Cognitive Performance and Iron Status are Negatively Associated with Hookworm Infection in Cambodian Schoolchildren

Khov Kuong Department of Fisheries Post-Harvest Technologies and Quality Control, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, Cambodia.
Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.

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Marion Fiorentino Institut de Recherche pour le Développement, Montpellier, France.

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Marlene Perignon Institut de Recherche pour le Développement, Montpellier, France.

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Chhoun Chamnan Department of Fisheries Post-Harvest Technologies and Quality Control, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, Cambodia.

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Jacques Berger Institut de Recherche pour le Développement, Montpellier, France.

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Muth Sinuon National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia.

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Vann Molyden National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia.

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Kurt Burja United Nations World Food Program, Phnom Penh, Cambodia.

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Megan Parker PATH, Seattle, Washington.

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Sou Chheng Ly Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.

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Henrik Friis Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.

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Nanna Roos Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.

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Frank T. Wieringa Institut de Recherche pour le Développement, Montpellier, France.

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Soil-transmitted helminth (STH) infection has been associated with lower cognitive performance of schoolchildren. To identify pathways through which STH infection might affect school performance, baseline data from a large rice-fortification trial in Cambodian schoolchildren were used to investigate associations between STH infection, micronutrient status, anemia, and cognitive performance. Complete data on anthropometry, cognitive performance, and micronutrient status were available for 1,760 schoolchildren, 6–16 years of age. STH infection was identified using Kato–Katz, whereas cognitive performance was assessed using Raven's Colored Progressive Matrices (RCPM), block design, and picture completion. STH infection was found in 18% of the children; almost exclusively hookwork infection. After adjusting for age and gender, raw cognitive test scores were significantly lower in hookworm-infected children (−0.65; −0.78; −2.03 points for picture completion, RCPM, and block design, respectively; P < 0.05 for all). Hookworm infection was associated with iron status (total body iron), but not with vitamin A and zinc status, nor with inflammation or anthropometry. Body iron was negatively associated with increased intensity of hookworm infection (R = 0.22, P < 0.001). Hookworm infection in Cambodian schoolchildren was associated with lower cognitive performance, an effect most likely mediated through lower body iron. Interventions that are more effective against hookworm infection are needed to contribute to better health and improvement of cognitive performance.

Author Notes

* Address correspondence to Khov Kuong, Department of Fisheries Post-Harvest Technologies and Quality Control, Ministry of Agriculture, Forestry and Fisheries, No. 186, Preah Norodom Boulevard, Phnom Penh 12301, Cambodia. E-mail: kuong.kh@gmail.com

Financial support: FORISCA study was funded by the U.S. Department of Agriculture (USDA) in collaboration with the World Food Program (WFP), IRD, and DSM consortium.

Authors' addresses: Khov Kuong and Chhoun Chamnan, Department of Fisheries Post-Harvest Technologies and Quality Control, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, Cambodia, E-mails: kuong.kh@gmail.com and chhounchamnan@gmail.com. Marion Fiorentino, Marlene Perignon, Jacques Berger, and Frank T. Wieringa, Institut de Recherche pour le Développement, Montpellier, France, E-mails: marionfiorentino@hotmail.com, perignonmarlene@gmail.com, jacques.berger@ird.fr, and franck.wieringa@ird.fr. Muth Sinuon and Vann Molyden, National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia, E-mails: sinuonm@gmail.com and vannmolyden@gmail.com. Kurt Burja, United Nations World Food Program, Phnom Penh, Cambodia, E-mail: kurt.burja@wfp.org. Megan Parker, PATH, Seattle, WA, E-mail: mparker@path.org. Sou Chheng Ly, Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands, E-mail: souchheng.ly@gmail.com. Henrik Friis and Nanna Roos, Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark, E-mail: hfr@nexs.ku.dk and nro@nexs.ku.dk.

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