NUTRITIONAL FACTORS ASSOCIATED WITH RHEUMATIC-FEVER

The determinants for a child with group A beta-haemolytic streptococca l throat infection (BHS infection) to develop rheumatic fever (RF) rem ain unclear. In this ease-control study, we deal with BHS infected chi ldren to examine whether nutritional factors are related to RF. In a R F hospital in Dhaka (Bangladesh) we examined 218 consecutive out-patie nts who had antecedent RHS infection. Sixty of them met the updated Jo nes criteria for RF (cases) while 104 did not (controls). Fifty-four p ossible RF patients were excluded. We used anthropometric measurements and a food frequency questionnaire to assess nutritional factors. Hig her risk of RF was observed for low height for age (odds ratio 3.82, 9 5% confidence interval 1.73-8.42); low weight for age (2.41, 1.12-5.57 ); low upper arm circumference for age (3.76, 1.87-7.89); and low cons umption of eggs (3.81, 1.95-7.63), milk (2.60, 1.36-5.08), chicken (2. 62, 1.35-5.21), pulses (1.98, 1.03-3.84), fruits (2.29, 1.20-4.45), an d ruti (home-made bread) (3.15, 1.61-6.34), Reduced risk was observed for soybean oil consumption (0.28, 0.12-0.62). The significant associa tion of upper arm circumference and eggs persisted after adjustment fo r multiple sociodemographic confounders. The association of ruti and s oybean oil appeared to be suggestive (0.05 < p < 0.1). Protein-energy malnutrition is likely to be associated with RF, The protective effect of moderate consumption of eggs and soybean oil may support other pub lished work which suggests that the antiinflammatory substance present in these food items may prevent maturation of the rheumatic process.