Child nutrition and lower respiratory tract disease burden in New Zealand: A global context for a national perspective

Aim: To consider the contribution of malnutrition to acute lower respiratory infection (ALRI) disease burden in children <5 years old in New Zealand (NZ). Methods: The contribution of maternal and child malnutrition to ALRI disease burden in early childhood globally was described. A literature review was conducted to describe the nutritional status and ALRI disease burden of NZ children <5 years old. Results: The four key nutritional risk factors for ALRI disease burden globally are macronutrient undernutrition, low birthweight, zinc deficiency and suboptimal breastfeeding. In addition, maternal nutritional status and vitamin D deficiency are potentially important nutritional determinants of ALRI disease burden. Relative to other developed countries, NZ has a large ALRI disease burden in pre-school-aged children. Pneumonia and bronchiolitis hospitalisation rates are two to four times greater than other developed countries. The ALRI disease burden varies with ethnicity, being highest in Pacific, intermediate in Maori and lowest in European children. Three of the four key nutritional risk factors for global ALRI disease burden - low birthweight, zinc deficiency and suboptimal breastfeeding - are potential contributors to ALRI disease burden in NZ. In addition to these factors, vitamin D deficiency during early childhood and maternal vitamin D deficiency are also potentially important particularly with respect to the larger disease burden in Pacific and Maori children. Conclusion: The contribution of malnutrition to ALRI disease burden in NZ requires greater clarification. Such clarification is necessary to inform the development of nutritional policy, which seeks to improve early child health.