Early life predictors of antibody response to vaccination in Bangladeshi children

现在已经确定，生命早期的因素（如产前营养和产后喂养习惯）可以影响长期健康。例如，有证据表明，出生时的小尺寸可以增加个体？老年人以后易患慢性退行性疾病，如心脏病和糖尿病。也有证据表明，免疫功能也可能是？程序化的？在生命早期，传染病的发病率和死亡率风险增加。作为一个研究小组，我们目前正在调查被认为是低出生体重婴儿的高比率和高水平接触传染病的综合影响的最大风险的人口群体的免疫功能的早期生命预测因素。在孟加拉国农村，大部分人口的营养状况很差，这可以从观察到的宫内发育迟缓的高发病率看出。一项关于改善母婴健康的综合干预措施的大规模研究（The？MINIMat研究？）正在研究产前和产后干预措施，以解决孟加拉国农村地区孕产妇、胎儿和婴儿营养不良的问题。在研究设计中，所有女性在怀孕期间随机接受蛋白质能量和微量营养素补充剂的组合。主要研究现已完成，共有3，282名婴儿出生。目前正在对这些婴儿进行跟踪，以观察产前营养干预的长期后果。这项拟议的研究旨在作为主要研究的补充，专门探讨孟加拉国儿童早期营养状况和免疫功能之间的直接关系。在目前的研究中，我们计划给从主要队列中选出的1000名儿童接种伤寒和肺炎球菌疫苗，然后测量对疫苗接种的反应，通过测量在儿童接种疫苗前后采集的血液样本中的抗体水平。我们还计划使用迟发型超敏反应皮肤试验来测量细胞介导的免疫力。然后，我们将根据儿童的产前营养状况比较其反应率。如果我们能够找到生命早期营养和后期免疫功能之间的关系，那么这将有助于我们了解疾病规划中涉及的一些机制，然后可以采取进一步措施来改善孟加拉国和其他高危人群的出生结果和婴儿生长。

It is now established that factors in early life (such as prenatal nutrition and post-natal feeding practices) can influence long-term health. For example, evidence exists to suggest that small size at birth can increase an individual?s later susceptibility to chronic degenerative diseases such as heart disease and diabetes. Evidence is also emerging to suggest that immune function may also be ?programmed? early in life, increasing risk of morbidity and mortality from infectious diseases. As a research group we are currently investigating the early life predictors of immune function in population groups considered to be at greatest risk from the combined effects of high rates of low birth weight infants and high levels of exposure to infectious disease. In rural Bangladesh, the nutritional status of much of the population is poor and this can be seen through the high prevalence of intrauterine growth retardation observed. A large-scale study of combined interventions to improve maternal and infant health (the ?MINIMat study?) is looking at both pre- and post-natal interventions to address the issues of maternal, fetal, and infant malnutrition in rural Bangladesh. Within the study design, all women are randomised to receive a combination of protein energy and micronutrient supplements during pregnancy. The main study is now complete, with a total of 3,282 infants born. These infants are now being followed up to look at the long-term consequences of prenatal nutrition interventions. The proposed study is designed as an add on to the main study to specifically explore the direct relationship between early-life nutritional status and immune function in young Bangladeshi children.In the current study, we plan to give a typhoid and pneumococcal vaccine to a sub-group of 1000 children selected from the main cohort, and then measure response to vaccination, by measuring antibody levels in blood samples collected before and after the children received the vaccine. We also plan to measure cell mediated immunity using a delayed-type hypersensitivity skin test. We will then compare response rates in children according to their pre-natal nutritional status. If we are able find a relationship between early life nutrition and later immune function, then this will help us to understand some of the mechanisms involved in programming of disease, and further measures can then be taken to health improve birth outcomes and infant growth in Bangladesh and in other at risk population groups.