@article{fdi:010066075,
  title = {{M}icronutrient-fortified rice can increase hookworm infection risk : a cluster randomized trial},
  author = {de {G}ier, {B}. and {P}once, {M}. {C}. and {P}erignon, {M}arl{\`e}ne and {F}iorentino, {M}. and {K}hov, {K}. and {C}hamnan, {C}. and de {B}oer, {M}. {R}. and {P}arker, {M}. {E}. and {B}urja, {K}. and {D}ijkhuizen, {M}. {A}. and {B}erger, {J}acques and {P}olman, {K}. and {W}ieringa, {F}ranck},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {F}ortification of staple foods is considered an effective and safe strategy to combat micronutrient deficiencies, thereby improving health. {W}hile improving micronutrient status might be expected to have positive effects on immunity, some studies have reported increases in infections or inflammation after iron supplementation. {O}bjective {T}o study effects of micronutrient-fortified rice on hookworm infection in {C}ambodian schoolchildren. {M}ethods {A} double-blinded, cluster-randomized trial was conducted in 16 {C}ambodian primary schools partaking in the {W}orld {F}ood {P}rogram school meal program. {T}hree types of multi-micronutrient fortified rice were tested against placebo rice within the school meal program: {U}ltra{R}ice_original, {U}ltra{R}ice_improved and {N}utri{R}ice. {F}our schools were randomly assigned to each study group (placebo n = 492, {U}ltra{R}ice_original n = 479, {U}ltra{R}ice_improved n = 500, {N}utri{R}ice n = 506). {I}ntestinal parasite infection was measured in fecal samples by {K}ato-{K}atz method at baseline and after three and seven months. {I}n a subgroup ({N} = 330), fecal calprotectin was measured by {ELISA} as a marker for intestinal inflammation. {R}esults {B}aseline prevalence of hookworm infection was 18.6%, but differed considerably among schools (range 0%-48.1%). {M}icronutrient-fortified rice significantly increased risk of new hookworm infection. {T}his effect was modified by baseline hookworm prevalence at the school; hookworm infection risk was increased by all three types of fortified rice in schools where baseline prevalence was high (>15%), and only by {U}ltra{R}ice_original in schools with low baseline prevalence. {N}either hookworm infection nor fortified rice was related to fecal calprotectin. {C}onclusions {C}onsumption of rice fortified with micronutrients can increase hookworm prevalence, especially in environments with high infection pressure. {W}hen considering fortification of staple foods, a careful risk-benefit analysis is warranted, taking into account severity of micronutrient deficiencies and local prevalence of parasitic infections.},
  keywords = {{CAMBODGE}},
  booktitle = {},
  journal = {{P}los {O}ne},
  volume = {11},
  numero = {1},
  pages = {e0145351 [12 p.]},
  ISSN = {1932-6203},
  year = {2016},
  DOI = {10.1371/journal.pone.0145351},
  URL = {https://www.documentation.ird.fr/hor/fdi:010066075},
}