Session/Event: Double Burden of Malnutrition (Oral 16)

(OR16-06-22) Assessing Environmental Enteric Dysfunction via Multiplex Assay and its Relation to Infant Growth Among HIV-Exposed Infants in Dar es Salaam, Tanzania

On Demand

Presenting Author(s)

Jacqueline M. Lauer, PhD, MPH

Clinical Assistant Professor
Boston University
Boston, Massachusetts, United States

Disclosure: Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.

View Presentation

Co-Author(s)

Miles A. Kirby, PhD

Research Associate
Harvard T.H. Chan School of Public Health
Yarmouth, Maine, United States
AM

Alfa Muhihi, MD

Management and Development for Health
NU

Nzovu Ulenga, PhD

Management and Development for Health
SA

Said Aboud

Muhimbili University of Health and Allied Sciences
EL

Enju Liu, PhD

Boston Children's Hospital
Boston, Massachusetts, United States
RC

Robert K.M Choy, PhD

PATH
JK

Jianqun Kou

Georgia State University
AG

Andrew T. Gewirtz, PhD

Professor
Institute for Biomedical Sciences, Georgia State University
Atlanta, Georgia, United States
WF

Wafaie W. Fawzi, MBBS, MPH, MS, DrPH

Professor
Harvard T.H. Chan School of Public Health
Boston, Massachusetts, United States
Christopher R. Sudfeld, ScD

Assistant Professor of Global Health and Nutrition
Harvard T.H. Chan School of Public Health
Boston, Massachusetts, United States
KM

Karim P. Manji, MD, MPH

Muhimbili University of Health and Allied Sciences
Christopher P. Duggan, MD, PhD

Editor in Chief, American Journal of Clinical Nutrition
Boston Children’s Hospital
Boston, Massachusetts, United States

Objectives: Environmental enteric dysfunction (EED), a subclinical state of intestinal inflammation, may contribute to poor growth in children in low-resource settings, but validated biomarkers are lacking. Multiplex assays, such as the 11-plex Micronutrient and EED Assessment Tool (MEEDAT), hold promise due to their ability to capture multiple domains of EED; however, MEEDAT’s ability to predict poor growth has not been well established. We sought to examine the relationship between markers of EED and growth among HIV-exposed infants in Dar es Salaam, Tanzania.

Methods: We performed a sub-study of 467 infants of HIV-infected mothers who participated in a randomized, double-blind, placebo-controlled trial assessing the effect of vitamin D3 supplementation during pregnancy. Infant serum samples collected at 6 weeks and 6 months were analyzed for anti-flagellin and anti-LPS IgA and IgG via ELISA as well as MEEDAT, which incorporates two markers of EED [fatty acid-binding protein (I-FABP) and soluble CD14 (sCD14)]. Biomarkers were categorized into quartiles for primary analyses and as continuous exposures for exploratory analyses. Associations with subsequent growth outcomes [length-for-age Z-score (LAZ), weight-for-length Z-score (WLZ), and weight-for-age Z-score (WAZ)] at 12 months of age were assessed using linear regression.

Results: At 12 months, nearly half (~46%) of infants were stunted (LAZ < -2), and ~3% were wasted (WLZ < -2). Higher concentrations of anti-LPS IgG at 6 months were significantly associated with lower LAZ at 12 months (p_trend=0.034). In continuous analyses, higher concentrations of anti-flagellin IgA at 6 weeks were significantly associated with lower LAZ at 12 months (β: -0.46, 95% CI: -0.82, -0.11) as were anti-LPS IgA (β: -0.28, 95% CI: -0.53, -0.03) and anti-LPS IgG (β: -0.24, 95% CI: -0.48, -0.01) at 6 months. Higher concentrations of anti-flagellin IgA and anti-LPS IgA at 6 months were significantly associated with lower WAZ at 12 months (β: -0.34, 95% CI: -0.61, -0.07; β: -0.24, 95% CI: -0.44, -0.04). No significant associations were observed between I-FABP or sCD14 and infant growth at 12 months.

Conclusions: Unlike anti-flagellin and anti-LPS Igs, MEEDAT’s biomarkers of EED, I-FABP and sCD14, were not associated with subsequent growth among HIV-exposed infants in Tanzania.

Funding Sources: NIDDK and NICHD