Original Article
European Journal of Clinical Nutrition (2009) 63, 1130–1135; doi:10.1038/ejcn.2009.25; published online 27 May 2009
Vitamin A deficiency and other factors associated with severe tuberculosis in Timor and Rote Islands, East Nusa Tenggara Province, Indonesia
T A Pakasi1,2, E Karyadi1,8, Y Wibowo1, Y Simanjuntak1, N M D Suratih3, M Salean4, N Darmawidjaja5, J W M van der Meer6, K van der Velden7 and W M V Dolmans6
- 1SEAMEO TROPMED RCCN and formerly joint research with, University of Indonesia, Jakarta, Indonesia
- 2Department of Community Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
- 3Department of General Medicine, WZ Johannes General Hospital, Kupang, Indonesia
- 4Department of Radiology, WZ Johannes General Hospital, Kupang, Indonesia
- 5Kefamenanu General Hospital, North Middle Timor District (TTU), Indonesia
- 6Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- 7Department of Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
Correspondence: Dr TA Pakasi, Department of Community Medicine, Faculty of Medicine, School of Medicine, University of Indonesia, JI. Pegangsaan Timur no. 16, Jakarta Pusast, Jakarta 10430, Indonesia. E-mail: tpakasi_commed@fk.ui.ac.id
8Current address: Micronutrient Initiative, Komp. Bappenas A-1 Jl. Siaga raya Pejaten Barat, Jakarta 12510, Indonesia.
Received 4 June 2008; Revised 13 January 2009; Accepted 2 March 2009; Published online 27 May 2009.
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) 
80 or severe TB (KS <80). 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 (
=3.2, 95%CI (confidence interval) 1.6–4.9, P=0.000) but not zinc, correlated with the severity of TB. MUAC was better than BMI as a predictor of TB severity (=1.3, 95%CI 0.6–6.2, P=0.000).
Conclusions:
Severe TB was associated with vitamin A deficiency. MUAC can be applied as a measure of TB severity.
Keywords:
vitamin A, zinc, CRP, MUAC, severity, tuberculosis
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