Effects of nutritional status on diarrhea in Peruvian children

William Checkley, Robert H. Gilman, Robert E. Black, Andres G. Lescano, Lilia Cabrera, David N. Taylor, Lawrence H. Moulton

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


Objectives: We conducted a 4-year (1995-1998) field study in a Peruvian peri-urban community (pueblo joven) to examine the relation between diarrhea and nutritional status in 230 children <3 years of age. Methods: We followed the birth cohort daily for diarrhea and monthly for anthropometry. We modeled diarrheal incidence with a multivariate time-to-event regression model to account for multiple episodes per child and irregular follow-up periods and diarrheal duration with a mixed-effects gamma regression model to account for disease heterogeneity across children. Results: During 159,551 child-days of follow-up, we identified 1387 diarrheal episodes, which yielded an average incidence of 3.2 episodes per child-year. Diarrhea was seasonal, for example, infants had up to 8 diarrheal episodes during the summer; however, these variations decreased noticeably with age. Nutritional status was significantly associated with diarrheal incidence. The frequency of diarrhea increased by 15% per standard deviation decrease in height-for-age z score. Diarrheal episodes in children <6 months of age lasted significantly longer than episodes among older children. Conclusions: These results identify infants and children of poor nutritional status as priority risk groups for prevention efforts aimed at reducing the burden of acute childhood diarrhea.

Original languageEnglish (US)
Pages (from-to)210-218
Number of pages9
JournalJournal of Pediatrics
Issue number2
StatePublished - 2002

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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