title: A case-control study of nutritional factors associated with chronic suppurative otitis media in Yemeni children.
abstract: OBJECTIVE
  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.
  
  
  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 (PO(4)) 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), PO(4) (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.
authors.affiliation: WHO Collaborating Centre for Prevention of Hearing Impairment, Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Elemraid
authors.forename: I J
authors.initials: IJ
authors.lastname: Mackenzie
authors.forename: W D
authors.initials: WD
authors.lastname: Fraser
authors.forename: G
authors.initials: G
authors.lastname: Harper
authors.forename: B
authors.initials: B
authors.lastname: Faragher
authors.forename: Z
authors.initials: Z
authors.lastname: Atef
authors.forename: N
authors.initials: N
authors.lastname: Al-Aghbari
authors.forename: B J
authors.initials: BJ
authors.lastname: Brabin
mesh_terms: D002118:Calcium / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000453:epidemiology*; D018977:Micronutrients / Q000494:pharmacology; D009752:Nutritional Status; D010035:Otitis Media, Suppurative / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012307:Risk Factors; D012643:Selenium / Q000097:blood; D011795:Surveys and Questionnaires; D014808:Vitamin D Deficiency / Q000150:complications; D015006:Yemen / Q000453:epidemiology; D015032:Zinc / Q000097:blood
chemical_list: D018977:Micronutrients; D012643:Selenium; D015032:Zinc; D002118:Calcium