A double-blind, placebo-controlled study of vitamin A and zinc supplementation in persons with tuberculosis in Indonesia: effects on clinical response and nutritional status123

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ABSTRACT

Background:

The results of cross-sectional studies indicate that micronutrient deficiencies are common in patients with tuberculosis. No published data exist on the effect of vitamin A and zinc supplementation on antituberculosis treatment.

Objective:

Our goal was to investigate whether vitamin A and zinc supplementation increases the efficacy of antituberculosis treatment with respect to clinical response and nutritional status.

Design:

In this double-blind, placebo-controlled trial, patients with newly diagnosed tuberculosis were divided into 2 groups. One group (n = 40) received 1500 retinol equivalents (5000 IU) vitamin A (as retinyl acetate) and 15 mg Zn (as zinc sulfate) daily for 6 mo (micronutrient group). The second group (n = 40) received a placebo. Both groups received the same antituberculosis treatment recommended by the World Health Organization. Clinical examinations, assessments of micronutrient status, and anthropometric measurements were carried out before and after 2 and 6 mo of antituberculosis treatment.

Results:

At baseline, 64% of patients had a body mass index (in kg/m2) < 18.5, 32% had plasma retinol concentrations < 0.70 μmol/L, and 30% had plasma zinc concentrations < 10.7 μmol/L. After antituberculosis treatment, plasma zinc concentrations were not significantly different between groups. Plasma retinol concentrations were significantly higher in the micronutrient group than in the placebo group after 6 mo (P < 0.05). Sputum conversion (P < 0.05) and resolution of X-ray lesion area (P < 0.01) occurred earlier in the micronutrient group.

Conclusion:

Vitamin A and zinc supplementation improves the effect of tuberculosis medication after 2 mo of antituberculosis treatment and results in earlier sputum smear conversion.

KEY WORDS

Tuberculosis
vitamin A
zinc
sputum smear conversion
X-ray lesion area
tuberculosis transmission
micronutrient supplementation
Indonesia

Cited by (0)

1

From the SEAMEO-TROPMED Regional Center for Community Nutrition (EK) and the Department of General Internal Medicine, Faculty of Medicine (RHHN and ZA), University of Indonesia, Jakarta, Indonesia; the Departments of Gastroenterology (CEW) and of Internal Medicine (WMVD and JWMV), University Medical Center, Nijmegen, Netherlands; the Division of Human Nutrition and Epidemiology, Wageningen University, Wageningen, Netherlands (EK and CEW); Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH, Eschborn, Germany (WS and RG); and the Laboratory of Clinical Chemistry and Hematology, Faculty of Medicine, University of Bonn, Bonn, Germany (HS).

2

Supported by grants from Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH, Eschborn, Germany; the Neys-van Hoogstraten Foundation; the Directorate General of Communicable Disease Control and Environmental Health, Indonesia; and the Integrated Excellent Research project from the Ministry of Research and Technology Indonesia. PT Kimia Farma, Indonesia, provided the micronutrient supplements and placebo, and PT Indo Farma, Indonesia, provided the standard antituberculosis drugs.

3

Address reprint requests to CE West, Division of Human Nutrition and Epidemiology, Wageningen University, Bomenweg 2, PO Box 8129, 6700 EV Wageningen, Netherlands. E-mail: [email protected].