WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.
Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
BMC Med. 2018 Oct 29;16(1):186. doi: 10.1186/s12916-018-1177-5.
Despite substantial improvement in the control of malaria and decreased prevalence of malnutrition over the past two decades, both conditions remain heavy burdens that cause hundreds of thousands of deaths in children in resource-poor countries every year. Better understanding of the complex interactions between malaria and malnutrition is crucial for optimally targeting interventions where both conditions co-exist. This systematic review aimed to assess the evidence of the interplay between malaria and malnutrition.
Database searches were conducted in PubMed, Global Health and Cochrane Libraries and articles published in English, French or Spanish between Jan 1980 and Feb 2018 were accessed and screened. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale and the risk of bias across studies was assessed using the GRADE approach. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline were followed.
Of 2945 articles screened from databases, a total of 33 articles were identified looking at the association between malnutrition and risk of malaria and/or the impact of malnutrition in antimalarial treatment efficacy. Large methodological heterogeneity of studies precluded conducting meaningful aggregated data meta-analysis. Divergent results were reported on the effect of malnutrition on malaria risk. While no consistent association between risk of malaria and acute malnutrition was found, chronic malnutrition was relatively consistently associated with severity of malaria such as high-density parasitemia and anaemia. Furthermore, there is little information on the effect of malnutrition on therapeutic responses to artemisinin combination therapies (ACTs) and their pharmacokinetic properties in malnourished children in published literature.
The evidence on the effect of malnutrition on malaria risk remains inconclusive. Further analyses using individual patient data could provide an important opportunity to better understand the variability observed in publications by standardising both malaria and nutritional metrics. Our findings highlight the need to improve our understanding of the pharmacodynamics and pharmacokinetics of ACTs in malnourished children. Further clarification on malaria-malnutrition interactions would also serve as a basis for designing future trials and provide an opportunity to optimise antimalarial treatment for this large, vulnerable and neglected population.
PROSPERO CRD42017056934 .
尽管在过去的二十年中，疟疾的控制和营养不良的患病率都有了显著改善，但这两种情况仍然是沉重的负担，每年导致资源匮乏国家数以十万计的儿童死亡。更好地了解疟疾和营养不良之间的复杂相互作用对于最佳针对这两种情况共存的干预措施至关重要。本系统评价旨在评估疟疾和营养不良之间相互作用的证据。
在 PubMed、全球卫生和 Cochrane 图书馆中进行数据库搜索，并获取和筛选了 1980 年 1 月至 2018 年 2 月期间以英文、法文或西班牙文发表的文章。使用纽卡斯尔-渥太华量表评估纳入研究的方法学质量，并使用 GRADE 方法评估研究间的偏倚风险。遵循系统评价和荟萃分析的首选报告项目 (PRISMA) 指南。
从数据库中筛选出的 2945 篇文章中，共有 33 篇文章研究了营养不良与疟疾风险之间的关联，以及营养不良对抗疟治疗效果的影响。研究的方法学异质性很大，无法进行有意义的汇总数据分析。关于营养不良对疟疾风险的影响，报告的结果存在分歧。虽然没有发现疟疾风险与急性营养不良之间存在一致的关联，但慢性营养不良与疟疾的严重程度（如高密度寄生虫血症和贫血）相对一致相关。此外，关于营养不良对青蒿素联合疗法 (ACTs) 的治疗反应及其在营养不良儿童中的药代动力学特性的影响，发表的文献中信息很少。
关于营养不良对疟疾风险影响的证据仍然不确定。使用个体患者数据进行进一步分析可能提供一个重要机会，通过标准化疟疾和营养指标，更好地理解出版物中观察到的变异性。我们的研究结果强调需要更好地了解营养不良儿童中 ACTs 的药效动力学和药代动力学。进一步澄清疟疾-营养不良相互作用也将为设计未来试验提供依据，并为这一庞大、脆弱和被忽视的人群提供优化抗疟治疗的机会。
PROSPERO CRD42017056934 。
Zotero 插件