title: The impact of lipid-based nutrient supplementation on anti-malarial antibodies in pregnant women in a randomized controlled trial.
abstract: BACKGROUND
  Malaria and undernutrition frequently coexist, especially in pregnant women and young children. Nutrient supplementation of these vulnerable groups might reduce their susceptibility to malaria by improving immunity.
  
  
  METHODS
  Antibody immunity to antigens expressed by a placental-binding parasite isolate, a non-placental binding parasite isolate, merozoites and schizonts at enrolment (before 20 gestation weeks) and at 36 gestation weeks were measured in 1,009 Malawian pregnant women receiving a daily lipid-based nutrient supplement, multiple micronutrients or iron and folic acid, who were participants in a randomized clinical trial assessing the effects of nutrient supplementation on pregnancy outcomes and child development (registration ID: NCT01239693).
  
  
  RESULTS
  Antibodies to placental-binding isolates significantly increased while antibodies to most merozoite antigens declined over pregnancy. Overall, after adjustment for covariates, the type of supplementation did not influence antibody levels at 36 gestation weeks or the rate of change in antibody levels from enrolment to 36 weeks. A negative association between maternal body mass index and opsonizing antibodies to placental-binding antigens (coefficient (95% CI) -1.04 (-1.84, -0.24), was observed. Similarly, women with higher socioeconomic status had significantly lower IgG and opsonizing antibodies to placental-binding antigens. Neither of these associations was significantly influenced by the supplementation type.
  
  
  CONCLUSIONS
  In the current cohort nutrient supplementation did not affect anti-malarial antibody responses, but poor and undernourished mothers should be a priority group in future trials.
authors.affiliation: Department of Medicine, Clinical Sciences Building, The University of Melbourne, Royal Parade, Parkville, VIC, 3052, Australia. upekshapc@gmail.com.
authors.forename: Upeksha P
authors.initials: UP
authors.lastname: Chandrasiri
authors.affiliation: Macfarlane Burnet Institute of Medical Research, 85 Commercial Road, Melbourne, Australia. fowkes@burnet.edu.au.|Centre for Epidemiology and Biostatistics, Department of Epidemiology, The University of Melbourne, Melbourne, Australia. fowkes@burnet.edu.au.|Preventive Medicine and Department of Infectious Diseases, Monash University, Melbourne, Australia. fowkes@burnet.edu.au.
authors.forename: Freya J I
authors.initials: FJ
authors.lastname: Fowkes
authors.affiliation: Department of Medicine, Clinical Sciences Building, The University of Melbourne, Royal Parade, Parkville, VIC, 3052, Australia. richards@burnet.edu.au.|Macfarlane Burnet Institute of Medical Research, 85 Commercial Road, Melbourne, Australia. richards@burnet.edu.au.
authors.forename: Jack S
authors.initials: JS
authors.lastname: Richards
authors.affiliation: Macfarlane Burnet Institute of Medical Research, 85 Commercial Road, Melbourne, Australia. langer@burnet.edu.au.
authors.forename: Christine
authors.initials: C
authors.lastname: Langer
authors.affiliation: Department for International Health, University of Tampere School of Medicine, Tampere, Finland. Yuemei.Fan@uta.fi.|Department of Paediatrics, Tampere University Hospital, Tampere, Finland. Yuemei.Fan@uta.fi.
authors.forename: Yue-Mei
authors.initials: YM
authors.lastname: Fan
authors.affiliation: Duke University Medical Center, Durham, North Carolina, USA. stevemyertaylor@gmail.com.|Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA. stevemyertaylor@gmail.com.
authors.forename: Steve M
authors.initials: SM
authors.lastname: Taylor
authors.affiliation: Department of Medicine, Clinical Sciences Building, The University of Melbourne, Royal Parade, Parkville, VIC, 3052, Australia. beeson@burnet.edu.au.|Macfarlane Burnet Institute of Medical Research, 85 Commercial Road, Melbourne, Australia. beeson@burnet.edu.au.
authors.forename: James G
authors.initials: JG
authors.lastname: Beeson
authors.affiliation: Department of Nutrition, University of California Davis, Davis, California, USA. kgdewey@ucdavis.edu.
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey
authors.affiliation: College of Medicine, University of Malawi, Blantyre, Malawi. ken.maleta@gmail.com.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Maleta
authors.affiliation: Department for International Health, University of Tampere School of Medicine, Tampere, Finland. per.ashorn@uta.fi.|Department of Paediatrics, Tampere University Hospital, Tampere, Finland. per.ashorn@uta.fi.
authors.forename: Per
authors.initials: P
authors.lastname: Ashorn
authors.affiliation: Department of Medicine, Clinical Sciences Building, The University of Melbourne, Royal Parade, Parkville, VIC, 3052, Australia. sroger@unimelb.edu.au.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Rogerson
mesh_terms: D056704:Adaptive Immunity / Q000187:drug effects*; D000293:Adolescent; D000328:Adult; D000913:Antibodies, Protozoan / Q000097:blood*; D015331:Cohort Studies; D019587:Dietary Supplements / Q000032:analysis*; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000378:metabolism; D050356:Lipid Metabolism / Q000187:drug effects*; D008288:Malaria / Q000178:diet therapy* / Q000469:parasitology; D008295:Malawi; D052940:Merozoites / Q000276:immunology; D018977:Micronutrients / Q000008:administration & dosage / Q000378:metabolism; D010961:Plasmodium / Q000276:immunology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D052939:Schizonts / Q000276:immunology; D055815:Young Adult
chemical_list: D000913:Antibodies, Protozoan; D018977:Micronutrients; D005492:Folic Acid; D007501:Iron