title: Effects of nutritional status on diarrhea in Peruvian children.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of International Health, The Johns Hopkins School of Public Health, Baltimore, Md. 21205, USA.
authors.forename: William
authors.initials: W
authors.lastname: Checkley
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.forename: Andres G
authors.initials: AG
authors.lastname: Lescano
authors.forename: Lilia
authors.initials: L
authors.lastname: Cabrera
authors.forename: David N
authors.initials: DN
authors.lastname: Taylor
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Moulton
mesh_terms: D001942:Breast Feeding; D002675:Child, Preschool; D003968:Diarrhea, Infantile / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009752:Nutritional Status; D010568:Peru / Q000453:epidemiology; D012044:Regression Analysis; D012621:Seasons