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

Pakasi TA, Karyadi E, Suratih NM, Salean M, Darmawidjaja N, Bor H, van der Velden K, Dolmans WM, van der Meer JW - Nutr J (2010)

Bottom Line: Patients in the zinc + vitamin A group showed earlier sputum conversion time (mean 1.9 weeks) compared with that in the other groups; however the difference was not significant.Also, no benefit could be demonstrated of any of the used supplementations on clinical, nutritional, chest x-ray, or laboratory findings.This study among severely malnourished TB patients, did not confirm that single or combined supplementation of zinc and vitamin A significantly reduced sputum conversion time or had other significant benefit.

View Article: PubMed Central - HTML - PubMed

Affiliation: South East Asia Minister of Education Organization Tropical Medicine, Regional Center for Community Nutrition, University of Indonesia, Jl, Salemba Raya no 6, Jakarta Pusat 10420, Indonesia. tpakasi_commed@fk.ui.ac.id

ABSTRACT

Background: A previous study showed that combination of zinc and vitamin A reduced sputum conversion time in pulmonary tuberculosis (TB) patients.

Objective: We studied the efficacy of which single micronutrient contributed more to the sputum conversion time.

Methods: In a double-blind randomized community trial, newly sputum smear positive pulmonary TB patients were assigned randomly to receive zinc, vitamin A, zinc + vitamin A or placebo on top of TB treatment. Patients were asked to deliver their sputum on weekly basis to measure positivity of the bacteria. Nutritional status, chest x-ray, hemoglobin, C-reactive protein (CRP), retinol and zinc level were examined prior to, after 2 and 6 months of treatment.

Results: Initially, 300 patients were enrolled, and 255 finished the treatment. Most patients were severely malnourished (mean BMI 16.5 ± 2.2 Kg/m2). Patients in the zinc + vitamin A group showed earlier sputum conversion time (mean 1.9 weeks) compared with that in the other groups; however the difference was not significant. Also, no benefit could be demonstrated of any of the used supplementations on clinical, nutritional, chest x-ray, or laboratory findings.

Conclusions: This study among severely malnourished TB patients, did not confirm that single or combined supplementation of zinc and vitamin A significantly reduced sputum conversion time or had other significant benefit.

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Related in: MedlinePlus

Cumulative percentage of the sputum conversion time. The zinc + vitamin A (n = 50) and vitamin A groups (n = 56) showed less weeks to reach 85% of sputum conversion, followed by the placebo group (n = 62).
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Figure 2: Cumulative percentage of the sputum conversion time. The zinc + vitamin A (n = 50) and vitamin A groups (n = 56) showed less weeks to reach 85% of sputum conversion, followed by the placebo group (n = 62).

Mentions: In total 237 patients delivered all required sputum samples and of good quality and the rest was considered as missing data. As shown in table 1, mean sputum conversion time of the zinc + vitamin A intervention group was the shortest, and that of the zinc intervention group the longest. The zinc + vitamin A (n = 50) and vitamin A groups (n = 56) showed less weeks to reach 85% of sputum conversion, followed by the placebo group (n = 62). The zinc supplementation group (n = 68) showed the longest time to reach 85% of sputum conversion. However, no significant difference of the sputum conversion time was observed between groups (ANCOVA, p > 0.05). Factors included in the analysis were AFB level, compliance, and the differences of zinc and retinol level from the baseline. After one week, sputum was smear negative in 58.5% of patients from the zinc + vitamin A group, in 45.6% of patients in the vitamin A and placebo groups, whereas the zinc group showed the lowest percentage (35.3%). The zinc + vitamin A (n = 50) and vitamin A groups (n = 56) showed less weeks to reach 85% of sputum conversion, followed by the placebo group (n = 62). The zinc supplementation group (n = 68) showed the longest time to reach 85% of sputum conversion. After two months no significant differences were found between the groups (Figure 2). Taking into account the WHO success rate target of 85% conversion to negative, we observed that patients in the zinc + vitamin A supplementation group reached the target within 4 weeks, similar to the vitamin A group, followed by placebo group (5 weeks), and zinc group (6.6 weeks).


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

Pakasi TA, Karyadi E, Suratih NM, Salean M, Darmawidjaja N, Bor H, van der Velden K, Dolmans WM, van der Meer JW - Nutr J (2010)

Cumulative percentage of the sputum conversion time. The zinc + vitamin A (n = 50) and vitamin A groups (n = 56) showed less weeks to reach 85% of sputum conversion, followed by the placebo group (n = 62).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2957385&req=5

Figure 2: Cumulative percentage of the sputum conversion time. The zinc + vitamin A (n = 50) and vitamin A groups (n = 56) showed less weeks to reach 85% of sputum conversion, followed by the placebo group (n = 62).
Mentions: In total 237 patients delivered all required sputum samples and of good quality and the rest was considered as missing data. As shown in table 1, mean sputum conversion time of the zinc + vitamin A intervention group was the shortest, and that of the zinc intervention group the longest. The zinc + vitamin A (n = 50) and vitamin A groups (n = 56) showed less weeks to reach 85% of sputum conversion, followed by the placebo group (n = 62). The zinc supplementation group (n = 68) showed the longest time to reach 85% of sputum conversion. However, no significant difference of the sputum conversion time was observed between groups (ANCOVA, p > 0.05). Factors included in the analysis were AFB level, compliance, and the differences of zinc and retinol level from the baseline. After one week, sputum was smear negative in 58.5% of patients from the zinc + vitamin A group, in 45.6% of patients in the vitamin A and placebo groups, whereas the zinc group showed the lowest percentage (35.3%). The zinc + vitamin A (n = 50) and vitamin A groups (n = 56) showed less weeks to reach 85% of sputum conversion, followed by the placebo group (n = 62). The zinc supplementation group (n = 68) showed the longest time to reach 85% of sputum conversion. After two months no significant differences were found between the groups (Figure 2). Taking into account the WHO success rate target of 85% conversion to negative, we observed that patients in the zinc + vitamin A supplementation group reached the target within 4 weeks, similar to the vitamin A group, followed by placebo group (5 weeks), and zinc group (6.6 weeks).

Bottom Line: Patients in the zinc + vitamin A group showed earlier sputum conversion time (mean 1.9 weeks) compared with that in the other groups; however the difference was not significant.Also, no benefit could be demonstrated of any of the used supplementations on clinical, nutritional, chest x-ray, or laboratory findings.This study among severely malnourished TB patients, did not confirm that single or combined supplementation of zinc and vitamin A significantly reduced sputum conversion time or had other significant benefit.

View Article: PubMed Central - HTML - PubMed

Affiliation: South East Asia Minister of Education Organization Tropical Medicine, Regional Center for Community Nutrition, University of Indonesia, Jl, Salemba Raya no 6, Jakarta Pusat 10420, Indonesia. tpakasi_commed@fk.ui.ac.id

ABSTRACT

Background: A previous study showed that combination of zinc and vitamin A reduced sputum conversion time in pulmonary tuberculosis (TB) patients.

Objective: We studied the efficacy of which single micronutrient contributed more to the sputum conversion time.

Methods: In a double-blind randomized community trial, newly sputum smear positive pulmonary TB patients were assigned randomly to receive zinc, vitamin A, zinc + vitamin A or placebo on top of TB treatment. Patients were asked to deliver their sputum on weekly basis to measure positivity of the bacteria. Nutritional status, chest x-ray, hemoglobin, C-reactive protein (CRP), retinol and zinc level were examined prior to, after 2 and 6 months of treatment.

Results: Initially, 300 patients were enrolled, and 255 finished the treatment. Most patients were severely malnourished (mean BMI 16.5 ± 2.2 Kg/m2). Patients in the zinc + vitamin A group showed earlier sputum conversion time (mean 1.9 weeks) compared with that in the other groups; however the difference was not significant. Also, no benefit could be demonstrated of any of the used supplementations on clinical, nutritional, chest x-ray, or laboratory findings.

Conclusions: This study among severely malnourished TB patients, did not confirm that single or combined supplementation of zinc and vitamin A significantly reduced sputum conversion time or had other significant benefit.

Show MeSH
Related in: MedlinePlus