Effect of anthelmintic treatment on insulin resistance: A cluster-randomized, placebo-controlled trial in Indonesia

Dicky Levenus Tahapary, Karin De Ruiter, Ivonne Martin, Eric A.T. Brienen, Lisette Van Lieshout, Christa M. Cobbaert, Pradana Soewondo, Yenny Djuardi, Aprilianto E. Wiria, Jeanine J. Houwing-Duistermaat, Erliyani Sartono, Johannes W.A. Smit, Maria Yazdanbakhsh, Taniawati Supali

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)

Abstract

Background. Emerging evidence suggests that helminth infections are associated with lower insulin resistance (IR). Current deworming programs might remove this helminth-associated protective effect. Therefore, we evaluated the anthelmintic treatment effect on changes in IR. Methods. We conducted a double-blind, household-cluster-randomized, placebo-controlled clinical trial on Flores island, Indonesia, an area endemic for soil-transmitted helminths (STHs). All subjects received 4 rounds of albendazole or matching placebo with 3-month intervals, for 3 consecutive days. The primary outcome was the change in homeostatic model assessment of IR in those aged >16 years. An intention-to-treat analysis was performed involving all subjects and ad hoc in the helminth-infected subjects. Results. We examined 797 (in 329 households) and 872 (in 353 households) subjects, who were assigned randomly into the albendazole and placebo arms, respectively. Albendazole was associated with a significant reduction in STH prevalence, total immunoglobulin E (IgE), and eosinophil count. Whereas albendazole had no effect on IR (estimated treatment effect, 0.006 [95% confidence interval, -.010 to .021]; P = .48) at the community level, it was associated with a significant increase in IR (estimated treatment effect, 0.031 [95% confidence interval, .004 to .059]; P = .04) (P value for interaction = .01) among helminth-infected subjects as detected by microscopy. Pathway analysis suggested that this might in part be due to an increased body mass index or a reduced eosinophil count. Conclusions. Anthelmintic treatment reduces STH prevalence, total IgE, and eosinophil count but has no effect on IR at the community level. In helminth-infected subjects, treatment significantly increases IR, highlighting the need for metabolic health monitoring with ongoing deworming programs. Clinical Trials Registration. ISRCTN 75636394.

Original languageEnglish
Pages (from-to)764-771
Number of pages8
JournalClinical Infectious Diseases
Volume65
Issue number5
DOIs
Publication statusPublished - 1 Jan 2017

Keywords

  • Anthelmintic
  • Deworming
  • Diabetes
  • Helminths
  • Insulin resistance

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