1921
Volume 72, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

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.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.2005.72.527
2005-05-01
2017-11-18
Loading full text...

Full text loading...

/deliver/fulltext/14761645/72/5/0720527.html?itemId=/content/journals/10.4269/ajtmh.2005.72.527&mimeType=html&fmt=ahah

References

  1. Administrative Committee on Coordination/Subcommittee on Nutrition (ACC,SCN), 2000. Fourth Report on the World Nutrition Situation. Geneva: ACC/SCN in collaboration with IFPRI.
  2. Partnership for Child Development, 1997. Better health, nutrition and education for the school-aged child. The Partnership for Child Development, Trans R Soc Trop Med Hyg 91 : 1–2.
  3. Agarwal DK, Upadhyay SK, Agarwal KN, 1989. Influence of malnutrition on cognitive development assessed by Piagetian tasks. Acta Paediatr Scand 78 : 115–122.
  4. Sigman M, Neumann C, Jansen AA, Bwibo N, 1989. Cognitive abilities of Kenyan children in relation to nutrition, family characteristics, and education. Child Dev 60 : 1463–1474.
  5. Sigman M, Neumann C, Baksh M, Bwibo N, McDonald MA, 1989. Relationship between nutrition and development in Kenyan toddlers. J Pediatr 115 : 357–364.
  6. Nelson M, 1996. Anaemia in adolescent girls: effects on cognitive function and activity. Proc Nutr Soc 55 : 359–367.
  7. Stivelman JC, 2000. Benefits of anaemia treatment on cognitive function. Nephrol Dial Transplant 15 (Suppl 3): 29–35.
  8. Hutchinson SE, Powell CA, Walker SP, Chang SM, Grantham-McGregor SM, 1997. Nutrition, anaemia, geohelminth infection and school achievement in rural Jamaican primary school children. Eur J Clin Nutr 51 : 729–735.
  9. Hall A, Khanh LN, Son TH, Dung NQ, Lansdown RG, Dar DT, Hanh NT, Moestue H, Khoi HH, Bundy DA, 2001. An association between chronic undernutrition and educational test scores in Vietnamese children. Eur J Clin Nutr 55 : 801–804.
  10. Haas JD, Brownlie TT, 2001. Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship. J Nutr 131 : 676S–688S.
  11. Pelletier DL, 1994. The potentiating effects of malnutrition on child mortality: epidemiologic evidence and policy implications. Nutr Rev 52 : 409–415.
  12. Pelletier DL, Frongillo EA Jr, Schroeder DG, Habicht JP, 1994. A methodology for estimating the contribution of malnutrition to child mortality in developing countries. J Nutr 124 : 2106S–2122S.
  13. McGarvey ST, Aligui G, Daniel BL, Peters P, Olveda R, Olds GR, 1992. Child growth and schistosomiasis japonica in northeastern Leyte, The Philippines: cross-sectional results. Am J Trop Med Hyg 46 : 571–581.
  14. McGarvey ST, Wu G, Zhang S, Wang Y, Peters P, Olds GR, Wiest PM, 1993. Child growth, nutritional status, and schistosomiasis japonica in Jiangxi, People’s Republic of China. Am J Trop Med Hyg 48 : 547–553.
  15. McGarvey ST, Aligui G, Graham KK, Peters P, Olds GR, Olveda R, 1996. Schistosomiasis japonica and childhood nutritional status in northeastern Leyte, The Philippines: a randomized trial of praziquantel versus placebo. Am J Trop Med Hyg 54 : 498–502.
  16. WHO, 1987. Prevention and Control of Intestinal Parasitic Infections. Geneva: World Health Organization, Technical Report Series 749: 8–28.
  17. Stephenson LS, Holland CV, Cooper ES, 2000. The public health significance of Trichuris trichiura. Parasitology 121 (Suppl): S73–S95.
  18. Widjana DP, Sutisna P, 2000. Prevalence of soil-transmitted helminth infections in the rural population of Bali, Indonesia. Southeast Asian J Trop Med Public Health 31 : 454–459.
  19. Tanner J, 1990. Fetus into Man. Cambridge, MA: Harvard University Press.
  20. Jelliffe DB, 1966. The assessment of the nutritional status of the community (with special reference to field surveys in developing regions of the world). Monogr Ser World Health Organ 53 : 3–271.
  21. Bailey KV, Ferro-Luzzi A, 1995. Use of body mass index of adults in assessing individual and community nutritional status. Bull World Health Organ 73 : 673–680.
  22. Gibson R, 1990. Principles of Nutritional Assessment. New York: Oxford University Press.
  23. WHO, 1995. Physical Status: The Use of and Interpretation of Anthropometry. Geneva: World Health Organization.
  24. Hamill PV, Drizd TA, Johnson CL, Reed RB, Roche AF, 1977. NCHS growth curves for children birth-18 years. United States. Vital Health Stat 11 (i–iv): 1–74.
  25. Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R, Grummer-Strawn LM, Curtin LR, Roche AF, Johnson CL, 2002. Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics 109 : 45–60.
  26. Frisancho AR, 1990. Anthropometric Standards for the Assessment of Growth and Nutritional Status. Ann Arbor: University of Michigan Press.
  27. Filmer D, Pritchett LH, 2001. Estimating wealth effects without expenditure data–or tears: an application to educational enrollments in states of India. Demography 38 : 115–132.
  28. Warren KS, Su DL, Xu ZY, Yuan HC, Peters PA, Cook JA, Mott KE, Houser HB, 1983. Morbidity in schistosomiasis japonica in relation to intensity of infection. A study of two rural brigades in Anhui Province, China. N Engl J Med 309 : 1533–1539.
  29. Cook JA, Baker ST, Warren KS, Jordan P, 1974. A controlled study of morbidity of schistosomiasis mansoni in St. Lucian children, based on quantitative egg excretion. Am J Trop Med Hyg 23 : 625–633.
  30. Lehman JS Jr, Mott KE, Morrow RH Jr, Muniz TM, Boyer MH, 1976. The intensity and effects of infection with Schistosoma mansoni in a rural community in northeast Brazil. Am J Trop Med Hyg 25 : 285–294.
  31. Ndamba J, Makaza N, Kaondera KC, Munjoma M, 1991. Morbidity due to Schistosoma mansoni among sugar-cane cutters in Zimbabwe. Int J Epidemiol 20 : 787–795.
  32. Layrisse M, Aparcedo L, Martinez-Torres C, Roche M, 1967. Blood loss due to infection with Trichuris trichiura. Am J Trop Med Hyg 16 : 613–619.
  33. Albonico M, Stoltzfus RJ, Savioli L, Tielsch JM, Chwaya HM, Ercole E, Cancrini G, 1998. Epidemiological evidence for a differential effect of hookworm species, Ancylostoma duodenale or Necator americanus, on iron status of children. Int J Epidemiol 27 : 530–537.
  34. Ramdath DD, Simeon DT, Wong MS, Grantham-McGregor SM, 1995. Iron status of schoolchildren with varying intensities of Trichuris trichiura infection. Parasitology 110 : 347–351.
  35. Means RT Jr, 2000. The anaemia of infection. Baillieres Best Pract Res Clin Haematol 13 : 151–162.
  36. Robinson A, Lewert RM, 1980. The production and nature of anemia in Schistosoma japonicum infections. Am J Trop Med Hyg 29 : 1301–1306.
  37. Crompton DW, Nesheim MC, 2002. Nutritional impact of intestinal helminthiasis during the human life cycle. Annu Rev Nutr 22 : 35–59.
  38. Stephenson LS, Latham MC, Adams EJ, Kinoti SN, Pertet A, 1993. Weight gain of Kenyan school children infected with hookworm, Trichuris trichiura and Ascaris lumbricoides is improved following once- or twice-yearly treatment with al-bendazole. J Nutr 123 : 656–665.
  39. Stephenson LS, Latham MC, Adams EJ, Kinoti SN, Pertet A, 1993. Physical fitness, growth and appetite of Kenyan school boys with hookworm, Trichuris trichiura and Ascaris lumbricoides infections are improved four months after a single dose of albendazole. J Nutr 123 : 1036–1046.
  40. Stoltzfus RJ, Albonico M, Chwaya HM, Tielsch JM, Schulze KJ, Savioli L, 1998. Effects of the Zanzibar school-based deworming program on iron status of children. Am J Clin Nutr 68 : 179–186.
  41. Henri S, Chevillard C, Mergani A, Paris P, Gaudart J, Camilla C, Dessein H, Montero F, Elwali NE, Saeed OK, Magzoub M, Dessein AJ, 2002. Cytokine regulation of periportal fibrosis in humans infected with Schistosoma mansoni: IFN-gamma is associated with protection against fibrosis and TNF-alpha with aggravation of disease. J Immunol 169 : 929–936.
  42. Remoue F, To Van D, Schacht AM, Picquet M, Garraud O, Vercruysse J, Ly A, Capron A, Riveau G, 2001. Gender-dependent specific immune response during chronic human Schistosomiasis haematobia. Clin Exp Immunol 124 : 62–68.
  43. Tracey KJ, Cerami A, 1992. Tumor necrosis factor in the malnutrition (cachexia) of infection and cancer. Am J Trop Med Hyg 47 : 2–7.
  44. Starnes HF Jr, Warren RS, Jeevanandam M, Gabrilove JL, Larchian W, Oettgen HF, Brennan MF, 1988. Tumor necrosis factor and the acute metabolic response to tissue injury in man. J Clin Invest 82 : 1321–1325.
  45. Plata-Salaman CR, 1996. Anorexia induced by activators of the signal transducer gp 130. Neuroreport 7 : 841–844.
  46. Heim ME, Siegmund R, Illiger HJ, Klee M, Rieche K, Berdel WE, Edler L, 1990. Tumor necrosis factor in advanced colorectal cancer: a phase II study. A trial of the phase I/II study group of the Association for Medical Oncology of the German Cancer Society. Onkologie 13 : 444–447.
  47. Arnalich F, Martinez P, Hernanz A, Gonzalez J, Plaza MA, Montiel C, Pena JM, Vazquez JJ, 1997. Altered concentrations of appetite regulators may contribute to the development and maintenance of HIV-associated wasting. Aids 11 : 1129–1134.
  48. Mantovani G, Maccio A, Lai P, Massa E, Ghiani M, Santona MC, 1998. Cytokine involvement in cancer anorexia/cachexia: role of megestrol acetate and medroxyprogesterone acetate on cytokine downregulation and improvement of clinical symptoms. Crit Rev Oncog 9 : 99–106.
  49. Darling G, Fraker DL, Jensen JC, Gorschboth CM, Norton JA, 1990. Cachectic effects of recombinant human tumor necrosis factor in rats. Cancer Res 50 : 4008–4013.
  50. Norgan NG, 2000. Long-term physiological and economic consequences of growth retardation in children and adolescents. Proc Nutr Soc 59 : 245–256.
  51. Harper DM, Johnson CA, Harper WH, Liese BS, 1995. Prenatal predictors of cesarean section due to labor arrest. Arch Gynecol Obstet 256 : 67–74.
  52. Allen LH, 2000. Anemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr 71 : 1280S–1284S.
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2005.72.527
Loading
/content/journals/10.4269/ajtmh.2005.72.527
Loading

Data & Media loading...

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

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error