Immune parameters in soil-transmitted helminth uninfected and infected participants.

<p>Abbreviations: HsCRP = High sensitive C reactive protein, TNF = tumor necrosis factor, IL10 = interleukin 10, IgE = Immunoglobulin E. HsCRP, TNF, IL10 and IgE are log-transformed.</p><p># The difference is expressed as increase or decrease in the parameter per increasing number of infections per patient (maximum = 3).</p><p>Immune parameters in soil-transmitted helminth uninfected and infected participants.</p

Infection with Soil-Transmitted Helminths Is Associated with Increased Insulin Sensitivity

<div><p>Objective</p><p>Given that helminth infections have been shown to improve insulin sensitivity in animal studies, which may be explained by beneficial effects on energy balance or by a shift in the immune system to an anti-inflammatory profile, we investigated whether soil-transmitted helminth (STH)-infected subjects are more insulin sensitive than STH-uninfected subjects.</p><p>Design</p><p>We performed a cross-sectional study on Flores island, Indonesia, an area with high prevalence of STH infections.</p><p>Methods</p><p>From 646 adults, stool samples were screened for <i>Trichuris trichiura</i> by microscopy and for <i>Ascaris lumbricoides</i>, <i>Necator americanus</i>, <i>Ancylostoma duodenale</i>, <i>and Strongyloides stercoralis</i> by qPCR. No other helminth was found. We collected data on body mass index (BMI, kg/m²), waist-to-hip ratio (WHR), fasting blood glucose (FBG, mmol/L), insulin (pmol/L), high sensitive C-reactive protein (ng/ml) and Immunoglobulin E (IU/ml). The homeostatic model assessment for insulin resistance (HOMAIR) was calculated and regression models were used to assess the association between STH infection status and insulin resistance.</p><p>Results</p><p>424 (66%) participants had at least one STH infection. STH infected participants had lower BMI (23.2 vs 22.5 kg/m², p value = 0.03) and lower HOMAIR (0.97 vs 0.81, p value = 0.05). In an age-, sex- and BMI-adjusted model a significant association was seen between the number of infections and HOMAIR: for every additional infection with STH species, the HOMAIR decreased by 0.10 (p for linear trend 0.01). This effect was mainly accounted for by a decrease in insulin of 4.9 pmol/L for every infection (p for trend = 0.07).</p><p>Conclusion</p><p>STH infections are associated with a modest improvement of insulin sensitivity, which is not accounted for by STH effects on BMI alone.</p></div

Parameters of glucose metabolism parameters in soil-transmitted helminth uninfected and infected participants.

<p>Abbreviations: BMI = body mass index, WHR = waist to hip ratio, FBG = fasting blood glucose, HOMAIR = Homeostasis model assessment for insulin resistance.</p><p>* WHR is calculated by waist circumference (cm) / hip circumference (cm)</p><p>** HOMAIR index is calculated with HOMAIR formula = fasting serum insulin x fasting glucose / 22.5, using HOMA2 calculator (<a href="https://www.dtu.ox.ac.uk/homacalculator/" target="_blank">https://www.dtu.ox.ac.uk/homacalculator/</a>)</p><p># The difference is expressed as increase or decrease in the parameter per increasing number of helminth species per patient (maximum = 3). Insulin and HOMAIR were log-transformed.</p><p>Parameters of glucose metabolism parameters in soil-transmitted helminth uninfected and infected participants.</p

Characteristics of the study population.

<p>Abbreviations: BMI = body mass index, WHR = waist to hip ratio, FBG = fasting blood glucose, HOMAIR = Homeostasis model assessment for insulin resistance, HsCRP = High sensitive C reactive protein, TNF = tumor necrosis factor, IL10 = interleukin 10, IgE = Immunoglobulin E.</p><p>^*after logarithmic transformation</p><p>Characteristics of the study population.</p

The association of number of soil-transmitted helminth species per subject and Homeostasis Model Assessment for insulin Resistance (HOMAIR).

<p>The association of number of helminth species infections with HOMAIR (mean, 95%CI) with correction for age, sex, and BMI. The numbers of participants with none, one, two or at least three species were respectively 161, 189, 98 and 29. The p for linear trend is 0.01. *Adjusted mean for HOMAIR were derived from linear regression. White circle = no soil-transmitted helminth infection; black circle = infected with one soil-transmitted helminth species; white square = infected with two soil-transmitted helminth species; black square = infected with at least three soil-transmitted helminth species.</p

Characteristic of the group with intima media thickness measurement (population 40+).

<p>1. positive by microscopy.</p><p>2. positive by PCR.</p><p>Abbreviations: BMI = body mass index, WHR = waist to hips ratio, FBG = fasting blood glucose, TC = total cholesterol, TG = triglyceride, HDL-c = high density lipoprotein cholesterol, LDL-c = low density lipoprotein cholesterol, TIgE = total immunoglobulin E, hs-CRP = high sensitive C reactive protein, TNF = tumor necrosis factor, IL-10 = interleukin 10. *Adjusted mean difference for TIgE, hs-CRP and cytokines were anti-log transformed and represent ratio.</p

Characteristics of the study population regarding helminth uninfected and infected.

<p>1. positive by microscopy.</p><p>2. positive by PCR.</p><p>Abbreviations: BMI = body mass index, WHR = waist to hips ratio, FBG = fasting blood glucose, TC = total cholesterol, TG = triglyceride, HDL-c = high density lipoprotein cholesterol, LDL-c = low density lipoprotein cholesterol, TIgE = total immunoglobulin E, hs-CRP = high sensitive C reactive protein, TNF = tumor necrosis factor, IL-10 = interleukin 10 cytokines were stimulated for 24 h with <i>E. coli</i> lipopolysaccharide (LPS). *Adjusted mean difference for TIgE, hs-CRP and cytokines were anti-log transformed and represent ratio.</p

Effect of albendazole treatment on malarial parasitemia based on two age categories.

<p>Malarial parasitemia A) ≤15 and B) >15 years of age. The risk of malarial parasitemia after albendazole treatment compared to placebo is shown as odds ratio with 95% CI. The reference line is set at 1, indicating that symbols at the right of this line represent an increased risk, while symbols at the left of the line would predict decreased risk of malarial parasitemia. Note: at 9 month time point in those >15 years of age, the OR is ∞.</p

Effect of three-monthly albendazole treatment on malaria outcomes: Malarial parasitemia by PCR.

<p>The number of positives (n) of the total population examined (N). Odds ratio and 95% confidence interval based on logistic mixed models. The statistically significant results are given in bold. The p-values are generated from the modeled data for the combined effect of albendazole treatment over time for each of the species separately, which were significant for <i>P. falciparum</i> (P = 0.029) and <i>P. malariae</i> (P = 0.016).</p

Baseline characteristics.

1<p>diagnosed by PCR; ²diagnosed by microscopy.</p><p>The number of positives (n) of the total population examined (N).</p