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American Journal of Clinical Nutrition, Vol. 75, No. 4, 720-727, April 2002
© 2002 American Society for Clinical Nutrition

Original Research Communication

A double-blind, placebo-controlled study of vitamin A and zinc supplementation in persons with tuberculosis in Indonesia: effects on clinical response and nutritional status1,2,3

Elvina Karyadi, Clive E West, Werner Schultink, Ronald HH Nelwan, Rainer Gross, Zulkifli Amin, Wil MV Dolmans, Harald Schlebusch and Jos WM van der Meer

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).

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




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