title: Vitamin A deficiency and other factors associated with severe tuberculosis in Timor and Rote Islands, East Nusa Tenggara Province, Indonesia.
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) > or =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 (beta=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 (beta=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.
authors.affiliation: University of Indonesia, Jakarta, Indonesia. tpakasi_commed@fk.ui.ac.id
authors.forename: T A
authors.initials: TA
authors.lastname: Pakasi
authors.forename: E
authors.initials: E
authors.lastname: Karyadi
authors.forename: Y
authors.initials: Y
authors.lastname: Wibowo
authors.forename: Y
authors.initials: Y
authors.lastname: Simanjuntak
authors.forename: N M D
authors.initials: NM
authors.lastname: Suratih
authors.forename: M
authors.initials: M
authors.lastname: Salean
authors.forename: N
authors.initials: N
authors.lastname: Darmawidjaja
authors.forename: J W M
authors.initials: JW
authors.lastname: van der Meer
authors.forename: K
authors.initials: K
authors.lastname: van der Velden
authors.forename: W M V
authors.initials: WM
authors.lastname: Dolmans
mesh_terms: D000328:Adult; D001132:Arm / Q000033:anatomy & histology; D049628:Body Size; D002097:C-Reactive Protein / Q000032:analysis; D003430:Cross-Sectional Studies; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007214:Indonesia; D008168:Lung / Q000473:pathology; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000150:complications*; D012709:Serum Albumin / Q000032:analysis; D012720:Severity of Illness Index; D014376:Tuberculosis / Q000097:blood / Q000150:complications* / Q000473:pathology; D014801:Vitamin A / Q000097:blood*; D014802:Vitamin A Deficiency / Q000097:blood / Q000150:complications*; D055815:Young Adult
chemical_list: D006454:Hemoglobins; D012709:Serum Albumin; D014801:Vitamin A; D002097:C-Reactive Protein