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

European Journal of Clinical Nutrition volume 63, pages 1130–1135 (2009)Cite this article

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 (β=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 (β=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.

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Acknowledgements

This study was carried out with financial support from the Canadian International Development Agency (CIDA) through World Vision International, Indonesia: Food Integrated to Hinder Tuberculosis Project (the WVI—FIGHT Project) in East Nusa Tenggara. We would like to thank the provincial and district health offices in NTT, as well as the Puskesmas and the three district hospitals for collaboration in this study. We send our gratitude to our research team in Kupang, administrative and laboratory staffs in SEAMEO TROPMED RCCN, University of Indonesia, Jakarta. In this study, TAP carried out the field work as the coordinator, data management and analysis, and drafted the paper with the help of two master students, YW and YS. NMDS, MS and ND carried out the data collection and analysis of the participants. EK designed the study, participated in the coordinating and supervision of the data collection, and helped drafting the paper. JvdM, WD and KvdV helped in the interpretation of the data, and the drafting of the paper. All authors have read and approved the final paper.

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Author notes

  1. E Karyadi

    Present address: 8Current address: Micronutrient Initiative, Komp. Bappenas A-1 Jl. Siaga raya Pejaten Barat, Jakarta 12510, Indonesia.,

Authors and Affiliations

  1. SEAMEO TROPMED RCCN and formerly joint research with, University of Indonesia, Jakarta, Indonesia

    T A Pakasi, E Karyadi, Y Wibowo & Y Simanjuntak

  2. Department of Community Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia

    T A Pakasi

  3. Department of General Medicine, WZ Johannes General Hospital, Kupang, Indonesia

    N M D Suratih

  4. Department of Radiology, WZ Johannes General Hospital, Kupang, Indonesia

    M Salean

  5. Kefamenanu General Hospital, North Middle Timor District (TTU), Indonesia

    N Darmawidjaja

  6. Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    J W M van der Meer & W M V Dolmans

  7. Department of Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    K van der Velden

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  1. T A Pakasi
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Correspondence to T A Pakasi.

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Pakasi, T., Karyadi, E., Wibowo, Y. et al. Vitamin A deficiency and other factors associated with severe tuberculosis in Timor and Rote Islands, East Nusa Tenggara Province, Indonesia. Eur J Clin Nutr 63, 1130–1135 (2009). https://doi.org/10.1038/ejcn.2009.25

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