Arias-Bravo Guisselle, Valderrama Gustavo, Inostroza Jaime, Reyes-Farías Marjorie, Garcia-Diaz Diego F, Zorondo-Rodríguez Francisco, Fuenzalida Loreto F
Facultad de Ciencias de la Salud, Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Santiago, Chile.
Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile.
Front Pediatr. 2020 Feb 18;8:44. doi: 10.3389/fped.2020.00044. eCollection 2020.
To investigate the relationship of overnutrition (obese and overweight) with severity of illness in children hospitalized with acute lower respiratory infections (ALRIs), frequency of viral coinfections and leptin levels. We studied 124 children <2 years old that were hospitalized for ALRI. Nutritional status was calculated by z-scores according to weight-for-age z-scores, length or height-for-age z-scores, and weight-for-height z-scores. Nasopharyngeal aspirates (NPAs) were obtained and viral respiratory pathogens were identified using reverse transcription polymerase chain reactions (RT-PCR). Respiratory syncytial virus (RSV) load was assessed using quantitative RT-PCR. NPA and plasma leptin level were measured. Clinical data and nutritional status were recorded, and patients were followed up until hospital discharge. Viral coinfection was defined as the presence of two or more viruses detected in the same respiratory sample. Severity of illness was determined by length of hospitalization and duration of oxygen therapy. Children with overnutrition showed a greater frequency of viral coinfection than those with normal weight (71% obese vs. 37% normal weight = 0.013; 68% overweight vs. 37% normal weight = 0.004). A lower RSV load was found in obese (5.91 log copies/mL) and overweight children (6.49 log copies/mL) compared to normal weight children (8.06 log copies/mL; = 0.021 in both cases). In multivariate analysis, obese, and overweight infants <6 months old were associated with longer hospital stays (RR = 1.68; CI: 1.30-2.15 and obese: RR = 1.68; CI: 1.01-2.71, respectively) as well as a greater duration of oxygen therapy (RR = 1.80; IC: 1.41-2.29 and obese: RR = 1.91; CI: 1.15-3.15, respectively). Obese children <6 months showed higher plasma leptin level than normal weight children (7.58 vs. 5.12 ng/μl; <0.046). In infants younger than 6 months, overnutrition condition was related to increased severity of infections and high plasma leptin level. Also, children with overnutrition showed a greater frequency of viral coinfection and low RSV viral load compared to normal weights children. These findings further contribute to the already existent evidence supporting the importance of overnutrition prevention in pediatric populations.
为了研究营养过剩（肥胖和超重）与因急性下呼吸道感染（ALRIs）住院儿童的疾病严重程度、病毒合并感染频率和瘦素水平之间的关系。我们研究了124名2岁以下因ALRIs住院的儿童。根据年龄别体重z评分、年龄别身长或身高z评分以及身高别体重z评分计算营养状况。采集鼻咽抽吸物（NPA），并使用逆转录聚合酶链反应（RT-PCR）鉴定呼吸道病毒病原体。使用定量RT-PCR评估呼吸道合胞病毒（RSV）载量。测量NPA和血浆瘦素水平。记录临床数据和营养状况，并对患者进行随访直至出院。病毒合并感染定义为在同一呼吸道样本中检测到两种或更多种病毒。根据住院时间和氧疗持续时间确定疾病严重程度。营养过剩的儿童比体重正常的儿童病毒合并感染频率更高（肥胖儿童为71%，正常体重儿童为37%，P = 0.013；超重儿童为68%，正常体重儿童为37%，P = 0.004）。与体重正常的儿童（8.06 log拷贝/mL）相比，肥胖儿童（5.91 log拷贝/mL）和超重儿童（6.49 log拷贝/mL）的RSV载量较低（两种情况P均 = 0.021）。在多变量分析中，6个月以下的肥胖和超重婴儿住院时间更长（RR = 1.68；CI：1.30 - 2.15，肥胖：RR = 1.68；CI：1.01 - 2.71），氧疗持续时间也更长（RR = 1.80；IC：1.41 - 2.29，肥胖：RR = 1.91；CI：1.15 - 3.15）。6个月以下的肥胖儿童血浆瘦素水平高于体重正常的儿童（7.58 vs. 5.12 ng/μl；P <0.046）。在6个月以下的婴儿中，营养过剩状况与感染严重程度增加和血浆瘦素水平升高有关。此外，与体重正常的儿童相比，营养过剩的儿童病毒合并感染频率更高，RSV病毒载量更低。这些发现进一步为已有的证据提供了支持，证明了预防儿童营养过剩的重要性。
