| Supplemental meat, milk or energy were provided to 555 undernourished school children aged 5–14 (mean 7.4) y in a rural, malaria-endemic area of Kenya, at one school meal daily during one school year. Blood and stool samples were collected at baseline and after one year to measure stool parasites, malaria, hemoglobin, and C-reactive protein (CRP), ferritin, iron, zinc, and copper, vitamin B-12, folate, and retinol in serum or plasma, and erythrocyte riboflavin. Antibodies to Helicobacter pylori (IgA, IgG and IgM isotypes), hepatitis A virus (HAV), rotavirus, tetanus toxoid (IgG), and a panel of recombinant malarial antigens (MSP119, MSP2, Ag512, MSP4, and MSP5) were measured on a subsample (n = 200). At baseline, the prevalence of deficiencies was: 48.9% anemia, 52.4% low serum iron and 65.6% zinc; 30.5% severe plus 37.7% moderate vitamin B-12 deficiency; 22.0% severe plus 68.6% moderate vitamin A deficiency, and 24.3% low RBC riboflavin. Plasma ferritin was low in 6.3%, and there were no low serum copper values. At the end of the school year of supplementation, plasma vitamin B-12 concentrations were significantly increased in children fed the snacks with meat or milk. Malaria was associated with: lower hemoglobin and a higher prevalence of anemia, higher ferritin, lower serum iron, a higher prevalence of low serum iron; more low serum zinc; higher serum copper; lower plasma vitamin B-12 and retinol; higher RBC riboflavin concentrations and a lower prevalence of riboflavin deficiency. Elevated CRP was associated with: a higher mean plasma ferritin and lower serum iron; a higher prevalence of serum iron and zinc deficiencies; higher serum copper; lower plasma retinol and a higher prevalence of vitamin A deficiency. Nearly all children showed high antibody titers to H. pylori, HAV, rotavirus, and malaria, even though there was a high prevalence of micronutrient deficiencies and stunting, but many had a concentration of tetanus toxoid IgG antibodies below the protective level. Children with low hemoglobin status had a greater proportion of elevated H. pylori IgM antibody titers at baseline, and compared to the control group, only the meat group showed a significant increase in H. pylori IgM (p = 0.019). |
