Abstract
BackgroundThere is evidence that suggests that undernutrition has a detrimental effect on malarial immunity in children. The aim of the study was to discover whether nutrient supplementation improved development of malarial antibody immunity in children up to 18 months of age.MethodsThe study was conducted with a subset of 432 Malawian children from a randomized controlled trial of nutritional supplements. The arms included pre- and postnatal small-quantity lipid-based nutrient supplements for both mother and child; prenatal supplementation with iron and folic acid; and pre- and postnatal supplementation with multiple micronutrients. Paired plasma samples were collected at 6 and 18 months of age. The levels of antibodies against merozoite surface protein 1 (MSP1 19kD) and MSP2, erythrocyte binding antigen 175 (EBA175), reticulocyte binding protein homologue 2A (Rh2A9), schizont extract and variant antigens expressed on the surface of infected erythrocytes were measured.ResultsAt 18 months of age, 5.4% of children were parasitaemic by microscopy and 49.1% were anaemic. Antibodies to the tested merozoite antigens and schizont extract increased between 6 and 18 months and this increase was statistically significant for MSP1, MSP2 and EBA175 (p < 0.0001) whereas IgG to variant surface antigens decreased with increasing age (p < 0.0001). However, the supplementation type did not have any impact on the prevalence or levels of antibodies at either 6 or 18 months of age to any of the tested malaria antigens in either univariate analysis or multivariate analysis after adjusting for covariates.ConclusionsPre- and postnatal lipid-based nutrient supplementation did not alter malaria antibody acquisition during infancy, compared to prenatal supplementation with iron and folic acid or pre- and postnatal supplementation with multiple micronutrients.Trail registeration Clinicaltrials.gov registration number NCT01239693
Highlights
There is evidence that suggests that undernutrition has a detrimental effect on malarial immunity in children
Study location and participants The study participants were a cohort of 432 infants residing in Lungwena, Malindi and Mangochi from rural Malawi who participated in the International Lipid-based Nutrient Supplement (iLiNS) Project DYADMalawi nutrient supplementation trial, part of the iLiNS Project [20]
This study investigated the impact of nutritional supplementation on malarial immunity in a subset of young children from a randomized controlled trial of pre-natal
Summary
There is evidence that suggests that undernutrition has a detrimental effect on malarial immunity in children. The disease can be caused by five different species of the genus Plasmodium, of which Plasmodium falciparum causes the highest rates of mortality and morbidity and is prominent in young children of sub-Saharan Africa, with an estimated 292,000 deaths in 2015 [1]. In sub-Saharan Africa, malaria and malnutrition often co-exist, and both contribute significantly to deaths in young children. In a cross-sectional study among pre-school Kenyan children [2] and a longitudinal study in Gambian children under 5 years of age [3], stunting was associated with increased malarial risk, but in Papua New Guinea it was reported that stunting might protect children against clinical malaria episodes [4]. Some other studies noted no significant association between anthropometric measurements [5], stunting [6] or undernutrition [7] and altered susceptibility to malaria
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