{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T19:00:15Z","timestamp":1766516415779,"version":"3.48.0"},"reference-count":22,"publisher":"BMJ","issue":"7054","license":[{"start":{"date-parts":[[1996,8,17]],"date-time":"1996-08-17T00:00:00Z","timestamp":840240000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"accepted":{"date-parts":[[1996,6,11]]},"published-print":{"date-parts":[[1996,8,17]]},"abstract":"Abstract<\/jats:title>\n \n Objectives<\/jats:bold>\n : To investigate risk factors for dehydrating diarrhoea in infants, with special interest in the weaning period.\n <\/jats:p>\n \n Design<\/jats:bold>\n : Case-control study.\n <\/jats:p>\n \n Setting<\/jats:bold>\n : Metropolitan area of Porto Alegre, Brazil.\n <\/jats:p>\n \n Subjects<\/jats:bold>\n : Cases were 192 children aged 0-23 months hospitalised with acute diarrhoea and moderate to severe dehydration. Controls were 192 children matched for age and neighbourhood who did not have diarrhoea in the previous week.\n <\/jats:p>\n \n Main outcome measures<\/jats:bold>\n : Associations between dehydrating diarrhoea and child's age, type of milk consumed, time since breast feeding stopped, and breast feeding status.\n <\/jats:p>\n \n Results<\/jats:bold>\n : In infants aged <12 months the risk of dehydrating diarrhoea was significantly higher in the first 9 months of life (P<0.001), and in those aged 12-23 months the risk was again greater in younger children (12-17 months) (P = 0.03). The type of milk consumed before start of diarrhoea episode was strongly associated with dehydration independent of socioeconomic, environmental, maternal reproductive, demographic, and health services factors. Compared with infants exclusively breast fed, bottle fed infants were at higher risk (odds ratio (95% confidence interval) for cow's milk 6.0 (1.8 to 19.8), for formula milk 6.9 (1.4 to 33.3)). Compared with those still breast feeding, children who stopped in the previous two months were more likely to develop dehydrating diarrhoea (odds ratio 8.4 (2.4 to 29.6)). This risk decreased with time since breast feeding stopped.\n <\/jats:p>\n \n Conclusion<\/jats:bold>\n : These results confirm the protective effect of breast feeding and suggest there is a vulnerable period soon after breast feeding is stopped, which may be of relevance for developing preventive strategies.\n <\/jats:p>\n \n \n \n Key messages<\/jats:title>\n \n \n In this study infants who were exclusively breast fed were six times less likely to have dehydrating diarrhoea than bottle fed infants<\/jats:p>\n <\/jats:list-item>\n \n Partially breast fed infants were at intermediate levels of risk<\/jats:p>\n <\/jats:list-item>\n \n Children who were recently weaned showed a higher risk of dehydrating diarrhoea than those who had been weaned for six months or more<\/jats:p>\n <\/jats:list-item>\n \n Recently weaned children presenting with diarrhoea should receive closer attention from health workers<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>\n <\/jats:boxed-text>\n <\/jats:p>","DOI":"10.1136\/bmj.313.7054.391","type":"journal-article","created":{"date-parts":[[2011,10,31]],"date-time":"2011-10-31T16:59:58Z","timestamp":1320080398000},"page":"391-394","source":"Crossref","is-referenced-by-count":27,"title":["Case-control study of risk of dehydrating diarrhoea in infants in vulnerable period after full weaning"],"prefix":"10.1136","volume":"313","author":[{"given":"Sandra Costa","family":"Fuchs","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cesar Gomes","family":"Victora","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose","family":"Martines","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1996,8,17]]},"reference":[{"key":"2025122310494280000_313.7054.391.1","first-page":"605","article-title":"The magnitude of the global problem of acute diarrhoeal disease: a review of active surveillance data.","volume":"60","author":"Snyder","year":"1982","journal-title":"Bull World Health Organ"},{"key":"2025122310494280000_313.7054.391.2","first-page":"467","article-title":"Breast-feeding, nutritional status, and other prognostic factors for dehydration among young children with diarrhoea in Brazil.","volume":"70","author":"Victora","year":"1992","journal-title":"Bull World Health Organ"},{"key":"2025122310494280000_313.7054.391.3","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/S0140-6736(87)90902-0","article-title":"et al. Evidence for protection by breast-feeding against infant deaths from infectious diseases in Brazil.","volume":"ii","author":"Victora","year":"1987","journal-title":"Lancet"},{"key":"2025122310494280000_313.7054.391.4","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1136\/bmj.300.6716.11","article-title":"Protective effect of breast feeding against infection.","volume":"300","author":"Howie","year":"1990","journal-title":"BMJ"},{"issue":"(suppl)","key":"2025122310494280000_313.7054.391.5","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1542\/peds.75.1.172","article-title":"et al. Protective factors in milk and the development of the immune system.","volume":"75","author":"Hanson","year":"1985","journal-title":"Pediatrics"},{"key":"2025122310494280000_313.7054.391.6","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1093\/oxfordjournals.aje.a115193","article-title":"Incidence and etiology of infantile diarrhea and major route of transmission in Huascar, Peru.","volume":"129","author":"Black","year":"1989","journal-title":"Am J Epidemiol"},{"key":"2025122310494280000_313.7054.391.7","unstructured":"World Health Organisation . Indicators for assessing breast-feeding practices. Geneva: WHO, 1991. (WHO\/CDD\/SER\/91.14.)"},{"key":"2025122310494280000_313.7054.391.8","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1111\/j.1651-2227.1992.tb12279.x","article-title":"Risk factors for early termination of breast feeding in Brazil.","volume":"81","author":"Giugliani","year":"1992","journal-title":"Acta Paediatr"},{"key":"2025122310494280000_313.7054.391.9","unstructured":"Barros FC Victora CG .Breastfeeding and diarrhea in Brazilian children. Columbia MD: Population Council, 1990. (Demographic and health surveys No 3.)"},{"issue":"(suppl)","key":"2025122310494280000_313.7054.391.10","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1111\/j.1651-2227.1989.tb11224.x","article-title":"Human milk and neonatal infections.","volume":"351","author":"Narayanan","year":"1989","journal-title":"Acta Paediatr Scand"},{"key":"2025122310494280000_313.7054.391.11","unstructured":"Breslow NE Day NE .Statistical methods in cancer research.Vol 1. The analysis of case-control studies. Lyon: International Agency for Research on Cancer, 1980."},{"key":"2025122310494280000_313.7054.391.12","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1093\/oxfordjournals.aje.a115207","article-title":"et al. Infant feeding and death due to diarrhea: a case control study.","volume":"129","author":"Victora","year":"1989","journal-title":"Am J Epidemiol"},{"key":"2025122310494280000_313.7054.391.13","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1542\/peds.93.6.977","article-title":"Risk factors for pneumonia among Brazilian children: a hierarchical analysis.","volume":"93","author":"Victora","year":"1994","journal-title":"Pediatrics"},{"key":"2025122310494280000_313.7054.391.14","first-page":"271","article-title":"Interventions for the control of diarrhoeal diseases among young children: promotion of breast-feeding.","volume":"62","author":"Feachem","year":"1984","journal-title":"Bull World Health Organ"},{"key":"2025122310494280000_313.7054.391.15","first-page":"701","article-title":"Infant feeding and risk of severe diarrhoea in Basrah city, Iraq: a case-control study.","volume":"67","author":"Mahmood","year":"1989","journal-title":"Bull World Health Organ"},{"issue":"(suppl)","key":"2025122310494280000_313.7054.391.16","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1111\/j.1651-2227.1989.tb11225.x","article-title":"The protective effect of human milk against diarrhoea: a review of studies from Bangladesh.","volume":"351","author":"Glass","year":"1989","journal-title":"Acta Paediatr Scand"},{"key":"2025122310494280000_313.7054.391.17","doi-asserted-by":"publisher","DOI":"10.1016\/0196-0709(94)90134-1"},{"key":"2025122310494280000_313.7054.391.18","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1542\/peds.91.5.867","article-title":"Exclusive breast-feeding for at least 4 months protects against otitis media.","volume":"91","author":"Duncan","year":"1993","journal-title":"Pediatrics"},{"key":"2025122310494280000_313.7054.391.19","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1097\/00006454-199403000-00003","article-title":"et al. A prospective cohort study on breastfeeding and otitis media in Swedish infants.","volume":"13","author":"Aniansson","year":"1994","journal-title":"Pediatr Infect Dis J"},{"key":"2025122310494280000_313.7054.391.20","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1203\/00006450-199104000-00013","article-title":"et al. The antibody response in breast-fed and non-breast-fed infants after artificial colonization of the intestine with Escherichia coli 083.","volume":"29","author":"Lodinova","year":"1991","journal-title":"Pediatr Res"},{"key":"2025122310494280000_313.7054.391.21","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1128\/iai.29.2.417-424.1980","article-title":"Mannose-biding activity of Escherichia coli a determinant of attachment and ingestion of the bacteria by macrophages.","volume":"29","author":"Bar-Ahavit","year":"1980","journal-title":"Infect Immun"},{"key":"2025122310494280000_313.7054.391.22","unstructured":"Schlesselman JJ . Case-control studies: design, conduct, analysis. Oxford: Oxford University Press, 1982."}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.313.7054.391","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.313.7054.391","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T18:49:51Z","timestamp":1766515791000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.313.7054.391"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1996,8,17]]},"references-count":22,"journal-issue":{"issue":"7054","published-online":{"date-parts":[[1996,8,17]]},"published-print":{"date-parts":[[1996,8,17]]}},"alternative-id":["10.1136\/bmj.313.7054.391"],"URL":"https:\/\/doi.org\/10.1136\/bmj.313.7054.391","relation":{},"ISSN":["0959-8138","1468-5833"],"issn-type":[{"type":"print","value":"0959-8138"},{"type":"electronic","value":"1468-5833"}],"subject":[],"published":{"date-parts":[[1996,8,17]]}}}