Volume 72, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


The objectives of this study were 1) to provide more accurate estimates of the relationship between infection and both protein energy malnutrition (PEM) and anemia through better adjustment for potential confounders such as socioeconomic status (SES) and geo-helminth infections and 2) to assess the role of occult blood loss in mediating –associated anemia. We examined cross-sectionally 729 individuals (86.7% –infected and 13.3% –uninfected) aged 7–30 years in Leyte, The Philippines. The main outcome measures were height-for-age Z-score (HAZ), body-mass-index Z-score (BMIZ), triceps skinfold Z-score, hemoglobin, and fecal occult blood loss. Multivariate models were created to assess the relationship between infection and nutritional status after adjusting for age, gender, other helminths, and SES. After controlling for confounders, intensity of infection was inversely related to hemoglobin in all age groups ( < 0.0001) and HAZ among children ≤ 12 years ( = 0.03), but not to BMIZ ( = 0.52) or triceps skinfold Z-score ( = 0.11). Individuals with high-intensity infection were 3.5 times more likely to have occult blood in the stool. Adjustment for occult blood did not attenuate the relationship between and hemoglobin, suggesting other mechanisms are involved. Adjustment for SES allows more accurate assessment of the relationship between and both PEM and anemia. Exploration of the mechanisms of –associated anemia suggests that processes other than extracorporeal blood loss, such as anemia or inflammation, may be involved.


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  • Received : 14 Apr 2004
  • Accepted : 13 Aug 2004

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