In Ivorian school-age children, infection with hookworm does not reduce dietary iron absorption or systemic iron utilization, whereas afebrile Plasmodium falciparum infection reduces iron absorption by half.
BACKGROUND
In sub-Saharan Africa, parasitic diseases and low bioavailable iron intake are major causes of anemia. Anemia results from inflammation, preventing iron recycling and decreasing dietary iron absorption. Hookworm, Plasmodium, and Schistosoma infections contribute to anemia, but their influence on dietary iron absorption and recycling is unknown.


OBJECTIVE
The objective was to measure inflammation biomarkers, hepcidin, iron absorption, and utilization pre- and posttreatment in children with afebrile malaria, hookworm, and Schistosoma haematobium infection.


METHODS
Ivorian children aged 11-17 y with afebrile Plasmodium falciparum (n = 17), hookworm (n = 16), or S. haematobium infection (n = 8) consumed a syrup containing 3 mg ⁵⁷Fe as ferrous sulfate and received an intravenous infusion of 50 μg ⁵⁸Fe as ferrous citrate. Children were treated for their respective infection, and the iron studies were repeated 4 wk later. Iron and inflammation biomarkers and hepcidin were measured.


RESULTS
Geometric mean iron absorptions in the afebrile malaria and hookworm groups were 12.9% and 32.2% (P < 0.001) before treatment and 23.6% and 30.0% (P = 0.113) after treatment, respectively. Treatment of afebrile malaria reduced inflammation (P < 0.001) and serum hepcidin (P = 0.004) and improved iron absorption (P = 0.003). Treatment of hookworm infection neither affected inflammation biomarkers nor altered iron absorption. Similarly, there was a lack of treatment effects in the S. haematobium-infected group; however, the small sample size limits conclusions. Geometric mean iron utilization ranged between 79.1% and 88.0% in the afebrile malaria and hookworm groups with no significant differences pre- and posttreatment.


CONCLUSIONS
In school-age children, hookworm infection does not produce inflammation or increase serum hepcidin, and it does not influence iron absorption or utilization. In contrast, afebrile malaria causes inflammation, increases hepcidin, and reduces iron absorption but not utilization. These findings provide insights into the iron metabolism and the etiology of anemia in parasitic infections.
From the Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland (DG, RFH, CZ, MBZ, and RW); the Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, and University of Basel, Basel, Switzerland (AAR and JU); Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire (LGA); the Department of Laboratory Medicine (Hepcidinanalysis.com), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (HT); and Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, and Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire (EKN).
Dominik
D
Glinz
From the Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland (DG, RFH, CZ, MBZ, and RW); the Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, and University of Basel, Basel, Switzerland (AAR and JU); Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire (LGA); the Department of Laboratory Medicine (Hepcidinanalysis.com), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (HT); and Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, and Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire (EKN).
Richard F
RF
Hurrell
From the Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland (DG, RFH, CZ, MBZ, and RW); the Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, and University of Basel, Basel, Switzerland (AAR and JU); Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire (LGA); the Department of Laboratory Medicine (Hepcidinanalysis.com), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (HT); and Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, and Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire (EKN).
Aurélie A
AA
Righetti
From the Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland (DG, RFH, CZ, MBZ, and RW); the Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, and University of Basel, Basel, Switzerland (AAR and JU); Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire (LGA); the Department of Laboratory Medicine (Hepcidinanalysis.com), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (HT); and Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, and Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire (EKN).
Christophe
C
Zeder
From the Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland (DG, RFH, CZ, MBZ, and RW); the Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, and University of Basel, Basel, Switzerland (AAR and JU); Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire (LGA); the Department of Laboratory Medicine (Hepcidinanalysis.com), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (HT); and Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, and Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire (EKN).
Lukas G
LG
Adiossan
From the Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland (DG, RFH, CZ, MBZ, and RW); the Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, and University of Basel, Basel, Switzerland (AAR and JU); Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire (LGA); the Department of Laboratory Medicine (Hepcidinanalysis.com), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (HT); and Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, and Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire (EKN).
Harold
H
Tjalsma
From the Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland (DG, RFH, CZ, MBZ, and RW); the Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, and University of Basel, Basel, Switzerland (AAR and JU); Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire (LGA); the Department of Laboratory Medicine (Hepcidinanalysis.com), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (HT); and Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, and Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire (EKN).
Jürg
J
Utzinger
From the Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland (DG, RFH, CZ, MBZ, and RW); the Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, and University of Basel, Basel, Switzerland (AAR and JU); Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire (LGA); the Department of Laboratory Medicine (Hepcidinanalysis.com), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (HT); and Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, and Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire (EKN).
Michael B
MB
Zimmermann
From the Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland (DG, RFH, CZ, MBZ, and RW); the Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, and University of Basel, Basel, Switzerland (AAR and JU); Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire (LGA); the Department of Laboratory Medicine (Hepcidinanalysis.com), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (HT); and Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, and Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire (EKN).
Eliézer K
EK
N'Goran
From the Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland (DG, RFH, CZ, MBZ, and RW); the Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, and University of Basel, Basel, Switzerland (AAR and JU); Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire (LGA); the Department of Laboratory Medicine (Hepcidinanalysis.com), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (HT); and Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, and Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire (EKN).
Rita
R
Wegmüller
D000293:Adolescent; D018798:Anemia, Iron-Deficiency / Q000209:etiology* / Q000517:prevention & control; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002648:Child; D015331:Cohort Studies; D007560:Cote d'Ivoire; D015536:Down-Regulation / Q000187:drug effects; D005260:Female; D064451:Hepcidins / Q000097:blood; D006725:Hookworm Infections / Q000188:drug therapy / Q000276:immunology / Q000378:metabolism* / Q000503:physiopathology; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007408:Intestinal Absorption / Q000187:drug effects; D007413:Intestinal Mucosa / Q000187:drug effects / Q000276:immunology / Q000378:metabolism* / Q000469:parasitology; D007503:Iron Isotopes; D019266:Iron, Dietary / Q000378:metabolism*; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000276:immunology / Q000378:metabolism* / Q000503:physiopathology; D008297:Male; D012553:Schistosomiasis haematobia / Q000188:drug therapy / Q000276:immunology / Q000378:metabolism / Q000503:physiopathology
D000871:Anthelmintics; D000962:Antimalarials; D015415:Biomarkers; C578702:HAMP protein, human; D064451:Hepcidins; D018836:Inflammation Mediators; D007503:Iron Isotopes; D019266:Iron, Dietary
Côte d’Ivoire; Schistosoma haematobium; absorption; afebrile Plasmodium; anemia; hepcidin; hookworm; inflammation; iron; stable isotopes