Effect of Anthelmintic Treatment on Insulin Resistance: A Cluster-Randomized, Placebo-Controlled Trial in Indonesia

Tahapary, Dicky L.; Ruiter, Karin de; Martin, Ivonne; Brienen, Eric A. T.; Lieshout, Lisette van; Cobbaert, Christa; Soewondo, Pradana; Djuardi, Yenny; Wiria, Aprilianto E.; Houwing-Duistermaat, Jeanine J.; Sartono, Erliyani; Smit, Johannes W. A.; Yazdanbakhsh, Maria; Supali, Taniawati

doi:10.1093/cid/cix416

Cited by 42 publications

(76 citation statements)

References 29 publications

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“…However, in the present study the baseline prevalence of helminth infections was much lower at 19.6% compared to the 41.7% reported in adults [26]. This indicates that biannual MDA might be sufficient in areas where there is a low prevalence of helminth infections.…”

Section: Discussioncontrasting

confidence: 78%

“…The finding that the level of CRP, a marker of inflammation, decreased after albendazole treatment is in contrast with our previously reported study conducted in adults (age ≥ 16 years) in the same area, which showed that albendazole treatment had no effect on high-sensitivity CRP levels [26]. Similarly, a study in Tanzanian school children infected with hookworm or Schistosoma haematobium reported that albendazole or praziquantel treatment had no effect on CRP levels [31].…”

Section: Discussioncontrasting

confidence: 57%

“…The substantial decrease in the prevalence of helminth infections in our study, due to a biannual single-dose albendazole MDA program, is rather surprising given that an earlier study [26] in adults in the same area showed that 3 consecutive doses of albendazole at 3 monthly intervals are needed to achieve an 86.6% reduction in helminth prevalence. However, in the present study the baseline prevalence of helminth infections was much lower at 19.6% compared to the 41.7% reported in adults [26].…”

Section: Discussioncontrasting

confidence: 55%

“…Likewise, a school-based cluster-randomized study in Ecuador observed a strong association between total IgE and STH infection but not with age, nutritional, or socioeconomic status, suggesting that STH infection is an important determinant of total IgE [30]. With respect to the number of STH infections, Tahapary et al [26] observed that the effect of albendazole treatment on total IgE levels and eosinophil counts was more pronounced in subjects with multiple helminth infections compared to single or no infection. However, this was not observed in the current study, probably due to the lower STH prevalence and the small sample size.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of Atopy following Mass Drug Administration with Albendazole: A Study in School Children on Flores Island, Indonesia

Staal

Hogendoorn

Voets

et al. 2018

Int Arch Allergy Immunol

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Background: In many rural areas of tropical countries such as Indonesia, the prevalence of soil-transmitted helminths (STH) infections remains high. At the same time, the burden of allergic disorders in such rural areas is reported to be low and inversely associated with helminth infections. To reduce the morbidity and transmission of helminth infections, the world health organization recommends preventive treatment of school children by providing mass drug administration (MDA) with albendazole. Here, we had an opportunity to evaluate the prevalence of skin reactivity to allergens before and after albendazole treatment to get an indication of the possible impact of MDA on allergic sensitization. Methods: A study was conducted among 150 school children living in an area endemic for STH infections. Before and 1 year after anthelminthic treatment with albendazole, stool samples were examined for the presence of STH eggs, skin prick tests (SPT) for cockroach and house dust mites were performed, blood eosinophilia was assessed, and total immunoglobulin E (IgE) and C-reactive protein (CRP) were measured in plasma. Results: Anthelminthic treatment significantly reduced the prevalence of STH from 19.6 before treatment to 6% after treatment (p < 0.001). Levels of total IgE (estimate: 0.30; 95% CI 0.22–0.42, p < 0.0001), CRP (estimate: 0.60; 95% CI 0.42–0.86, p = 0.006), and eosinophil counts (estimate: 0.70; 95% CI 0.61–0.80, p < 0.001) decreased significantly. The prevalence of SPT positivity increased from 18.7 to 32.7%. Multivariate analysis adjusted for confounding factors showed an increased risk of being SPT positive to any allergen (OR 3.04; 95% CI 1.338–6.919, p = 0.008). Conclusions: This study indicates that 1 year of MDA with albendazole was associated with a reduced prevalence of STH infections. This study shows that the prevalence of allergic sensitization increases after 1 year of albendazole treatment. Placebo-controlled and larger studies are needed to further substantiate a role of deworming treatment in an increased risk of allergic sensitization.

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Section: Discussioncontrasting

confidence: 78%

Section: Discussioncontrasting

confidence: 57%

Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

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Prevalence of Atopy following Mass Drug Administration with Albendazole: A Study in School Children on Flores Island, Indonesia

Staal

Hogendoorn

Voets

et al. 2018

Int Arch Allergy Immunol

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“…More importantly, they could show a significant deterioration of these parameters after anthelmintic therapies . Two others studies in Indonesia and Uganda demonstrated similar outcomes after treatment against STHs and S. mansoni, respectively . Finally, a cross‐sectional analyses of several studies linking helminth infection and metabolic syndrome confirmed the trend towards a decreased prevalence of metabolic syndrome in people with past or present helminth infection .…”

Section: Helminth Infection and Metabolic Statusmentioning

confidence: 99%

The interplay of type 2 immunity, helminth infection and the microbiota in regulating metabolism

2019

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Type 2 immunity has recently emerged as a critical player in metabolic status, with numerous studies investigating the role of type 2 immune cells within adipose tissue. Metabolic dysfunction is often characterised as a low‐grade or chronic inflammatory state within tissues, and type 2 immunity may facilitate a return to metabolic homeostasis. A complex network of type 2 resident cells including M2 macrophages, eosinophils and ILC2s has been identified within adipose tissue. Although the effector cells in this equilibrium have not been clearly identified, any alteration of the type 2 microenvironment resulted in an altered metabolic state. Historically, the type 2 immune response has been associated with helminth infection. The type 2 immune response drives host resistance and plays an important role in promoting tissue repair following the migration of helminth larvae through tissues. Although helminths are largely eradicated in developed countries, infection rates remain high in poor communities within the developing world. Interestingly, there is strong evidence that helminth infection is inversely correlated with autoimmune or inflammatory disorders. Recently, an increasing amount of epidemiological and field studies suggest that it could be the same for obesity and metabolic syndrome. In the current review, we summarise the literature linking type 2 immunity to improved adipose tissue function. We then discuss more recent evidence indicating that helminth infection can provide protection against metabolic syndrome. Lastly, we explore the possible contributions of altered nutrient uptake, adipose tissue function and/or the intestinal microbiota with the ability of helminths to alter metabolic status.

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Public health deworming programmes for soil-transmitted helminths in children living in endemic areas

Taylor-Robinson

Maayan

Donegan

et al. 2019

Cochrane Database of Systematic Reviews

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Background The World Health Organization (WHO) recommends treating all school children at regular intervals with deworming drugs in areas where helminth infection is common. Global advocacy organizations claim routine deworming has substantive health and societal effects beyond the removal of worms. In this update of the 2015 edition we included six new trials, additional data from included trials, and addressed comments and criticisms. Objectives To summarize the effects of public health programmes to regularly treat all children with deworming drugs on child growth, haemoglobin, cognition, school attendance, school performance, physical fitness, and mortality. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; LILACS; the meta Register of Controlled Trials ( m RCT); reference lists; and registers of ongoing and completed trials up to 19 September 2018. Selection criteria We included randomized controlled trials (RCTs) and quasi‐RCTs that compared deworming drugs for soil‐transmitted helminths (STHs) with placebo or no treatment in children aged 16 years or less, reporting on weight, height, haemoglobin, and formal tests of cognition. We also sought data on other measures of growth, school attendance, school performance, physical fitness, and mortality. Data collection and analysis At least two review authors independently assessed the trials for inclusion, risk of bias, and extracted data. We analysed continuous data using the mean difference (MD) with 95% confidence intervals (CIs). Where data were missing, we contacted trial authors. We stratified the analysis based on the background burden of STH infection. We used outcomes at time of longest follow‐up. We assessed the certainty of the evidence using the GRADE approach. Main results We identified 51 trials, including 10 cluster‐RCTs, that met the inclusion criteria. One trial evaluating mortality included over one million children, and the remaining 50 trials included a total of 84,336 participants. Twenty‐four trials were in populations categorized as high burden, including nine trials in children selected because they were helminth‐stool positive; 18 with intermediate burden; and nine as low burden. First or single dose of deworming drugs Fourteen trials reported on weight after a single dose of deworming drugs (4970 participants, 14 RCTs). The effects were variable. There was little or no effect in studies conducted in low and intermediate worm burden groups. In the high‐burden group, there was little or no effect in most studies, except for a large effect detected from one study area in Kenya reported in two trials carried out over 30 years ago. These trials result in qualitative hete...

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Effect of Anthelmintic Treatment on Insulin Resistance: A Cluster-Randomized, Placebo-Controlled Trial in Indonesia

Abstract: ISRCTN 75636394.

Cited by 42 publications

References 29 publications

Prevalence of Atopy following Mass Drug Administration with Albendazole: A Study in School Children on Flores Island, Indonesia

Prevalence of Atopy following Mass Drug Administration with Albendazole: A Study in School Children on Flores Island, Indonesia

The interplay of type 2 immunity, helminth infection and the microbiota in regulating metabolism

Public health deworming programmes for soil-transmitted helminths in children living in endemic areas

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