Association between nutritional status and dengue severity in Thai children and adolescents

Abstract

Most cases of dengue virus infection are mild, but severe cases can be fatal. Therefore, identification of factors associated with dengue severity is essential to improve patient outcomes and reduce mortality. The objective of this study was to assess associations between nutritional status and dengue severity among Thai children and adolescents. This retrospective cross-sectional study was based on the medical records of 355 patients with dengue treated at the Hospital for Tropical Disease (Bangkok, Thailand) from 2017 to 2019. Subjects were Thai children aged less than 18 years with dengue virus infection confirmed by positive NS1 antigen or IgM. The 1997 and 2009 World Health Organization (WHO) dengue classifications were used to define disease severity and body mass index for age while the WHO growth chart was used to classify nutritional status. The proportions of patients with dengue fever who were underweight, normal weight, and overweight were 8.8%, 61.5%, and 29.7%, respectively. The proportions of patients with dengue haemorrhagic fever (DHF) who were underweight, normal weight, and overweight were 10.2%, 66.1%, and 23.7%, respectively. The proportions of patients with non-severe dengue who were underweight, normal weight, and overweight were 8.6%, 60.9%, and 30.5%, respectively; the same proportions of patients with severe dengue were 10.5%, 67.1%, and 22.4%, respectively. Higher proportions of patients with severe plasma leakage (DHF grade III and IV) were overweight compared with those with mild plasma leakage (DHF grade I and II) (45.5% vs. 18.8%). No difference in nutritional status was observed in patients with different dengue severity.

Associations of obesity and dengue-associated mortality, acute liver failure and mechanical ventilation in children with dengue shock syndrome

“…Markedly, obesity has been shown to be associated with increased risks of developing DSS, dengue-induced hepatitis, severe plasma leakage and respiratory distress. [12][13][14][15] However, data on the effects of obesity on dengue-associated mortality and acute liver failure are lacking.…”

“…[9][10][11] It has been shown a correlation between obesity and the development of progressive plasma leakage and dengue shock syndrome (DSS). [12][13][14] Severe respiratory distress requiring high-flow oxygen support may develop, resulting from severe plasma leakage in patients with severe dengue infection. Likewise, obese dengue-infected patients were reported to have a higher risk of developing severe hepatitis than a comparable nonobese cohort.…”

Interferome signature dynamics during the anti-dengue immune response: a systems biology characterization

“…However, no information allowed us to consistently identify the samples regarding either reinfection or DENV serotype, which can affect the response to infection ( 71 ). Other populational factors affecting the response to DENV that could not be considered in this study are ethnicity, geographic location, nutritional status, and comorbidities ( 72 , 73 ), as that information were unavailable and/or not comparable. Despite these limitations and the cohort heterogeneity, we found consistent molecular signatures across the studies, indicating our results are robust and characteristic of the overall DENV infection.…”

Importance of proper nutrition in dengue infections

“…However, there is still insufficient data on proper nutrition for dengue shock syndrome and dengue hemorrhagic fever other than a general liquid diet followed by a soft diet. 11 Dengue patients need a balanced diet rich in protein, good fat found in omega 3,6,9 (all three), and calculative carbohydrates available in cereals as a daily staple food. Tentatively 50%-55% of carbohydrates, more than 1 gram per kg body weight protein, and around 20%-25 % visible fat would be the proper segregation of total calories to make a diet plan in a day.…”