Genton B, Al-Yaman F, Ginny M, Taraika J, Alpers M P
Papua New Guinea Institute of Medical Research, Madang and Maprik.
Am J Clin Nutr. 1998 Sep;68(3):734-41. doi: 10.1093/ajcn/68.3.734.
The interaction between malnutrition and malaria is complex and there is evidence that malnutrition decreases the susceptibility to malaria. To investigate the relation between anthropometric measurements and subsequent malaria morbidity and to examine whether the effect observed was due to interaction with host immunity, we followed for 1 y a cohort of 136 children aged 10 to < 120 mo in Wosera, East Sepik Province, Papua New Guinea. At baseline, 21% were stunted, 10% were wasted, and 5% were both stunted and wasted. After adjustment for age and use of bed nets, height-for-age z score (HAZ) at baseline predicted the number of clinical episodes of falciparum malaria during the following year: incidence rate increased with increasing HAZ. Humoral responses to specific malarial antigens were lowest in the wasted children. The prevalence of lymphoproliferative responders was not significantly different between well-nourished and undernourished children. In contrast, the prevalence of cytokine producers was higher in the undernourished than in the well-nourished children. Our findings support the view that stunting but not wasting protects against falciparum malaria. The mechanism may be related to an improved ability of malnourished children to produce certain cytokines in response to stimulation by specific malarial antigens.
营养不良与疟疾之间的相互作用很复杂，有证据表明营养不良会降低对疟疾的易感性。为了研究人体测量指标与随后疟疾发病率之间的关系，并检验观察到的效应是否归因于与宿主免疫的相互作用，我们在巴布亚新几内亚东塞皮克省沃塞拉对136名年龄在10至120个月的儿童进行了为期1年的随访。在基线时，21%的儿童发育迟缓，10%的儿童消瘦，5%的儿童既发育迟缓又消瘦。在对年龄和蚊帐使用情况进行调整后，基线时的年龄别身高Z评分（HAZ）可预测次年恶性疟原虫疟疾的临床发作次数：发病率随HAZ的增加而升高。消瘦儿童对特定疟疾抗原的体液反应最低。营养良好和营养不良儿童中淋巴细胞增殖反应者的患病率没有显著差异。相反，营养不良儿童中细胞因子产生者的患病率高于营养良好的儿童。我们的研究结果支持这样一种观点，即发育迟缓而非消瘦可预防恶性疟原虫疟疾。其机制可能与营养不良儿童在特定疟疾抗原刺激下产生某些细胞因子的能力提高有关。
