Friedman Jennifer F, Kwena Arthur M, Mirel Lisa B, Kariuki Simon K, Terlouw Dianne J, Phillips-Howard Penelope A, Hawley William A, Nahlen Bernard L, Shi Ya Ping, ter Kuile Feiko O
Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
Am J Trop Med Hyg. 2005 Oct;73(4):698-704.
Protein-energy malnutrition (PEM) affects millions of children in the developing world. The relationship between malaria and PEM is controversial. The goal of this study was to evaluate whether undernutrition is associated with increased or decreased malaria attributable morbidity. Three cross-sectional surveys were conducted using insecticide-treated bed nets (ITNs) among children aged 0-36 months living in an area with intense malaria transmission. Data were collected on nutritional status, recent history of clinical illness, socioeconomic status, current malaria infection status, and hemoglobin. In multivariate models, stunted children had more malaria parasitemia (odds ratio [OR] 1.98, P < 0.0001), high-density parasitemia (OR 1.84; P < 0.0001), clinical malaria (OR 1.77; P < 0.06), and severe malarial anemia (OR 2.65; P < 0.0001) than nonstunted children. The association was evident in children with mild-to-moderate (-3 < height-for-age Z-score [HAZ] < -2) and severe stunting (HAZ < -3). The cross-sectional nature of the study limits the interpretation of causality, but the data provide further observational support that the presence of undernutrition, in particular chronic undernutrition, places children at higher, not lower risk of malaria-related morbidity.
蛋白质-能量营养不良（PEM）影响着发展中国家数百万儿童。疟疾与PEM之间的关系存在争议。本研究的目的是评估营养不良是否与疟疾所致发病率的增加或降低相关。在疟疾传播强烈地区，对0至36个月大的儿童使用经杀虫剂处理的蚊帐（ITN）进行了三项横断面调查。收集了有关营养状况、近期临床疾病史、社会经济状况、当前疟疾感染状况和血红蛋白的数据。在多变量模型中，发育迟缓的儿童比未发育迟缓的儿童有更多的疟疾寄生虫血症（优势比[OR]1.98，P<0.0001）、高密度寄生虫血症（OR 1.84；P<0.0001）、临床疟疾（OR 1.77；P<0.06）和严重疟疾贫血（OR 2.65；P<0.0001）。这种关联在轻度至中度发育迟缓（年龄别身高Z评分[HAZ]<-2且>-3）和重度发育迟缓（HAZ<-3）儿童中很明显。该研究的横断面性质限制了对因果关系的解释，但数据提供了进一步的观察支持，即营养不良，尤其是慢性营养不良的存在，使儿童面临更高而非更低的疟疾相关发病风险。
