Effectiveness of a nutrition program in reducing symptoms of respiratory morbidity in children: A randomized field trial ☆ Márcia Regina Vitolo a, ⁎, Gisele Ane Bortolini b , Paula Dal Bó Campagnolo c , Carlos Alberto Feldens d a Department of Public Health, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil b Post-graduation Program in Medical Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil c Department of Public Health, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil d Department of Paediatric Dentistry, Lutheran University of Brazil. Canoas, Brazil abstract article info Article history: Available online 16 July 2008 Keywords: Infants Infant care Signs and symptoms Respiratory Primary health care Objectives. To assess the effectiveness of home visits advising mothers about breast feeding and weaning in reducing symptoms of respiratory morbidity at the age of 12 months. Methods. A randomized field trial was conducted with mothers who gave birth within the public health system in the Brazilian city of Sao Leopoldo (2001/2002). The intervention group received dietary advice during the first year based on a Brazilian national health policy for primary care, which is based on WHO guidelines. Morbidity data was assessed in 397 children at 12 months. Results. A total of 23.3% of the children in the intervention group and 39.7% of the controls had one or more of the following symptoms during the month preceding assessment: cough, stuffy nose, runny nose, or breathlessness. The risk of respiratory morbidity symptoms was 41% lower for the intervention group (RR: 0.59; 95% CI: 0.43–0.81). The number of families needed to be visited to avoid one children presenting symptoms of respiratory morbidity (Number Needed to Treat) was 6.1. The intervention-group status was also associated with a longer duration of exclusive (RR:1.59; 95% CI: 1.21–2.07; p = 0.001) and total breastfeeding (RR: 1.25; 95% CI:1.02–1.55; p =0.032) later introduction of solid foods (RR:1.11; 95% CI: 1.02– 1.21; p = 0.023), and a lower proportion of current medication use (RR:0.56; 95% CI:0.34–0.91;p = 0.016). Conclusion. A nutrition education program during the first year of life has a positive impact on reducing respiratory symptoms in infants. © 2008 Elsevier Inc. All rights reserved. Introduction Respiratory tract diseases are common, and young children represent an important subgroup of patients with respiratory illness. There is theoretical evidence that early childhood respiratory tract infections play a role in the development of atopy and asthma in school-age children, as well as asthma and chronic bronchitis in adults (Ramsey et al., 2007; Latzin et al., 2007). Global malnutrition is associated with a higher frequency of respiratory morbidity symp- toms, as demonstrated by the Government of Niger and the United Nations Children's Fund (UNICEF) in collaboration with the Centers of Diseases and Control (CDC) in an emergency survey that assessed the magnitude of malnutrition and recent illness among young children in Niger (Centers for Disease Control and Prevention, 2006). Nutritional programs during the first year of life seem to be a successful strategy for improving childhood health, as has been shown by cohort and interventional studies (Wilson et al., 1998; Sripaipan et al., 2002). Malnutrition, growth faltering, micronutrient deficiencies, and morbidities are highly prevalent during the first 2 years of life and have long-term consequences. Therefore, it is essential to adopt policies and programs that target this vulnerable age group. Most studies have focused on the benefits of breastfeeding, including protection against infectious diseases, pneumonia, hospitalization and diarrhea (Chandra, 1979; Popkin et al., 1990; Duncan et al., 1993; Victora et al., 1994; César et al., 1999; Quigley et al., 2007). Others have evaluated the impact of providing food supplementation or nutrition education on linear growth (Bhandari et al., 2001; Bhandari et al., 2004; Guldan et al., 2000) and the role of specific micronutrient supplementation on mortality and morbidities (Sazawal et al., 2006, Long et al., 2006). However, there have been few well-designed intervention trials aimed at evaluating the effectiveness of various approaches toward health and the nutritional conditions of children during early life (Dewey et al., 2002). This randomized field trial was part of a much larger study (Vitolo et al., 2005) that was conducted to assess the impact of home visits advising mothers about good feeding practices during the first year of their children's life. Implementation of the “Ten Steps for Healthy Preventive Medicine 47 (2008) 384–388 ☆ Funding: funded by the CNPq (National Funding for Research). ⁎ Corresponding author. Department of Public Health, Rua: Sarmento Leite 245, Porto Alegre – RS 90050-170, Brazil. E-mail address: vitolo@fffcmpa.edu.br (M.R. Vitolo). 0091-7435/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2008.07.008 Contents lists available at ScienceDirect Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed