Nutritional factors associated with rheumatic fever.

The possible contribution of nutritional factors to rheumatic fever was investigated in a case-control study conducted Dhaka Bangladesh in 1994-95. Enrolled were 164 outpatients 5-20 years of age (mean age 11.4 years) from the National Center for Control of Rheumatic Fever and Heart Diseases who had an antecedent beta-hemolytic streptococcal throat infection. The 60 children who met the updated Jones criteria for rheumatic fever served as cases while the 104 who did not were controls. Anthropometric measurements and a food frequency questionnaire were used to assess nutritional factors. Rheumatic fever risk was significantly associated in the univariate analysis with low height-for-age (odds ratio (OR) 3.82; 95% confidence interval (CI) 1.73-8.42); low weight-for-age (OR 2.41; 95% CI 1.12-5.57); low mid-upper-arm circumference-for-age (OR 3.76; 95% CI 1.87-7.89); and low consumption of eggs (OR 3.81; 95% CI 1.95-7.63) milk (OR 2.60; 95% CI 1.36-5.08) chicken (OR 2.62; 95% CI 1.35-5.21) pulses (OR 1.98; 95% CI 1.03-3.84) fruits (OR 2.29; 95% CI 1.20-4.45) and home-made bread (OR 3.15; 95% CI 1.61-6.34). Soybean consumption was associated with a reduced risk (OR 0.28; 95% CI 0.12-0.62). The significant contribution of low mid-upper-arm circumference and low dietary intake of eggs persisted after adjustment for possible sociodemographic confounders. Rheumatic fever is likely associated with protein-energy malnutrition. Exposure to rheumatogenic streptococci in malnourished stunted children presumably results in an attack of rheumatic fever. However an anti-inflammatory compound contained in egg yolk and soybeans may suppress the hyper-responsiveness of susceptible children and subsequent maturation of the rheumatic process.