de Gier Brechje, Campos Ponce Maiza, van de Bor Margot, Doak Colleen M, Polman Katja
From the Department of Health Sciences (MCP, CMD, and KP) and Section of Health and Life Sciences (BdG and MvdB), VU University Amsterdam, Amsterdam, Netherlands, and the Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium (KP).
Am J Clin Nutr. 2014 Jun;99(6):1499-509. doi: 10.3945/ajcn.113.069955. Epub 2014 Apr 16.
Helminth infections and micronutrient deficiencies are highly prevalent in developing countries. Neither condition typically causes overt disease, but they do lead to indirect morbidity such as impaired physical and cognitive development.
We aimed to systematically review current evidence on the relation of helminth infections with micronutrient status in school-age children worldwide.
We included both observational studies and randomized controlled trials (RCTs). We applied a random-effects meta-analysis to estimate 1) cross-sectional associations between helminths and micronutrient status, 2) effects of anthelminthic treatment on micronutrient status, and 3) effects of micronutrient supplementation on helminth infection and reinfection.
Meta-analyses of observational studies showed an association between helminth infections and serum retinol [standardized mean difference (SMD): -0.30; 95% CI: -0.48, -0.13] but not serum ferritin (SMD: 0.00; 95% CI: -0.7, 0.7). Conversely, meta-analyses of anthelminthic treatment RCTs showed a positive effect on ferritin (SMD: 0.16; 95% CI: 0.09, 0.22) but not retinol (SMD: 0.04; 95% CI: -0.06, 0.14). The number of studies on micronutrients other than ferritin and retinol was not sufficient for pooling. Meta-analyses of micronutrient-supplementation RCTs showed only a modest protective effect for multimicronutrient interventions on helminth infection and reinfection rates (OR: 0.77; 95% CI: 0.61, 0.97).
In this review, we show evidence of distinct associations between helminth infections and micronutrients in school-age children. More studies are needed on micronutrients other than iron and vitamin A and on possible helminth species-specific effects. A thorough comprehension of the interplay between helminth infections and micronutrients will help guide integrated and sustainable intervention strategies in affected children worldwide.
蠕虫感染和微量营养素缺乏在发展中国家极为普遍。这两种情况通常都不会引发明显疾病，但它们确实会导致间接发病，如身体和认知发育受损。
我们旨在系统回顾全球学龄儿童中蠕虫感染与微量营养素状况之间关系的现有证据。
我们纳入了观察性研究和随机对照试验（RCT）。我们应用随机效应荟萃分析来估计：1）蠕虫与微量营养素状况之间的横断面关联；2）驱虫治疗对微量营养素状况的影响；3）微量营养素补充对蠕虫感染和再感染的影响。
观察性研究的荟萃分析显示蠕虫感染与血清视黄醇之间存在关联[标准化均数差（SMD）：-0.30；95%置信区间：-0.48，-0.13]，但与血清铁蛋白无关（SMD：0.00；95%置信区间：-0.7，0.7）。相反，驱虫治疗RCT的荟萃分析显示对铁蛋白有积极影响（SMD：0.16；95%置信区间：0.09，0.22），但对视黄醇没有影响（SMD：0.04；95%置信区间：-0.06，0.14）。关于铁蛋白和视黄醇以外的微量营养素的研究数量不足以进行汇总。微量营养素补充RCT的荟萃分析显示，多种微量营养素干预措施对蠕虫感染和再感染率仅具有适度的保护作用（比值比：0.77；95%置信区间：0.61，0.97）。
在本综述中，我们展示了学龄儿童中蠕虫感染与微量营养素之间存在明显关联的证据。需要对铁和维生素A以外的微量营养素以及可能的蠕虫物种特异性影响进行更多研究。全面理解蠕虫感染与微量营养素之间的相互作用将有助于指导全球受影响儿童的综合和可持续干预策略。
