title: Diet-related risk factors for leprosy: a case-control study.
abstract: BACKGROUND
  Food shortage was associated with leprosy in two recent studies investigating the relation between socioeconomic factors and leprosy. Inadequate intake of nutrients due to food shortage may affect the immune system and influence the progression of infection to clinical leprosy. We aimed to identify possible differences in dietary intake between recently diagnosed leprosy patients and control subjects.
  
  
  METHODS
  In a leprosy endemic area of Bangladesh, newly diagnosed leprosy patients and control subjects were interviewed about their socioeconomic situation, health and diet. Dietary intakes were recorded with a 24-hour recall, from which a Dietary Diversity Score (DDS) was calculated. Body Mass Index (BMI) was calculated and Household Food Insecurity Access Scale (HFIAS) was filled out for every participant. Using logistic regression, a univariate, block wise multivariate, and an integrated analysis were carried out.
  
  
  RESULTS
  52 leprosy cases and 100 control subjects were included. Food shortage was more common, dietary diversity was lower and household food insecurity was higher in the patient group. Patients consumed significantly less items from the DDS food groups 'Meat and fish' and 'Other fruits and vegetables.' Lower food expenditure per capita, lower BMI, lower DDS and absence of household food stocks are the main factors associated with an increased risk of having leprosy.
  
  
  CONCLUSIONS
  Low income families have only little money to spend on food and consequently have a low intake of highly nutritious non-rice foods such as meat, fish, milk, eggs, fruits and vegetables. Development of clinical leprosy could be explained by deficiencies of the nutrients that these foods normally provide.
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Inge
authors.initials: I
authors.lastname: Wagenaar
authors.affiliation: Wageningen University and Research Centre, Wageningen, The Netherlands.
authors.forename: Lisanne
authors.initials: L
authors.lastname: van Muiden
authors.affiliation: Rural Health Program, The Leprosy Mission International-Bangladesh, Nilphamari, Bangladesh.
authors.forename: Khorshed
authors.initials: K
authors.lastname: Alam
authors.affiliation: Rural Health Program, The Leprosy Mission International-Bangladesh, Nilphamari, Bangladesh.
authors.forename: Robert
authors.initials: R
authors.lastname: Bowers
authors.affiliation: Nilphamari Training Center, The Leprosy Mission International-Bangladesh, Nilphamari, Bangladesh.
authors.forename: Md Anwar
authors.initials: MA
authors.lastname: Hossain
authors.affiliation: Nilphamari Training Center, The Leprosy Mission International-Bangladesh, Nilphamari, Bangladesh.
authors.forename: Kolpona
authors.initials: K
authors.lastname: Kispotta
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Jan Hendrik
authors.initials: JH
authors.lastname: Richardus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001459:Bangladesh; D015992:Body Mass Index; D016022:Case-Control Studies; D004032:Diet; D005260:Female; D006801:Humans; D007918:Leprosy / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors