nutritional Science
Background:
- Rheumatic fever (RF) development after group A beta-haemolytic streptococcal (GABHS) throat infection is not fully understood.
- Nutritional status is a potential, yet underexplored, determinant in RF pathogenesis.
Purpose of the Study:
- To investigate the association between nutritional factors and the risk of developing rheumatic fever in children with GABHS infections.
- To identify specific dietary components and anthropometric indicators linked to RF susceptibility.
Main Methods:
- A case-control study was conducted with 218 outpatients in Dhaka, Bangladesh, who had a history of GABHS infection.
- Nutritional status was assessed using anthropometric measurements and a food frequency questionnaire.
- Cases (n=60) met the updated Jones criteria for RF; controls (n=104) did not.
Main Results:
- Low height-for-age, weight-for-age, and upper arm circumference-for-age were significantly associated with increased RF risk.
- Reduced consumption of eggs, milk, chicken, pulses, fruits, and ruti correlated with higher RF risk.
- Soybean oil consumption showed a protective effect against RF.
- The association between upper arm circumference, egg consumption, and RF remained significant after adjusting for confounders.
Conclusions:
- Protein-energy malnutrition appears to be associated with an increased risk of rheumatic fever.
- Dietary factors, particularly egg and soybean oil intake, may play a role in preventing RF development, potentially due to anti-inflammatory properties.
Abstract:
The determinants for a child with group A beta-haemolytic streptococcal throat infection (BHS infection) to develop rheumatic fever (RF) remain unclear. In this case-control study, we deal with BHS infected children to examine whether nutritional factors are related to RF. In a RF hospital in Dhaka (Bangladesh) we examined 218 consecutive out-patients who had antecedent BHS infection. Sixty of them met the updated Jones criteria for RF (cases) while 104 did not (controls). Fifty-four possible RF patients were excluded. We used anthropometric measurements and a food frequency questionnaire to assess nutritional factors. Higher risk of RF was observed for low height for age (odds ratio 3.82, 95% confidence interval 1.73-8.42); low weight for age (2.41, 1.12-5.57); low upper arm circumference for age (3.76, 1.87-7.89); and low consumption of eggs (3.81, 1.95-7.63), milk (2.60, 1.36-5.08), chicken (2.62, 1.35-5.21), pulses (1.98, 1.03-3.84), fruits 2.29, 1.20-4.45), and ruti (home-made bread) (3.15, 1.61-6.34). Reduced risk was observed for soybean oil consumption (0.28, 0.12-0.62). The significant association of upper arm circumference and eggs persisted after adjustment for multiple sociodemographic confounders. The association of ruti and soybean oil appeared to be suggestive (0.05 < p < 0.1). Protein-energy malnutrition is likely to be associated with RF. The protective effect of moderate consumption of eggs and soybean oil may support other published work which suggests that the anti-inflammatory substance present in these food items may prevent maturation of the rheumatic process.