Environmental enteric dysfunction (EED) is an intestinal disorder common among children in low-resource settings and is associated with increased risk of growth
stunting, cognitive deficits, and reduced oral vaccine immunogenicity. The
Micronutrient and EED Assessment Tool (MEEDAT) is a multiplexed immunoassay that measures
biomarkers previously associated with child growth faltering and/or oral vaccine immunogenicity:
intestinal fatty acid-binding protein (I-FABP),
soluble CD14 (
sCD14),
insulin-like growth factor 1 (IGF-1), and
fibroblast growth factor 21 (
FGF21). MEEDAT also measures systemic
inflammation (α1-
acid glycoprotein, C-reactive
protein),
ferritin, soluble
transferrin receptor,
retinol binding protein 4,
thyroglobulin, and Plasmodium falciparum antigenemia (
histidine-rich
protein 2). The performance of MEEDAT was compared with commercially available
enzyme-linked
immunosorbent assays (ELISAs) using 300 specimens from Malian infant clinical trial participants. Regression methods were used to test if MEEDAT
biomarkers were associated with seroconversion to meningococcal A
conjugate vaccine (MenAV),
yellow fever vaccine (YFV), and pentavalent
rotavirus vaccine (PRV) after 28 days, or with growth faltering over 12 weeks. The Pearson correlations between the MEEDAT and ELISA results were 0.97, 0.86, 0.80, and 0.97 for serum I-FABP,
sCD14,
IGF-1, and
FGF21, respectively. There were significant associations between I-FABP concentration and the probability of PRV
IgG seroconversion and between
IGF-1 concentration and the probability of YFV seroconversion. In multivariable models neither association remained significant, however there was a significant negative association between AGP concentration and YFV seroconversion. GLP-2 and
sCD14 concentrations were significantly negatively associated with 12-week change in weight-for-age z-score and weight-for-height z-score in multivariable models. MEEDAT performed well in comparison to commercially-available ELISAs for the measurement of four analytes for EED and
growth hormone resistance. Adoption of MEEDAT in low-resource settings could help accelerate the identification of interventions that prevent or treat child
stunting and interventions that boost the immunogenicity of child vaccinations.