title: Macronutrients during pregnancy and life-threatening respiratory syncytial virus infections in children.
abstract: BACKGROUND
  Respiratory syncytial virus (RSV) is an important cause of hospitalization and death in infants worldwide. Most RSV deaths occur in developing countries, where burden and risk factors for life-threatening illness are unclear.
  
  
  OBJECTIVE
  We defined the burden of life-threatening (O(2) saturation [O(2) sat] ≤ 87%) and fatal RSV infection, and characterized risk factors for life-threatening disease in hospitalized children. Special emphasis was placed on studying the impact of dietary habits during pregnancy. We hypothesized that dietary preferences, differing from those of our remote ancestors, would negatively impact children's pulmonary health. For instance, a diet rich in carbohydrates is a signature of recent millennia and typical of low-income populations, heavily burdened by life-threatening RSV disease.
  
  
  METHODS
  Prospective study in a catchment population of 56,560 children under 2 years of age during the RSV season in Argentina. All children with respiratory signs and O(2) sat less than 93% on admission were included.
  
  
  RESULTS
  Among 1,293 children with respiratory infections, 797(61.6%) were infected with RSV: 106 of these had life-threatening disease; 1.9 per 1,000 children (95% confidence interval [CI], 1.5-2.2/1,000) under 24 months. A total of 22 hospitalized children died (9 RSV(+)), 26 died at home due to acute respiratory infection (14 attributed to RSV); all were under 12 months old. The annual attributable mortality rate for RSV was 0.7 per 1,000 infants (95% CI, 0.4-1.1/1,000). Life-threatening disease was dose-dependently associated with carbohydrate ingestion during pregnancy (adjusted odds ratio from 3.29 [95% CI, 1.15-9.44] to 7.36 [95% CI, 2.41-22.5] versus the lowest quartile).
  
  
  CONCLUSIONS
  Life-threatening and fatal RSV infections are a heavy burden on infants in the developing world. Diets rich in carbohydrates during pregnancy are associated with these severe outcomes.
authors: Fundación INFANT, Ciudad de Buenos Aires, Argentina.
authors: F Martín
authors: FM
authors: Ferolla
authors: Diego R
authors: DR
authors: Hijano
authors: Patricio L
authors: PL
authors: Acosta
authors: Andrea
authors: A
authors: Rodríguez
authors: Karina
authors: K
authors: Dueñas
authors: Andrea
authors: A
authors: Sancilio
authors: Edgar
authors: E
authors: Barboza
authors: Adriana
authors: A
authors: Caría
authors: Guadalupe Fernández
authors: GF
authors: Gago
authors: Rodrigo Egües
authors: RE
authors: Almeida
authors: Laura
authors: L
authors: Castro
authors: Cecilia
authors: C
authors: Pozzolo
authors: María V
authors: MV
authors: Martínez
authors: Luciano Alva
authors: LA
authors: Grimaldi
authors: Beatriz
authors: B
authors: Rebec
authors: Mariel
authors: M
authors: Calvo
authors: Julieta
authors: J
authors: Henrichsen
authors: Celina
authors: C
authors: Nocito
authors: Mariela
authors: M
authors: González
authors: Guillermo
authors: G
authors: Barbero
authors: Juan Ves
authors: JV
authors: Losada
authors: Mauricio T
authors: MT
authors: Caballero
authors: Valeria
authors: V
authors: Zurankovas
authors: Mirta
authors: M
authors: Raggio
authors: Graciela
authors: G
authors: Schavlovsky
authors: Alicia
authors: A
authors: Kobylarz
authors: Vera
authors: V
authors: Wimmenauer
authors: Jimena
authors: J
authors: Bugna
authors: John V
authors: JV
authors: Williams
authors: Gustavo
authors: G
authors: Sastre
authors: Edgardo
authors: E
authors: Flamenco
authors: Alberto Rodríguez
authors: AR
authors: Pérez
authors: Fernando
authors: F
authors: Ferrero
authors: Romina
authors: R
authors: Libster
authors: Carlos G
authors: CG
authors: Grijalva
authors: Fernando P
authors: FP
authors: Polack
mesh_terms: D000208:Acute Disease; D019540:Area Under Curve; D001118:Argentina; D003906:Developing Countries; D004034:Diet Surveys; D004040:Dietary Carbohydrates / Q000009:adverse effects*; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D016015:Logistic Models; D008297:Male; D011203:Poverty; D011247:Pregnancy; D039401:Prenatal Nutritional Physiological Phenomena / Q000502:physiology*; D011446:Prospective Studies; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology*; D012136:Respiratory Syncytial Viruses; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology*; D012621:Seasons
chemical_list: D004040:Dietary Carbohydrates