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Article

Tomato Intake in Relation to Mortality and Morbidity among Sudanese Children¹

Wafaie Fawzi^*,2, M Guillermo Herrera^*,** and Penelope Nestel^**

Departments of ^* Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA 02115 and ^** Harvard Institute for International Development, Cambridge, MA

²To whom correspondence should be addressed.

The intake of foods that contain high levels of antioxidants may counteract the adverse effects of oxidative stress and lead to improved immune function and reduced risk of infectious disease. We prospectively examined the relationship between the consumption of tomatoes, a rich source of antioxidants, and mortality and diarrheal and respiratory morbidity rates among 28,753 children who were 6–60 mo old and enrolled in a longitudinal study in the Sudan. Children in each household were visited every 6 mo for a maximum of four visits. At each round, mothers recalled whether a child had consumed tomatoes in the previous 24 h. Events (death or morbidity) reported at each round were prospectively allocated according to the number of days of tomato intake. Intake of tomatoes for 2 or 3 d compared with none was associated, respectively, with 48% (relative risk, 0.53; 95% confidence interval, 0.30–0.91) and 83% (0.17; 0.04–0.72) reductions in morality rates (P for trend = 0.002). The association between tomato use and death remained statistically significant (P for trend = 0.004), even after further adjustment for total vitamin A intake. Tomato intake was also associated with a reduced risk of death associated with diarrhea in the week preceding death (P for trend = 0.009) or fever (P for trend = 0.04). Intake of tomatoes was also inversely and significantly associated with the risks of diarrheal and respiratory infections. Our data suggest that tomatoes may be beneficial for child health but also emphasize the general importance of food-based approaches to the prevention of micronutrient malnutrition and protection of the health of children in developing countries.

KEY WORDS: • vitamin A • tomato • children • diarrhea • respiratory infection • Sudan

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