Migliore Eleonora, Amaitsa Vivian K, Mutuku Francis M, Malhotra Indu J, Mukoko Dunstan, Sharma Anika, Kalva Prathik, Kang Amrik S, King Charles H, LaBeaud A Desiree
Division of Infectious Disease, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States.
Department of Community Health and Epidemiology, Kenyatta University, Nairobi, Kenya.
Front Nutr. 2022 May 23;9:830294. doi: 10.3389/fnut.2022.830294. eCollection 2022.
Vaccine and sufficient food availability are key factors for reducing pneumonia outbreaks in sub-Saharan Africa.
In this study, the 10-valent pneumococcal conjugate vaccine (Synflorix® or PCV10) was administered to a child cohort (5-7 years old, = 237) in Msambweni, Kenya, to determine relationships between dietary intake, nutritional/socioeconomic status of mothers/caregivers, and vaccine response. 7-day food frequency questionnaire (FFQ), dietary diversity score (DDS) and single 24-h dietary recall were used to address participants' dietary assessment and nutritional status. Individual food varieties were recorded and divided into 9 food groups as recommended by Food and Agriculture Organization. Anthropometric measurements, nasopharyngeal swabs and vaccine administration were performed at the initial visit. Participants were followed 4-8 weeks with a blood draw for pneumococcal IgG titers assessed by Luminex assay.
Chronic malnutrition was prevalent in the cohort (15% stunting, 16% underweight). Unbalanced dietary intake was observed, with mean energy intake 14% below Recommended Dietary Allowances (1,822 Kcal) for 5-7 years age range. 72% of the daily energy was derived from carbohydrates, 18% from fats and only 10% from proteins. Poor anthropometric status (stunting/underweight) was associated with low socioeconomic/educational status and younger mother/caregiver age ( < 0.002). Limited intake of essential micronutrients (vitamins A, E, K) and minerals (calcium, potassium) associated with low consumption of fresh fruits, vegetables, and animal source foods (dairy, meat) was observed and correlated with poor vaccine response ( < 0.001). In contrast, children who consumed higher amounts of dietary fiber, vitamin B1, zinc, iron, and magnesium had adequate vaccine response ( < 0.05). Correlation between higher dietary diversity score (DDS), higher Vitamin E, K, Zinc intake and adequate vaccine response was also observed ( < 0.03).
Overall, this study highlights ongoing food scarcity and malnutrition in Kenya and demonstrates the links between adequate socioeconomic conditions, adequate nutrient intake, and vaccine efficacy.
疫苗和充足的食物供应是减少撒哈拉以南非洲肺炎疫情的关键因素。
在本研究中，10价肺炎球菌结合疫苗（Synflorix®或PCV10）被接种给肯尼亚姆桑布韦尼的一个儿童队列（5至7岁，n = 237），以确定饮食摄入量、母亲/照顾者的营养/社会经济状况与疫苗反应之间的关系。使用7天食物频率问卷（FFQ）、饮食多样性评分（DDS）和单次24小时饮食回顾来评估参与者的饮食和营养状况。按照联合国粮食及农业组织的建议，记录个体食物种类并分为9个食物组。在初次就诊时进行人体测量、鼻咽拭子采集和疫苗接种。对参与者进行4至8周的随访，通过Luminex检测法采集血液以评估肺炎球菌IgG滴度。
该队列中慢性营养不良普遍存在（15%发育迟缓，16%体重不足）。观察到饮食摄入不均衡，5至7岁年龄组的平均能量摄入量比推荐膳食摄入量（1822千卡）低14%。每日能量的72%来自碳水化合物，18%来自脂肪，仅10%来自蛋白质。人体测量状况不佳（发育迟缓/体重不足）与社会经济/教育水平低以及母亲/照顾者年龄较小相关（P < 0.002）。观察到必需微量营养素（维生素A、E、K）和矿物质（钙、钾）的摄入量有限，这与新鲜水果、蔬菜和动物源性食物（乳制品、肉类）的低消耗量有关，并且与疫苗反应不佳相关（P < 0.001）。相比之下，摄入较多膳食纤维、维生素B1、锌、铁和镁的儿童疫苗反应良好（P < 0.05）。还观察到较高的饮食多样性评分（DDS）、较高的维生素E、K、锌摄入量与良好的疫苗反应之间存在相关性（P < 0.03）。
总体而言，本研究突出了肯尼亚持续存在的食物短缺和营养不良问题，并证明了充足的社会经济条件、充足的营养摄入与疫苗效力之间的联系。
