title: Exploring association between gastrointestinal heat retention syndrome and recurrent respiratory tract infections in children: a prospective cohort study.
abstract: BACKGROUND
  Recurrent respiratory tract infections (RRTIs) have a negative impact on both children's health and family wellbeing. Deficiency of ZhengQi used to be an instinct factor driving RRTI in Traditional Chinese Medicine (TCM). Our clinical observations suggest that children with gastrointestinal heat retention syndrome (GHRS) may have a greater risk of catching respiratory tract infections (RTIs). GHRS is a new predisposing factor for RRTI and it is dietary related. This study is aimed to explore association between GHRS and RRTI.
  
  
  METHODS
  A prospective cohort study has been conducted in Beijing, China; children aged 1-18 were enrolled. TCM symptoms, demographic and physiological characteristics were recorded by using semi-structured questionnaire. GHRS was considered as a predisposing factor. Children were followed up for next 12 months. We contacted with their parents using a face-to-face questionnaire survey, via email or phone every 3 months. Episodes of RTIs were recorded in detail.
  
  
  RESULTS
  Three hundred thirty four children were enrolled and 307 (91.92%) followed up for 12 months. The incidence of RTI was 4.32 episodes per child-year (95 % CI 4.03-4.61). 69 (43.13%) children in the group with GHRS suffered from RRTI; there were 48 (32.65%) children in group without GHRS. The risk ratio (RR) value of RRTI occurrence was 1.32 (95 % CI 0.91-1.91, P = 0.139), and the attributable risk percent (AR%) was 24.28%. Dry stool and irritability were positively correlated with RTI episodes, age and BMI were negatively correlated with RTI episodes in a linear regression model. Dry stool (OR = 1.510) was positively correlated with RRTI occurrence, age (OR = 0.889) and BMI (OR = 0.858) were negatively correlated with RRTI occurrence in our logistic regression model.
  
  
  CONCLUSIONS
  GHRS is associated with RRTI in this cohort. Dry stool was positively associated with RRTI, and BMI was negatively associated with RRTI. Studies with larger sample size and longer follow up are needed to further evaluate this association. Relieving GHRS should be considered when TCM practitioners treat RRTI children, and this may protect children from suffering RTIs.
  
  
  BACKGROUND
  Chinese Clinical Trial Registry Number: ChiCTR-CCH-13003756.
authors.affiliation: School of Basic Medical Science, Beijing University of Chinese Medicine, Beijing, China. dongfei@bucm.edu.cn.
authors.forename: Fei
authors.initials: F
authors.lastname: Dong
authors.affiliation: School of Basic Medical Science, Beijing University of Chinese Medicine, Beijing, China. yuhe221@126.com.
authors.forename: He
authors.initials: H
authors.lastname: Yu
authors.affiliation: School of Basic Medical Science, Beijing University of Chinese Medicine, Beijing, China. pdsmajiaju@163.com.|Beijing Hospital of Traditional Chinese Medicine, Beijing, China. pdsmajiaju@163.com.
authors.forename: Jiaju
authors.initials: J
authors.lastname: Ma
authors.affiliation: Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China. 13164272790@163.com.
authors.forename: Liqun
authors.initials: L
authors.lastname: Wu
authors.affiliation: School of Basic Medical Science, Beijing University of Chinese Medicine, Beijing, China. liutiegang2009@163.com.
authors.forename: Tiegang
authors.initials: T
authors.lastname: Liu
authors.affiliation: School of Basic Medical Science, Beijing University of Chinese Medicine, Beijing, China. lgk123456@126.com.|Beilun Hospital of Chinese Medicine, Ningbo City, China. lgk123456@126.com.
authors.forename: Guokai
authors.initials: G
authors.lastname: Lv
authors.affiliation: School of Basic Medical Science, Beijing University of Chinese Medicine, Beijing, China. 296231058@qq.com.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Zhen
authors.affiliation: School of Basic Medical Science, Beijing University of Chinese Medicine, Beijing, China. 644287964@qq.com.
authors.forename: Xiaofei
authors.initials: X
authors.lastname: Li
authors.affiliation: Complementary and Integrated Medicine Research Unit, Primary Care and Population Sciences, Southampton University, Southampton, UK. gl3@soton.ac.uk.
authors.forename: George
authors.initials: G
authors.lastname: Lewith
authors.affiliation: School of Basic Medical Science, Beijing University of Chinese Medicine, Beijing, China. guxh1003@126.com.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Gu
mesh_terms: D000068476:Beijing / Q000453:epidemiology; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005243:Feces; D005260:Female; D041981:Gastrointestinal Tract; D006358:Hot Temperature; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008516:Medicine, Chinese Traditional; D011446:Prospective Studies; D019413:Qi; D012008:Recurrence; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000209:etiology*; D011795:Surveys and Questionnaires; D013577:Syndrome