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A case–control study of nutritional factors associated with chronic suppurative otitis media in Yemeni children

European Journal of Clinical Nutrition volume 65, pages 895–902 (2011)Cite this article

Subjects

Abstract

Background/Objectives:

Undernutrition and chronic suppurative otitis media (CSOM) in children are common in low resource settings, but there are few studies of their interactions. The aim is to evaluate nutritional factors associated with CSOM in Yemeni children.

Subjects/Methods:

A case–control study of 75 children with CSOM and 74 healthy controls. Assessment included dietary history, anthropometry, haemoglobin (Hb) and serum analytes zinc (Zn), copper (Cu), selenium (Se), iron, calcium, phosphate (PO4) and total 25-hydroxy vitamin D (25(OH)D).

Results:

Cases had lower mean Z-scores for weight-for-age, weight-for-height, body mass index and mid-upper arm circumference (MUAC) (all P<0.05), and lower mean concentrations of serum Zn (P=0.032), Se (P<0.001) and calcium adjusted for albumin (P=0.026). Age-adjusted Hb and iron biomarkers did not differ between cases and controls. There was high prevalence of low serum Zn concentration (⩾90%) and vitamin D deficiency in both cases (80%) and controls (96%). Duration of ear discharge was negatively correlated with total 25(OH)D (P=0.028), calcium adjusted for albumin (P<0.001), PO4 (P=0.002), transferrin receptor/log ferritin ratio (P<0.001) and Cu (P<0.001), and positively correlated with child age and MUAC (both P<0.001).

Conclusions:

Children with CSOM were more undernourished than controls with lower mean serum Zn, Se and calcium concentrations. Vitamin D-deficient and iron-replete children had longer duration of infection, although this association was lost with age adjustment. Trials evaluating specific micronutrients are required in order to investigate specific nutrient–infection interactions in CSOM.

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Acknowledgements

This work was supported by the Liverpool School of Tropical Medicine, UK, and a Libyan Government Training Scholarship. We are grateful to Nawal Al-Harazi and Kefah Al-Abssy for their assistance, and to the paediatric, ENT and laboratory staff at Al-Thawra General Hospital. Our gratitude goes to the children and their parents for participation in the study.

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Authors and Affiliations

  1. WHO Collaborating Centre for Prevention of Hearing Impairment, Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK

    M A Elemraid, I J Mackenzie, G Harper, B Faragher & B J Brabin

  2. Department of Musculoskeletal Biology, Institute of Aging and Chronic Disease, Liverpool University, Liverpool, UK

    W D Fraser

  3. Department of Child Health, Al-Thawra General Hospital, Sana’a, Yemen

    Z Atef & N Al-Aghbari

  4. Global Child Health Group, Emma Kinderziekenhuis, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

    B J Brabin

  5. Department of Community Child Health, Royal Liverpool Children's NHS Trust, Liverpool, UK

    B J Brabin

Authors
  1. M A Elemraid
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  2. I J Mackenzie
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  3. W D Fraser
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  4. G Harper
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  5. B Faragher
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  6. Z Atef
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  7. N Al-Aghbari
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  8. B J Brabin
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Correspondence to B J Brabin.

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The authors declare no conflict of interest.

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Contributors: MAE, IJM, WDF and BJB wrote the manuscript; MAE, NA-A and BJB contributed to study design and data interpretation; BF, MAE and BJB performed data and statistical analyses; MAE, ZA and NA carried out logistics and data collection; WDF and GH performed technical and laboratory analyses.

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Elemraid, M., Mackenzie, I., Fraser, W. et al. A case–control study of nutritional factors associated with chronic suppurative otitis media in Yemeni children. Eur J Clin Nutr 65, 895–902 (2011). https://doi.org/10.1038/ejcn.2011.58

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