Relationship between carotid intima media thickness and helminth infections on Flores Island, Indonesia.
OBJECTIVE
To examine the association between helminth infections and atherosclerosis.


BACKGROUND
Chronic helminth infection, which can lead to poor nutritional status and anti-inflammatory response, might protect against the development of atherosclerosis.


METHODS
A cross-sectional study was performed in Flores, Indonesia, an area highly endemic for soil-transmitted helminths (STH). Stool samples from 675 participants aged 18-80 years were collected and screened for Trichuris trichiura by microscopy and for Ascaris lumbricoides, Necator americanus, Ancylostoma duodenale, and Strongyloides stercoralis by qPCR. We collected data on body mass index (BMI), waist to hip ratio (WHR), blood pressure, fasting blood glucose (FBG), lipid, high sensitive C-reactive protein (hs-CRP), total immunoglobulin-E (TIgE) and Escherichia coli lipopolysaccharide stimulated cytokines (tumor necrosis factor and interleukin-10). In a subset of 301 elderly adults (≥40 years of age) carotid intima media thickness (cIMT) was measured.


RESULTS
Participants with any STH infection had lower BMI (kg/m2) (mean difference -0.66, 95%CI [-1.26, -0.06]), WHR (-0.01, [-0.02, -0.00]), total cholesterol (mmol/L) (-0.22, [-0.43, -0.01]) and LDL-cholesterol (mmol/L) (-0.20, [-0.39, -0.00]) than uninfected participants. After additional adjustment for BMI the association between helminth infection and total cholesterol (mean difference -0.17, 95%CI [-0.37, 0.03]) as well as LDL-cholesterol (-0.15, [-0.33, 0.04]) was less pronounced. BMI, WHR, and total cholesterol were negatively associated with number species of helminth co-infections. Participants with high TIgE, an indicator of exposure to helminths, had lower FBG, TC, and HDL. The association between TIgE and TC and HDL remained significant after adjustment with BMI. No clear association was found between STH infection or TIgE and mean cIMT.


CONCLUSIONS
This cross-sectional study presents evidence that helminth infections were negatively associated with risk factors for cardiovascular disease, an association at least partially mediated by an effect on BMI. The significance of this finding needs to be determined.
Department of Parasitology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia. a.e.wiria@lumc.nl
Aprilianto Eddy
AE
Wiria
Linda J
LJ
Wammes
Firdaus
F
Hamid
Olaf M
OM
Dekkers
Margaretta A
MA
Prasetyani
Linda
L
May
Maria M M
MM
Kaisar
Jaco J
JJ
Verweij
Jouke T
JT
Tamsma
Felix
F
Partono
Erliyani
E
Sartono
Taniawati
T
Supali
Maria
M
Yazdanbakhsh
Johannes W A
JW
Smit
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D050197:Atherosclerosis / Q000097:blood / Q000469:parasitology / Q000473:pathology*; D001823:Body Composition; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D017536:Carotid Artery, Common / Q000378:metabolism / Q000473:pathology*; D059168:Carotid Intima-Media Thickness; D008078:Cholesterol, LDL / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006373:Helminthiasis / Q000097:blood / Q000469:parasitology / Q000473:pathology*; D006376:Helminths / Q000502:physiology; D006801:Humans; D007214:Indonesia; D016753:Interleukin-10 / Q000097:blood; D062312:Islands; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
D008078:Cholesterol, LDL; C508609:IL10 protein, human; D014280:Triglycerides; D016753:Interleukin-10; D002097:C-Reactive Protein