Serum lipids and lipoproteins in malaria - a systematic review and meta-analysis

Abstract

BackgroundSerum lipid profile changes have been observed during malaria infection. The underlying biological mechanisms remain unclear. The aim of this paper is to provide an overview on those serum lipid profile changes, and to discuss possible underlying biological mechanisms and the role of lipids in malaria pathogenesis.MethodsA systematic review and meta-analysis to determine lipid profile changes during malaria was conducted, following PRISMA guidelines. Without language restrictions, Medline/PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, Biosis Previews and the African Index Medicus were searched for studies published up to 11 July, 2013, that measured serum lipid parameters in malaria patients. Also, major trial registries were searched. Mean differences in lipid profile parameters were combined in fixed and random effects meta-analysis, with a separate analysis for different groups of controls (healthy, other febrile illnesses or very low parasitaemia). These parameters were also compared between severe malaria and uncomplicated malaria. Funnel plots were used to test for publication bias.ResultsOf 2,518 studies reviewed, 42 met the criteria for inclusion in the qualitative analysis, and of these, 15 reported the necessary data for inclusion in the meta-analysis for cholesterol; nine for high-density lipoprotein (HDL), eight for low-density lipoprotein (LDL), and nine for triglycerides, respectively. Total cholesterol, HDL and LDL concentrations were lower in malaria and other febrile diseases compared to healthy controls. The decline was more pronounced and statistically significant during malaria compared to other febrile diseases. These results were consistent across included studies. Triglycerides were raised compared to healthy controls, but not statistically significant when compared to symptomatic controls.ConclusionsThis meta-analysis suggests that the observed lipid profile changes are characteristic for malaria. Although a definite link with the pathogenesis of malaria cannot yet be demonstrated, plausible hypotheses of biological mechanisms involving host lipid alterations and the pathogenesis of malaria exist. An increased research effort to elucidate the precise pathways is warranted, since this could lead to better understanding of malaria pathophysiology and consequently to novel treatment approaches.

Altered total cholesterol and triglyceride levels during the course of Plasmodium falciparum infection in children

“…The decline of TC and the raise of TG observed have been shown to be more pronounced during malaria episode (Visser et al, 2013). In agreement with previous reports, these modifications that are accentuated during the parasitaemic phase of the disease are transient and present in both complicated and uncomplicated malaria compared to other febrile diseases (Batista et al, 1996;Badiaga et al, 2002).…”

“…One hypothesis is that these TG are derived from the phospholipids released by the red blood cell membrane following hemolysis. Although this way has never been investigated, hypertriglyceridemia is described in diseases with haemophagocytosis (Visser et al, 2013). During malaria, oxidative derivate production is one of the host mechanisms of defense against the parasite.…”

“…Although the mechanisms involved are not fully understood, some hypotheses have been raised from in vivo and in vitro studies (Cuisinier et al, 1990;Visser et al, 2013). Some fatty acids are produced and required for the parasites biosynthetic pathways.…”

Malaria parasitemia and its association with lipid and hematological parameters among malaria-infected patients attending at Metema Hospital, Northwest Ethiopia

“…They further noted that oxidized LDL from malarial patients increased the endothelial expression of adhesion molecules that increased the risk of cardiovascular disease. 47 Finally, although these changes in lipid and hematologic parameters in association with malaria infection are not novel, our findings have added more information, yet there is limited knowledge and few reports on alterations of blood parameters of malaria-infected individuals in Metema Hospital.…”

“…The decline was more pronounced and statistically significant during malaria compared to other febrile diseases but TG levels were found to be raised compared to healthy controls. 47 This might be due to possible hypothesis of biological mechanisms involving host lipid alterations and the pathogenesis of malaria. The other hypothesis is that TG is derived from the phospholipids of RBC membrane following hemolysis and hypertriglyceridemia is described in disease with hemophagocytosis although not investigated.…”