title: A double-blind, placebo-controlled study of vitamin A and zinc supplementation in persons with tuberculosis in Indonesia: effects on clinical response and nutritional status.
abstract: 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.
  
  
  METHODS
  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/m(2)) < 18.5, 32% had plasma retinol concentrations < 0.70 micromol/L, and 30% had plasma zinc concentrations < 10.7 micromol/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.
  
  
  CONCLUSIONS
  Vitamin A and zinc supplementation improves the effect of tuberculosis medication after 2 mo of antituberculosis treatment and results in earlier sputum smear conversion.
authors.affiliation: SEAMEO-TROPMED Regional Center for Community Nutrition, University of Indonesia, Jakarta, Indonesia.
authors.forename: Elvina
authors.initials: E
authors.lastname: Karyadi
authors.forename: Clive E
authors.initials: CE
authors.lastname: West
authors.forename: Werner
authors.initials: W
authors.lastname: Schultink
authors.forename: Ronald H H
authors.initials: RH
authors.lastname: Nelwan
authors.forename: Rainer
authors.initials: R
authors.lastname: Gross
authors.forename: Zulkifli
authors.initials: Z
authors.lastname: Amin
authors.forename: Wil M V
authors.initials: WM
authors.lastname: Dolmans
authors.forename: Harald
authors.initials: H
authors.lastname: Schlebusch
authors.forename: Jos W M
authors.initials: JW
authors.lastname: van der Meer
mesh_terms: D000293:Adolescent; D000328:Adult; D000886:Anthropometry; D000995:Antitubercular Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D016022:Case-Control Studies; D004311:Double-Blind Method; D004357:Drug Synergism; D005260:Female; D006801:Humans; D007214:Indonesia; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D016896:Treatment Outcome; D014374:Tuberculin Test; D014376:Tuberculosis / Q000097:blood / Q000188:drug therapy*; D014801:Vitamin A / Q000627:therapeutic use*; D015032:Zinc / Q000097:blood / Q000627:therapeutic use*
chemical_list: D000995:Antitubercular Agents; D014801:Vitamin A; D015032:Zinc