Sickle cell trait (HbAS) and stunting in children below two years of age in an area of high malaria transmission
Sickle cell trait (HbAS) and stunting in children below two years of age in an area of high malaria transmission
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DOI：
10.1186/1475-2875-8-16
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发表时间：
2009-01-16
期刊：
影响因子：
3
通讯作者：
May, Juergen
中科院分区：
文献类型：
--
作者：
Kreuels, Benno;Ehrhardt, Stephan;May, Juergen
背景：虽然镰状细胞性状（HbAS）对严重疟疾的保护作用以及由此产生的生存优势众所周知，但其对幼儿身体发育的影响仍不清楚。本研究旨在调查加纳阿散蒂地区两岁以下儿童的 HbS 携带与发育迟缓之间的关系。方法：招募了 1,070 名 3 个月大的儿童，并随访 21 个月，每三个月进行一次人体测量。通过泊松回归计算 95% 置信区间的发病率比，以估计 β 珠蛋白基因型与疟疾发作次数的关联。计算 β-珠蛋白基因型的发生和/或疟疾发作与发育迟缓之间的关联的比值比 (OR)。 β-珠蛋白基因型的年龄依赖性组间和组内效应通过群体平均模型进行评估，该模型由具有自回归相关结构的广义估计方程估计。结果：分析显示，与 HbAA 携带者 (n = 692）。这种效应仅限于在观察期间经历过疟疾发作的儿童，这表明β-珠蛋白 HbS 变体对发育迟缓发生率的有益作用与其预防轻度疟疾发作密切相关。结论：通过预防轻度疟疾发作介导的儿童早期慢性营养不良的风险较低，
Background: While the protective effects of sickle cell trait (HbAS) against severe malaria and the resulting survival advantage are well known, the impact on the physical development in young children remains unclear. This study was aimed to investigate the relationship between HbS carriage and stunting in children below two years of age in a cohort from the Ashanti Region, Ghana.Methods: 1,070 children were recruited at three months of age and followed-up for 21 months with anthropometric measurements performed every three months. Incidence rate ratios with 95% confidence intervals were calculated by Poisson regression to estimate the association of beta-globin genotypes with the number of malaria episodes. Odds ratios (OR) were calculated for the association between the occurrence of beta-globin genotypes and/or malaria episodes and stunting. The age-dependent between- group and within-group effects for the beta-globin genotypes were assessed by population-averaged models estimated by generalized estimation equation with autoregressive correlation structure.Results: Analyses showed a significantly lower age-dependent risk of stunting (OR 0.56; 95% CI 0.33-0.96) in carriers of the HbAS genotype (n = 102) in comparison to those with HbAA (n = 692). This effect was restricted to children who experienced malaria episodes during the observation period suggesting that the beneficial effect of the beta-globin HbS variant on the incidence of stunting is closely linked to its protection from mild malaria episodes.Conclusion: The lower risk of chronic malnutrition in early childhood, mediated by protection against mild malaria episodes,