RELATIONSHIP BETWEEN NUTRITIONAL STATUS AND SEVERITY OF ACUTE RESPIRATORY TRACT INFECTIONS IN CHILDREN

Background: Acute respiratory tract infections (ARTIs) are a major cause of morbidity and hospitalization among children. Nutritional status may influence susceptibility to infection and the ability to withstand severe respiratory illness. However, the relationship between nutritional status and the clinical severity of ARTIs remains important to investigate in local pediatric populations. Objectives: To assess the relationship between nutritional status and the severity of acute respiratory tract infections among children and to determine whether nutritional abnormalities are associated with increased clinical severity and adverse respiratory manifestations. Patients and methods: A hospital-based cross-sectional study was conducted among 121 children with acute respiratory tract infections at Al-Khansaa Teaching Hospital, Nineveh Directorate of Health, Nineveh Governorate, Iraq, from December 2024 to April 2026. Demographic and clinical data were collected, including respiratory rate, oxygen saturation, respiratory distress, chest indrawing, and feeding ability. Nutritional status was assessed using anthropometric measurements and WHO growth standards, including weight-for-age, height-for-age, weight-for-height, BMI-for-age, and MUAC where appropriate. The severity of ARTI was classified according to clinical respiratory findings and danger signs. Statistical analysis was performed using SPSS, with P<0.05 considered statistically significant. Results: The mean age of the children was 2.7 ± 1.4 years, and 55.4% were males. Cough was the most frequent clinical manifestation (95.0%), followed by fever (84.3%). Normal nutritional status was observed in 51.2% of children, while stunting, underweight, and wasting were present in 24.0%, 19.0%, and 17.4%, respectively. Mild, moderate, and severe ARTI accounted for 43.8%, 37.2%, and 19.0% of cases, respectively. Nutritional status was significantly associated with disease severity (P<0.001). Severe disease was observed in 26.1% of underweight children and 33.3% of wasted children compared with 6.5% of children with normal nutritional status. Undernourished children had higher respiratory rates and lower oxygen saturation, with significantly higher frequencies of tachypnea, chest indrawing, oxygen saturation <92%, and poor feeding. Undernutrition was strongly associated with severe ARTI (crude OR=11.12, 95% CI: 4.03–30.66; P<0.001) and remained independently associated after adjustment (adjusted OR=7.84, 95% CI: 2.67–23.04; P<0.001). Wasting (adjusted OR=2.96, 95% CI: 1.08–8.12; P=0.035) and stunting (adjusted OR=2.41, 95% CI: 1.01–5.77; P=0.048) were also independent predictors of severe disease. The combined nutritional indicators demonstrated moderate discriminatory ability for severe ARTI (AUC=0.801). Conclusions: Nutritional status was significantly associated with the severity of acute respiratory tract infections in children. Undernutrition, wasting, and stunting were associated with greater respiratory compromise and independently predicted severe disease. Routine nutritional assessment should therefore be incorporated into the clinical evaluation of children with ARTIs, particularly to identify those requiring closer monitoring and comprehensive supportive care.