Helminth infections and micronutrients in school-age children: a systematic review and meta-analysis

Brechje de Gier, Maiza Campos Ponce, Margot van de Bor, Colleen M Doak, Katja Polman

    Research output: Contribution to journalA1: Web of Science-articlepeer-review


    BACKGROUND: 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.

    OBJECTIVE: We aimed to systematically review current evidence on the relation of helminth infections with micronutrient status in school-age children worldwide.

    DESIGN: 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.

    RESULTS: 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).

    CONCLUSIONS: 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.

    Original languageEnglish
    JournalAmerican Journal of Clinical Nutrition
    Issue number6
    Pages (from-to)1499-1509
    Number of pages11
    Publication statusPublished - 2014


    • Adolescent
    • Adolescent Nutritional Physiological Phenomena
    • Child
    • Child Nutritional Physiological Phenomena
    • Child, Preschool
    • Female
    • Helminthiasis
    • Humans
    • Male
    • Micronutrients
    • Nutritional Status
    • Observational Studies as Topic
    • Prevalence
    • Randomized Controlled Trials as Topic
    • Recurrence
    • Risk Factors
    • Journal Article
    • Meta-Analysis
    • Review


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