Modern Pediatrics. Ukraine. (2023). 8(136): 19-25. doi: 10.15574/SP.2023.136.19
Voloshin O. M.^1,2, Marushko Yu. V.¹, Savchenko I. I.^2
1Bogomolets National Medical University, Kyiv, Ukraine
²Luhansk State Medical University, Rivne, Ukraine

For citation: Voloshin OM, Marushko YuV, Savchenko II. (2023). A linear regression analysis of the effect of bioelements on acute respiratory infections incidence in preschool children. Modern Pediatrics. Ukraine. 8(136): 19-25. doi: 10.15574/SP.2023.136.19.
Article received: Sep 24, 2023. Accepted for publication: Dec 12, 2023.

Purpose – to identify the bioelements having the most significant impact on the susceptibility of preschool children to frequent episodes of acute respiratory infections (ARI).
Materials and methods. A total of 30 children (14 boys and 16 girls) aged 1-6 years, undergoing inpatient treatment on ARI, were involved in the clinical study. Two integral indicators of acute respiratory infections recurrence, i.e. the infection index and the resistance index, were taken into account for each patient. The children were tested by X-ray fluorescence analysis of 17 bioelements in their hair – Zn, Fe, Cu, Se, Mn, Cr, Co, Br, Ni, Rb, Sr, Sn, Pb, Ca, K, S, and Cl. The statistical processing of the obtained digital material was performed with IBM SPSS Statistics 28 licensed software. A linear regression analysis with stepwise involvement of predictors was applied.
Results. In preschool children, there is a moderate negative correlation between hair Rb content and the calculated resistance index (ρ=-0.405; p=0.026; 95% CI: (-0.674)-(-0.042)), according to which lower concentrations of this bioelement are associated with more frequent episodes of ARI. Additionally, Rb has a statistically significant pairwise relationship with several other bioelements studied and the ratios between them. Rb was demonstrated to be directly and most closely correlated with K (ρ=0.842; p<0.001; 95% CI: 0.678-0.926). A prognostic model of the resistance index was obtained, using the linear regression analysis of independent factors. The formula of the prognostic model included only one of the factors studied – the ratio of Mn/Cr content in hair. The informativeness of the mentioned model was 24.9%, which is a quite significant value, taking into consideration a broad range of known predictors for recurrent respiratory infections.
Conclusions. The findings are complementary to the available scientific data on the participation of the bioelements in providing resistance to frequent ARI in preschool children. It is planned to continue examining the status of particular bioelements in combination with other potential predictors of recurrent respiratory infections.
The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committees of the institutions mentioned in the paper. An informed parental consent was obtained for the study in children.
No conflict of interests was declared by the authors.
Keywords: preschool children, recurrent respiratory infections, bioelements, linear regression analysis.
REFERENCES

1. Al-Daghri NM, Alfadul H, Kattak MNK, Yakout S. (2022). Vitamin D and its influence in circulating trace minerals among Arab adults with or without adequate vitamin D levels. Journal of King Saud University – Science. 34 (4): 102012. https://doi.org/10.1016/j.jksus.2022.102012

2. Alghamdi M, Gutierrez J, Komarnytsky S. (2022). Essential Minerals and Metabolic Adaptation of Immune Cells. Nutrients. 15 (1): 123. https://doi.org/10.3390/nu15010123; PMid:36615781 PMCid:PMC9824256

3. Ameli F, Brocchetti F, Mignosi S, Tosca MA, Gallo F, Ciprandi G. (2020). Recurrent respiratory infections in children: a study in clinical practice. Acta Biomedica. 91 (4): e2020179. doi: 10.23750/abm.v91i4.8585.

4. Bracchi I, Guimarães J, Rodrigues C et al. (2023). Essential Trace Elements Status in Portuguese Pregnant Women and Their Association with Maternal and Neonatal Outcomes: A Prospective Study from the IoMum Cohort. Biology. 12 (10): 1351. https://doi.org/10.3390/biology12101351; PMid:37887061 PMCid:PMC10604833

5. Dalkiran T, Unsal V, Ipek S, Oncu D, Mercan M, Kandur Y. (2022). Evaluation of trace elements analysis in Pediatric Patients with COVID-19：A report from Turkey. Medrxiv. https://doi.org/10.1101/2022.07.20.22277852

6. Ekemen Keleş Y, Yılmaz Çiftdoğan D, Çolak A et al. (2022). Serum zinc levels in pediatric patients with COVID-19. European Journal of Pediatrics. 181: 1575-1584. https://doi.org/10.1007/s00431-021-04348-w; PMid:35064310 PMCid:PMC8782687

7. Ibrahim Alhajjaji G, Alotaibi N, Abutaleb N et al. (2023). Effect of zinc supplementation on symptom reduction and length of hospital stay among pediatric patients with Coronavirus disease 2019 (COVID-19). Saudi Pharmaceutical Journal. 31 (4): 585-591. https://doi.org/10.1016/j.jsps.2023.02.011; PMid:37009426 PMCid:PMC9984234

8. Jayamanna U, Jayaweera JAA. (2023). Childhood Anemia and Risk for Acute Respiratory Infection, Gastroenteritis, and Urinary Tract Infection: A Systematic Review. Journal of Pediatric Infectious Diseases. 18 (2): 61-70. https://doi.org/10.1055/s-0042-1760237

9. Jayawardena R, Sooriyaarachchi P, Chourdakis M, Jeewandara C, Ranasinghe P. (2020). Enhancing immunity in viral infections, with special emphasis on COVID-19: A review. Diabetes & Metabolic syndrome: Clinical Research & Reviews. 14 (4): 367-382. https://doi.org/10.1016/j.dsx.2020.04.015; PMid:32334392 PMCid:PMC7161532

10. Kansen HM, Lebbink MA, Mul J et al. (2020). Risk factors for atopic diseases and recurrent respiratory tract infections in children. Pediatric pulmonology. 55 (11): 3168-3179. https://doi.org/10.1002/ppul.25042; PMid:32841506 PMCid:PMC7589449

11. Khan A, Fatima S, Ahmed J et al. (2022). Long-Term Impact of Multiple Micronutrient Supplementation on Micronutrient Status, Hemoglobin Level, and Growth in Children 24 to 59 Months of Age: A Non-Randomized Community-Based Trial from Pakistan. Nutrients. 15 (7): 1690. https://doi.org/10.3390/nu15071690; PMid:37049531 PMCid:PMC10096793

12. Knebusch N, Mansour M, Vazquez S, Coss-Bu JA. (2023). Macronutrient and Micronutrient Intake in Children with Lung Disease. Nutrients. 15 (19): 4142. https://doi.org/10.3390/nu15194142; PMid:37836425 PMCid:PMC10574027

13. Kosla T, Lasocka I, Skibniewska E, Kołnierzak M, Skibniewski M. (2018). Trivalent chromium (CrIII) as a trace element essential for animals and humans. Medycyna Weterynaryjna. 74 (9): 560-567. https://doi.org/10.21521/mw.6035

14. Kumar P, Kumar M, Bedi O et al. (2021). Role of vitamins and minerals as immunity boosters in COVID-19. Inflammopharmacology. 29 (4): 1001-1016. https://doi.org/10.1007/s10787-021-00826-7; PMid:34110533 PMCid:PMC8190991

15. Lewicki S, Zdanowski R, Krzyżowska M et al. (2014). The role of Chromium III in the organism and its possible use in diabetes and obesity treatment. Annals of agricultural and environmental medicine: AAEM. 21 (2): 331-335. https://doi.org/10.5604/1232-1966.1108599; PMid:24959784

16. Maywald M, Rink L. (2022). Zinc in Human Health and Infectious Diseases. Biomolecules. 12 (12): 1748. https://doi.org/10.3390/biom12121748; PMid:36551176 PMCid:PMC9775844

17. Mochulska OM, Boyarchuk OR, Kinash MI, Vorontsova TO, Volianska LA. (2021). The effects of vitamins A, E, D, disorders of their metabolism and the assessment of level of vitamin security in children (literature review). Modern pediatrics. Ukraine. 2: 58-66. https://doi.org/10.15574/SP.2021.114.58

18. Ovadia YS, Dror I, Liberty G et al. (2023). Amniotic fluid rubidium concentration association with newborn birthweight: a maternal-neonatal pilot study. American journal of obstetrics & gynecology MFM. 5 (11): 101149. https://doi.org/10.1016/j.ajogmf.2023.101149; PMid:37660761

19. Pecora F, Persico F, Argentiero A, Neglia C, Esposito S. (2020). The Role of Micronutrients in Support of the Immune Response against Viral Infections. Nutrients. 12 (10): 3198. https://doi.org/10.3390/nu12103198; PMid:33092041 PMCid:PMC7589163

20. Podlecka D, Jerzyńska J, Sanad K, Polańska K, Stelmach I, Brzozowska A. (2021). Micronutrients and the Risk of Allergic Diseases in School Children. International Journal of Environmental Research and Public Health. 19 (19): 12187. https://doi.org/10.3390/ijerph191912187; PMid:36231487 PMCid:PMC9566642

21. Rak K, Styczyńska M, Bronkowska M. (2022). Some Immune Parameters of Term Newborns at Birth Are Associated with the Concentration of Iron, Copper and Magnesium in Maternal Serum. Nutrients. 15 (8): 1908. https://doi.org/10.3390/nu15081908; PMid:37111127 PMCid:PMC10141145

22. Stępień E, Jerzyńska J, Gwardys M, Stelmach I. (2020). Serum zinc levels in children with recurrent infections and atopic diseases. Pediatria i Medycyna Rodzinna. 16: 181-185. https://doi.org/10.15557/PiMR.2020.0034

23. Voloshin OM, Marushko YuV, Gnylytska IP, Masnеva LP. (2020). Recurrent respiratory infections and macrobioelement balance in children aged one to six years. Bulletin of problems biology and medicine. 1: 329-333. https://doi.org/10.29254/2077-4214-2020-1-155-329-333

24. Voloshin OM, Marushko YuV, Osychnyuk LM. (2020). Microbioelements and acute respiratory infections in children of preschool age. Bulletin of problems biology and medicine. 4: 300-305. https://doi.org/10.29254/2077-4214-2020-4-158-300-305

25. Voloshin OM, Marushko YuV, Savchenko II. (2023). А bootstrap analysis of immune status in preschool children suffering from recurrent respiratory infections. Modern Pediatrics. Ukraine. 3: 13-21. https://doi.org/10.15574/SP.2023.131.13

26. Weyh C, Krüger K, Peeling P, Castell L. (2022). The Role of Minerals in the Optimal Functioning of the Immune System. Nutrients. 14 (3): 644. https://doi.org/10.3390/nu14030644; PMid:35277003 PMCid:PMC8840645

27. Wu Q, Mu Q, Xia Z, Min J, Wang F. (2021). Manganese homeostasis at the host-pathogen interface and in the host immune system. Seminars in cell & developmental biology. 115: 45-53. https://doi.org/10.1016/j.semcdb.2020.12.006; PMid:33419608

28. Zhang K, Qi C, Cai K. (2023). Manganese-Based Tumor Immunotherapy. Advanced Materials. 35 (19): 2205409. https://doi.org/10.1002/adma.202205409; PMid:36121368

29. Zhang L, Liu Y. (2020). Potential interventions for novel coronavirus in China: A systematic review. Journal of medical virology. 92 (5): 479-490. https://doi.org/10.1002/jmv.25707; PMid:32052466 PMCid:PMC7166986

30. Zhou B, Niu W, Liu F et al. (2021). Risk factors for recurrent respiratory tract infection in preschool-aged children. Pediatric Research. 90 (1): 223-231. https://doi.org/10.1038/s41390-020-01233-4; PMid:33173178