title: Diet as a risk factor for pneumococcal carriage and otitis media: a cross-sectional study among children in day care centers.
abstract: BACKGROUND
  Pharyngeal bacteria are exposed to different sugar conditions depending on the diet of the child. We hypothesized that dietary factors such as daily intake of carbohydrates could be associated with pneumococcal carriage and the occurrence of otitis media in children.
  
  
  METHODS
  Our study design was a cross-sectional study among 1006 children attending child day care centers. Parents filled in a food frequency questionnaire. Oropharyngeal swabs were collected from each child. The primary outcome was the occurrence of pneumococcal carriage and the secondary outcome the number of acute otitis media episodes during life. Principal component analysis was used to group dietary intake into nine factors. The models were adjusted for age, gender of the child and educational level of the mother.
  
  
  RESULTS
  The dietary factor which included high consumption of sweet pastries and jam was associated with an increased risk of pneumococcal carriage (OR 1.17, 95% CI 1.01 to 1.36, P-value 0.04). The factor including frequent consumption of fruit and berries was associated with a decreased risk of acute otitis (regression coefficient -0.51, 95% CI -0.98 to -0.03, P=0.04). A high intake of consumption of sweets and snacks (OR 1.36, 95% CI 1.03 to 1.80, P=0.03) was associated with an increased risk of caries.
  
  
  CONCLUSIONS
  Diet was associated with a risk of pneumococcal carriage and the occurrence of otitis media. Diet may thus be a modifiable risk factor for the occurrence of acute otitis media.
authors.affiliation: Department of Pediatrics, Oulu University Hospital, Oulu, Finland; Department of Pediatrics, University of Oulu, Oulu, Finland.
authors.forename: Terhi
authors.initials: T
authors.lastname: Tapiainen
authors.affiliation: Department of Pediatrics, Oulu University Hospital, Oulu, Finland; Department of Pediatrics, University of Oulu, Oulu, Finland.
authors.forename: Niko
authors.initials: N
authors.lastname: Paalanne
authors.affiliation: Department of Pediatrics, Oulu University Hospital, Oulu, Finland.
authors.forename: Tuula
authors.initials: T
authors.lastname: Arkkola
authors.affiliation: Department of Pediatrics, Oulu University Hospital, Oulu, Finland; Department of Pediatrics, University of Oulu, Oulu, Finland.
authors.forename: Marjo
authors.initials: M
authors.lastname: Renko
authors.affiliation: Department of Pediatrics, Oulu University Hospital, Oulu, Finland; Department of Pediatrics, University of Oulu, Oulu, Finland.
authors.forename: Tytti
authors.initials: T
authors.lastname: Pokka
authors.affiliation: National Institute for Health and Welfare, Oulu, Finland.
authors.forename: Tarja
authors.initials: T
authors.lastname: Kaijalainen
authors.affiliation: Department of Pediatrics, Oulu University Hospital, Oulu, Finland; Department of Pediatrics, University of Oulu, Oulu, Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Uhari
mesh_terms: D002353:Carrier State; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003631:Day Care, Medical; D004032:Diet; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D009061:Mouth Mucosa / Q000382:microbiology; D010033:Otitis Media / Q000453:epidemiology / Q000382:microbiology*; D010614:Pharynx / Q000382:microbiology; D012307:Risk Factors; D013296:Streptococcus pneumoniae