PRO-INFLAMMATORY CYTOKINES AND C-REACTIVE PROTEIN ARE ASSOCIATED WITH UNDERNUTRITION IN THE CONTEXT OF SCHISTOSOMA JAPONICUM INFECTION

HANNAH M. COUTINHO Center for International Health Research (CIHR), Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; CIHR and Department of Pediatrics, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; Research Institute of Tropical Medicine, Manila, the Philippines; Center for Statistical Sciences, Brown University, Providence, Rhode Island; Epidemiology Section, Department of Community Health and International Health Institute, Brown University, Providence, Rhode Island; CIHR and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island

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TJALLING LEENSTRA Center for International Health Research (CIHR), Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; CIHR and Department of Pediatrics, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; Research Institute of Tropical Medicine, Manila, the Philippines; Center for Statistical Sciences, Brown University, Providence, Rhode Island; Epidemiology Section, Department of Community Health and International Health Institute, Brown University, Providence, Rhode Island; CIHR and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island

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LUZ P. ACOSTA Center for International Health Research (CIHR), Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; CIHR and Department of Pediatrics, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; Research Institute of Tropical Medicine, Manila, the Philippines; Center for Statistical Sciences, Brown University, Providence, Rhode Island; Epidemiology Section, Department of Community Health and International Health Institute, Brown University, Providence, Rhode Island; CIHR and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island

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LI SU Center for International Health Research (CIHR), Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; CIHR and Department of Pediatrics, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; Research Institute of Tropical Medicine, Manila, the Philippines; Center for Statistical Sciences, Brown University, Providence, Rhode Island; Epidemiology Section, Department of Community Health and International Health Institute, Brown University, Providence, Rhode Island; CIHR and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island

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BLANCA JARILLA Center for International Health Research (CIHR), Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; CIHR and Department of Pediatrics, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; Research Institute of Tropical Medicine, Manila, the Philippines; Center for Statistical Sciences, Brown University, Providence, Rhode Island; Epidemiology Section, Department of Community Health and International Health Institute, Brown University, Providence, Rhode Island; CIHR and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island

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MARIO A. JIZ Center for International Health Research (CIHR), Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; CIHR and Department of Pediatrics, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; Research Institute of Tropical Medicine, Manila, the Philippines; Center for Statistical Sciences, Brown University, Providence, Rhode Island; Epidemiology Section, Department of Community Health and International Health Institute, Brown University, Providence, Rhode Island; CIHR and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island

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GRETCHEN C. LANGDON Center for International Health Research (CIHR), Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; CIHR and Department of Pediatrics, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; Research Institute of Tropical Medicine, Manila, the Philippines; Center for Statistical Sciences, Brown University, Providence, Rhode Island; Epidemiology Section, Department of Community Health and International Health Institute, Brown University, Providence, Rhode Island; CIHR and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island

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REMIGIO M. OLVEDA Center for International Health Research (CIHR), Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; CIHR and Department of Pediatrics, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; Research Institute of Tropical Medicine, Manila, the Philippines; Center for Statistical Sciences, Brown University, Providence, Rhode Island; Epidemiology Section, Department of Community Health and International Health Institute, Brown University, Providence, Rhode Island; CIHR and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island

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STEPHEN T. MCGARVEY Center for International Health Research (CIHR), Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; CIHR and Department of Pediatrics, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; Research Institute of Tropical Medicine, Manila, the Philippines; Center for Statistical Sciences, Brown University, Providence, Rhode Island; Epidemiology Section, Department of Community Health and International Health Institute, Brown University, Providence, Rhode Island; CIHR and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island

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JONATHAN D. KURTIS Center for International Health Research (CIHR), Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; CIHR and Department of Pediatrics, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; Research Institute of Tropical Medicine, Manila, the Philippines; Center for Statistical Sciences, Brown University, Providence, Rhode Island; Epidemiology Section, Department of Community Health and International Health Institute, Brown University, Providence, Rhode Island; CIHR and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island

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JENNIFER F. FRIEDMAN Center for International Health Research (CIHR), Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; CIHR and Department of Pediatrics, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island; Research Institute of Tropical Medicine, Manila, the Philippines; Center for Statistical Sciences, Brown University, Providence, Rhode Island; Epidemiology Section, Department of Community Health and International Health Institute, Brown University, Providence, Rhode Island; CIHR and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island

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Schistosomiasis is associated with undernutrition, but the mechanisms involved remain unknown. We analyzed baseline and follow-up data from a longitudinal treatment–reinfection study in N = 477 Schistosoma japonicum–infected subjects 7–20 years of age from Leyte, the Philippines. After baseline treatment with praziquantel, follow-up visits were scheduled every 3 months for 18 months; stool, venous blood, and anthropometric measurements were collected at each visit. Cytokine production by peripheral blood mononuclear cells (PBMCs) stimulated with specific S. japonicum antigens was measured once 4 weeks after treatment. After adjustment for confounders, S. japonicum intensity was associated with decreased serum albumin and Z-scores (all P < 0.05) and with increased serum C-reactive protein (CRP) and interleukin (IL)-6. CRP was associated with decreased albumin and Z-scores (all P < 0.01). Production of IL-1b and tumor necrosis factor (TNF)-α in response to worm antigen was associated with decreased albumin (both P < 0.005) and height-for-age Z-score (TNF-α only, P = 0.05). S. japonicum–associated undernutrition may, in part, result directly from inflammation.

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