Undernutrition & risk of infections in preschool children

Background & objectives: it is well documented that in preschool children undernutrition is associated with immune depression and increased risk of infections; infections aggravate undernutrition. Underweight is the most widely used indicator for assessment of undernutrition for investigating undernutrition and infection interactions. In India, nearly half the children are stunted and underweight; but majority of children have appropriate weight for their height and less than a fifth are wasted. The present study was undertaken to explore which of the five anthropometric indices for assessment of undernutrition (weight for age, height for age, wasting, BM I for age, and wasting and stunting with low BMI) is associated with more consistent and higher risk of morbidity due to infection in preschool children. Methods: The National Family Health Survey-3 (NFHS-3) database provided the following information in 56,438 preschool children: age, sex, weight, height, infant and young child feeding practices and morbidity due to infections in the last fortnight. Relative risk (RR) of morbidity due to infections was computed in infants and children with stunting, underweight, low BMI for age, wasting and stunting with low BMI (< mean-2SD of WHO 2006 standards). Results: Comparison of the RR for infections in undernourished children showed that the relative risk of morbidity due to infections was higher and more consistently seen in children with low BMI and wasting as compared to stunting or underweight. The small group of children who had stunting with wasting had the highest relative risk of morbidity due to infection. Interpretation & conclusions: In Indian preschool children, RR for infection was more consistently associated with BMI for age and wasting as compared to weight for age and height for age. Low BMI for age and wasting indicate current energy deficit; early detection and correction of the current energy deficit might reduce the risk of infection and also enable the child to continue in his/her growth trajectory for weight and height.