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


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=0.02); introduction of other dietary liquids than milk only after 6 months (cases 46/70 (66%), controls 31/66 (47%); P=0.03); use of liquid petroleum cooking fuel (cases 32/80 (40%), controls 40/70 (57%); P=0.04); infant not covered in swaddling cloths when exposed to sunlight before crawling (cases 11/52 (21%), controls 25/54 (46%); P=0.006); and serum 25OHD3 >22.5 nmol/l (cases 16/80 (20%), controls 48/70 (69%); P<0.001). In multivariate analysis, factors associated with significantly lower odds ratio for having severe ALRI were: serum 25OHD3 >22.5 nmol/l (OR: 0.09; 95% CI 0.03–0.24; P<0.001) and exclusive breastfeeding in the first 4 months of life (OR 0.42; 95% CI 0.18–0.99; P=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.

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We thank all the parents and children who participated in the study, and the Sanjeevani Paediatrics Hospital, Indapur and Dr L Kadam for their cooperation. We also thank Drs B Mulay, S Doshi and V Ranaware for carrying out laboratory work, and Drs N Thaware, L Hande, R Kavitkar and M Jamdar for their helpful advice and guidance, and S Lewycka, Institute of Child Health, for statistical advice. This work was undertaken in collaboration with Great Ormond Street Hospital for Children NHS Trust, which receives a proportion of its funding from the NHS Executive. Financial support for the work was provided from personal funds in connection with V Wayse's MSc degree at the Institute of Child Health.

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Guarantor: S Filteau.

Contributors: VW was involved in designing the study and collected and analysed the data. SF was involved in study design and statistical analysis. AY was involved in data analysis. KM was involved in data collection. VW and SF wrote the first draft of the paper and all authors contributed to the final draft.

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Correspondence to S Filteau.

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Wayse, V., Yousafzai, A., Mogale, K. et al. Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y. Eur J Clin Nutr 58, 563–567 (2004).

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