title: Infection with Soil-Transmitted Helminths Is Associated with Increased Insulin Sensitivity.
abstract: OBJECTIVE
  Given that helminth infections have been shown to improve insulin sensitivity in animal studies, which may be explained by beneficial effects on energy balance or by a shift in the immune system to an anti-inflammatory profile, we investigated whether soil-transmitted helminth (STH)-infected subjects are more insulin sensitive than STH-uninfected subjects.
  
  
  METHODS
  We performed a cross-sectional study on Flores island, Indonesia, an area with high prevalence of STH infections.
  
  
  METHODS
  From 646 adults, stool samples were screened for Trichuris trichiura by microscopy and for Ascaris lumbricoides, Necator americanus, Ancylostoma duodenale, and Strongyloides stercoralis by qPCR. No other helminth was found. We collected data on body mass index (BMI, kg/m2), waist-to-hip ratio (WHR), fasting blood glucose (FBG, mmol/L), insulin (pmol/L), high sensitive C-reactive protein (ng/ml) and Immunoglobulin E (IU/ml). The homeostatic model assessment for insulin resistance (HOMAIR) was calculated and regression models were used to assess the association between STH infection status and insulin resistance.
  
  
  RESULTS
  424 (66%) participants had at least one STH infection. STH infected participants had lower BMI (23.2 vs 22.5 kg/m2, p value = 0.03) and lower HOMAIR (0.97 vs 0.81, p value = 0.05). In an age-, sex- and BMI-adjusted model a significant association was seen between the number of infections and HOMAIR: for every additional infection with STH species, the HOMAIR decreased by 0.10 (p for linear trend 0.01). This effect was mainly accounted for by a decrease in insulin of 4.9 pmol/L for every infection (p for trend = 0.07).
  
  
  CONCLUSIONS
  STH infections are associated with a modest improvement of insulin sensitivity, which is not accounted for by STH effects on BMI alone.
authors.affiliation: Department of Parasitology, Faculty of Medicine, Universitas Indonesia, 10430, Jakarta, Indonesia; Department of Parasitology, Leiden University Medical Center, 2333ZA, Leiden, The Netherlands.
authors.forename: Aprilianto E
authors.initials: AE
authors.lastname: Wiria
authors.affiliation: Department of Parasitology, Faculty of Medicine, Universitas Indonesia, 10430, Jakarta, Indonesia; Department of Microbiology, Faculty of Medicine, Hasanuddin University, 90245, Makassar, Indonesia.
authors.forename: Firdaus
authors.initials: F
authors.lastname: Hamid
authors.affiliation: Department of Parasitology, Faculty of Medicine, Universitas Indonesia, 10430, Jakarta, Indonesia; Department of Parasitology, Leiden University Medical Center, 2333ZA, Leiden, The Netherlands.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Wammes
authors.affiliation: Department of Parasitology, Faculty of Medicine, Universitas Indonesia, 10430, Jakarta, Indonesia; Department of Parasitology, Leiden University Medical Center, 2333ZA, Leiden, The Netherlands.
authors.forename: Margaretta A
authors.initials: MA
authors.lastname: Prasetyani
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center, 2333ZA, Leiden, The Netherlands; Department of Endocrinology & General Internal Medicine, Leiden University Medical Center, 2333ZA, Leiden, The Netherlands.
authors.forename: Olaf M
authors.initials: OM
authors.lastname: Dekkers
authors.affiliation: Department of Parasitology, Leiden University Medical Center, 2333ZA, Leiden, The Netherlands.
authors.forename: Linda
authors.initials: L
authors.lastname: May
authors.affiliation: Department of Parasitology, Faculty of Medicine, Universitas Indonesia, 10430, Jakarta, Indonesia; Department of Parasitology, Leiden University Medical Center, 2333ZA, Leiden, The Netherlands.
authors.forename: Maria M M
authors.initials: MM
authors.lastname: Kaisar
authors.affiliation: Department of Parasitology, Leiden University Medical Center, 2333ZA, Leiden, The Netherlands; Laboratory for Medical Microbiology and Immunology, St. Elisabeth Hospital, 5022GC, Tilburg, The Netherlands.
authors.forename: Jaco J
authors.initials: JJ
authors.lastname: Verweij
authors.affiliation: Department of Parasitology, Leiden University Medical Center, 2333ZA, Leiden, The Netherlands; Department of Molecular Cell Biology, Leiden University Medical Center, 2333ZA, Leiden, The Netherlands.
authors.forename: Bruno
authors.initials: B
authors.lastname: Guigas
authors.affiliation: Department of Parasitology, Faculty of Medicine, Universitas Indonesia, 10430, Jakarta, Indonesia.
authors.forename: Felix
authors.initials: F
authors.lastname: Partono
authors.affiliation: Department of Parasitology, Leiden University Medical Center, 2333ZA, Leiden, The Netherlands.
authors.forename: Erliyani
authors.initials: E
authors.lastname: Sartono
authors.affiliation: Department of Parasitology, Faculty of Medicine, Universitas Indonesia, 10430, Jakarta, Indonesia.
authors.forename: Taniawati
authors.initials: T
authors.lastname: Supali
authors.affiliation: Department of Parasitology, Leiden University Medical Center, 2333ZA, Leiden, The Netherlands.
authors.forename: Maria
authors.initials: M
authors.lastname: Yazdanbakhsh
authors.affiliation: Department of Endocrinology & General Internal Medicine, Leiden University Medical Center, 2333ZA, Leiden, The Netherlands; Department of General Internal Medicine, Radboud University Medical Center, 6525GA, Nijmegen, The Netherlands.
authors.forename: Johannes W A
authors.initials: JW
authors.lastname: Smit
mesh_terms: D000328:Adult; D000722:Ancylostoma; D000818:Animals; D017164:Ascaris lumbricoides; D003430:Cross-Sectional Studies; D005260:Female; D006373:Helminthiasis / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D007214:Indonesia; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D017221:Necator americanus; D015995:Prevalence; D012987:Soil / Q000469:parasitology*; D017171:Strongyloides stercoralis; D014258:Trichuris
chemical_list: D012987:Soil