RESUMEN
OBJECTIVE: 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. DESIGN: We performed a cross-sectional study on Flores island, Indonesia, an area with high prevalence of STH infections. METHODS: From 646 adults, stool samples were screened for Trichuris trichiura by microscopy and for Ascaris lumbricoides, Necator americanus, Ancylostoma duodenale, and Strongyloides stercoralis 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. RESULTS: 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). CONCLUSION: STH infections are associated with a modest improvement of insulin sensitivity, which is not accounted for by STH effects on BMI alone.
Asunto(s)
Helmintiasis/epidemiología , Resistencia a la Insulina , Suelo/parasitología , Adulto , Ancylostoma , Animales , Ascaris lumbricoides , Estudios Transversales , Femenino , Helmintiasis/inmunología , Humanos , Indonesia , Masculino , Persona de Mediana Edad , Necator americanus , Prevalencia , Strongyloides stercoralis , TrichurisRESUMEN
OBJECTIVE: To examine the association between helminth infections and atherosclerosis. BACKGROUND: Chronic helminth infection, which can lead to poor nutritional status and anti-inflammatory response, might protect against the development of atherosclerosis. METHODS: A cross-sectional study was performed in Flores, Indonesia, an area highly endemic for soil-transmitted helminths (STH). Stool samples from 675 participants aged 18-80 years were collected and screened for Trichuris trichiura by microscopy and for Ascaris lumbricoides, Necator americanus, Ancylostoma duodenale, and Strongyloides stercoralis by qPCR. We collected data on body mass index (BMI), waist to hip ratio (WHR), blood pressure, fasting blood glucose (FBG), lipid, high sensitive C-reactive protein (hs-CRP), total immunoglobulin-E (TIgE) and Escherichia coli lipopolysaccharide stimulated cytokines (tumor necrosis factor and interleukin-10). In a subset of 301 elderly adults (≥40 years of age) carotid intima media thickness (cIMT) was measured. RESULTS: Participants with any STH infection had lower BMI (kg/m2) (mean difference -0.66, 95%CI [-1.26, -0.06]), WHR (-0.01, [-0.02, -0.00]), total cholesterol (mmol/L) (-0.22, [-0.43, -0.01]) and LDL-cholesterol (mmol/L) (-0.20, [-0.39, -0.00]) than uninfected participants. After additional adjustment for BMI the association between helminth infection and total cholesterol (mean difference -0.17, 95%CI [-0.37, 0.03]) as well as LDL-cholesterol (-0.15, [-0.33, 0.04]) was less pronounced. BMI, WHR, and total cholesterol were negatively associated with number species of helminth co-infections. Participants with high TIgE, an indicator of exposure to helminths, had lower FBG, TC, and HDL. The association between TIgE and TC and HDL remained significant after adjustment with BMI. No clear association was found between STH infection or TIgE and mean cIMT. CONCLUSIONS: This cross-sectional study presents evidence that helminth infections were negatively associated with risk factors for cardiovascular disease, an association at least partially mediated by an effect on BMI. The significance of this finding needs to be determined.
Asunto(s)
Aterosclerosis/patología , Arteria Carótida Común/patología , Grosor Intima-Media Carotídeo , Helmintiasis/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Aterosclerosis/sangre , Aterosclerosis/parasitología , Composición Corporal , Índice de Masa Corporal , Proteína C-Reactiva/metabolismo , Arteria Carótida Común/metabolismo , LDL-Colesterol/sangre , Estudios Transversales , Femenino , Helmintiasis/sangre , Helmintiasis/parasitología , Helmintos/fisiología , Humanos , Indonesia , Interleucina-10/sangre , Islas , Masculino , Persona de Mediana Edad , Factores de Riesgo , Triglicéridos/sangreRESUMEN
OBJECTIVES: Data relating blood pressure (BP) class to subclinical organ damage are infrequently reported in populations with a traditional 'nonwestern' lifestyle. As the relevance of BP stratification to cardiovascular prognosis has not been elucidated in these low-income countries at the second epidemiological transition, we aimed to study the effect of BP class on carotid artery intima-media thickness (IMT) in Flores Island, Indonesia. METHODS: A cross-sectional study was performed in 476 inhabitants (men/women) of Flores. BP was classified using the European Society of Hypertension/European Society of Cardiology classification. The primary endpoint was mean carotid-IMT measured by ultrasonography in classes of BP. Covariate analysis was performed adjusting for conventional cardiovascular risk factors. RESULTS: BP ranged from 94 to 250 mmHg systolic and 50 to 125 mmHg diastolic, 35% of the population had 'grade-I hypertension' or higher, 1.7% of the population was short-term treated with antihypertensive therapy. IMT significantly differed for BP classes (P < 0.001). Mean (± SEM) IMT was 587.8 (± 9.3) µm, 621.5 (± 7.6) µm, 653.6 (± 10.5) µm, 717.9 (± 14.0) µm, and 750.1 (± 21.8) µm for 'optimal', '(high) normal', 'grade-I, grade-II, and grade-III hypertension' classes, respectively. After adjustment for cardiovascular risk factors, similar results were obtained. CONCLUSION: A strong association was found between BP class and carotid artery IMT in treatment-naive participants of a population with a traditional lifestyle, at the second epidemiological transition. Intriguingly, the increase of IMT was already observed at the 'high normal' BP class. This study may help to prioritize preventive and therapeutic measures to lower BP in countries at the second epidemiological transition.