Vitamin A deficiency and other factors associated with severe tuberculosis in Timor and Rote Islands, East Nusa Tenggara Province, Indonesia

Abstract

Background: Plasma zinc and vitamin A concentrations have been reported to be low in tuberculosis (TB) patients in some studies, although it is not clear whether this constitutes a risk for a more severe clinical presentation among TB patients. The acute phase reaction may also deplete zinc and vitamin A in the plasma. Therefore, we further studied these associations. Methods: We carried out a cross-sectional study among newly diagnosed sputum smear-positive TB patients in East Nusa Tenggara. The patients were categorized as either mild TB when Karnofsky Score (KS) X80 or severe TB (KS o80). Body mass index (BMI), mid upper arm circumference (MUAC), chest radiograph, and the results of hemoglobin, erythrocyte sedimentation rate, albumin, C-reactive protein (CRP), zinc and vitamin A in plasma were correlated with TB category. Results: A total of 300 TB patients participated in the study (63% male and 37% female), and were categorized as mild TB (53%) or severe TB (47%). Vitamin A, hemoglobin and plasma albumin were significantly lower, and CRP was significantly higher, in severe TB than in mild TB, and the active lesion area on the chest radiograph was greater among severe TB patients. In a multiple regression analysis, after adjustment for CRP, low vitamin A (b ¼ 3.2, 95%CI (confidence interval) 1.6-4.9, P ¼ 0.000) but not zinc, correlated with the severity of TB. MUAC was better than BMI as a predictor of TB severity (b ¼ 1.3, 95%CI 0.6-6.2, P ¼ 0.000). Conclusions: Severe TB was associated with vitamin A deficiency. MUAC can be applied as a measure of TB severity.

Vitamin A and D Deficiencies Associated With Incident Tuberculosis in HIV-Infected Patients Initiating Antiretroviral Therapy in Multinational Case-Cohort Study

“…Vitamin A deficiency is commonly observed in individuals with prevalent TB and is associated with disease severity, but data from cohort studies evaluating vitamin A deficiency state and risk of downstream TB in high-TB, high-HIV settings are limited 10,19–21 . In vitro studies have demonstrated an ability of vitamin A to inhibit M. tuberculosis replication in culture and within macrophages 64–66 .…”

“…Animal models highlight a plausible role of deficiencies and TB risk and clinical outcomes 17,18 . Further, decreased levels of multiple micronutrients, including vitamins A 19–21 ; carotenoids 22 ; vitamin D 23–29 , vitamin E 30–32 and selenium 32–36 are frequently observed in patients with TB and often correlate with severity of disease. However, previous studies have mostly been cross-sectional, focused on single micronutrients, or supplementation trials including patients with prevalent TB, and most did not adjust other important variables including BMI or inflammatory markers.…”

Zinc and vitamin A supplementation fails to reduce sputum conversion time in severely malnourished pulmonary tuberculosis patients in Indonesia

“…The presence of vitamin A deficiency in sputum-positive pulmonary TB patients compared with healthy subjects was confirmed[1,4]. and associated with the future of pulmonary adult TB patients [5]. …”

Underweight increases the risk of pulmonary tuberculosis in adult

“…The present study is in line with another study conducted in the community of Nusa Tenggara Timur province, stating that low vitamin A intake carries a 3.2-fold risk of pulmonary tuberculosis. (16) On the other hand, a study conducted in Delft, Western Cape, South Africa, found no relationship between vitamin A intake and pulmonary tuberculosis incidence. (18) In the group of cases, 57.9% of the community members had poor adequacy levels for vitamin C, whereas in the group of controls, 26.3% had poor adequacy levels for vitamin C. This shows that in the group of controls the adequacy level for vitamin C was higher than that in the group of cases.…”

“…A similar study in the province of Nusa Tenggara Timur found that respondents with poor energy intakes were closely associated with pulmonary tuberculosis incidence. (16) The body uses 60-70% of the total energy requirement for maintaining its basic functions, called the basal metabolism. The energy is required for the basal metabolism and such body functions as digestion, processing, and absorption of food in the digestive tract, moving, walking, working, and other activities.…”