Fasting Blood Glucose in a Ghanaian Adult is Causally Linked with Malaria Parasite Count: A Mechanistic Case Study Using Convergent Cross Mapping
Abstract Background: Adults with diabetes mellitus (DM) in malaria-endemic areas might be more susceptible to Plasmodium infection than healthy individuals. Herein, we aimed at verifying the hypothesis that increased fasting blood glucose (FBG) promotes parasite growth as reflected by increased parasite density. Methods: Seven adults without DM were recruited in rural Ghana to determine the relationships between FBG and malaria parasite load. Socio-economic data were recorded in questionnaire-based interviews. Over a period of 6 weeks, we measured FBG and Plasmodium spc. infection in peripheral blood samples photometrically and by polymerase chain reaction (PCR)-assays, respectively. Daily physical activity and weather data were documented via smartphone recording. For the complex natural systems of homeostatic glucose control and Plasmodium spc. lifecycle, empirical dynamic modelling was applied. Results: At baseline, four men and three women (median age, 33 years; interquartile range, 30-48) showed a median FBG of 5.5 (5.1-6.0 mmol/L); one participant had an asymptomatic Plasmodium spc. infection (parasite density: 240 /µL). In this participant, convergent cross mapping (CCM) for 34 consecutive days, showed that FBG was causally affected by parasite density (p <0.02), while the reciprocal relationship was not discernible (p >0.05). Additionally, daily ambient temperature affected parasite density (p<0.01).Conclusion: In this study population living in a malaria-endemic area, we successfully piloted time series analyses for the relationships between FBG and Plasmodium spc. density. Longer observation periods and larger samples are required to confirm these findings and determine the direction of causality.