title: Daily multi-micronutrient supplementation during tuberculosis treatment increases weight and grip strength among HIV-uninfected but not HIV-infected patients in Mwanza, Tanzania.
abstract: Undernutrition is common among tuberculosis (TB) patients. The objective of this study was to assess the effect of multi-micronutrient supplementation during TB treatment on weight, body composition, and handgrip strength. A total of 865 patients with smear-positive (PTB+) or -negative (PTB-) pulmonary TB were randomly allocated to receive a daily biscuit with or without multi-micronutrients for 60 d during the intensive phase of TB treatment. Weight, arm fat area, arm muscle area, and handgrip strength were assessed at baseline and after 2 and 5 mo. At 2 mo, the multi-micronutrient supplementation led to a higher handgrip gain (1.22 kg; 95% CI = 0.50, 1.94; P = 0.001) but had no effects on other outcomes. The effects of multi-micronutrient supplementation were modified by HIV infection (P-interaction = 0.002). Among HIV- patients, multi-micronutrient supplementation increased weight gain by 590 g (95% CI = -40, 1210; P = 0.07) and handgrip strength by 1.6 kg (95% CI = 0.78, 2.47; P < 0.001), whereas among HIV+ patients, it reduced weight gain by 1440 g (95% CI = 290, 2590; P = 0.002) and had no effect on handgrip strength (0.07 kg; 95% CI = -1.30, 1.46; P = 0.91). The reduced weight gain among HIV+ patients receiving multi-micronutrient supplementation seemed to be explained by a higher proportion of patients reporting fever. At 5 mo, the effects on weight were sustained, whereas there was no effect on handgrip strength. In conclusion, multi-micronutrient supplementation given as a biscuit is beneficial among HIV- PTB patients and may be recommended to TB programs. More research is needed to develop an effective supplement for HIV+ PTB patients.
authors.affiliation: National Institute for Medical Research, Mwanza Centre Mwanza, Tanzania. gpraygod@yahoo.com
authors.forename: George
authors.initials: G
authors.lastname: PrayGod
authors.forename: Nyagosya
authors.initials: N
authors.lastname: Range
authors.forename: Daniel
authors.initials: D
authors.lastname: Faurholt-Jepsen
authors.forename: Kidola
authors.initials: K
authors.lastname: Jeremiah
authors.forename: Maria
authors.initials: M
authors.lastname: Faurholt-Jepsen
authors.forename: Martine G
authors.initials: MG
authors.lastname: Aabye
authors.forename: Lotte
authors.initials: L
authors.lastname: Jensen
authors.forename: Andreas V
authors.initials: AV
authors.lastname: Jensen
authors.forename: Harleen M S
authors.initials: HM
authors.lastname: Grewal
authors.forename: Pascal
authors.initials: P
authors.lastname: Magnussen
authors.forename: John
authors.initials: J
authors.lastname: Changalucha
authors.forename: Aase Bengaard
authors.initials: AB
authors.lastname: Andersen
authors.forename: Henrik
authors.initials: H
authors.lastname: Friis
mesh_terms: D000328:Adult; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000503:physiopathology*; D018737:Hand Strength; D006801:Humans; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage*; D008875:Middle Aged; D053580:Muscle Strength; D013636:Tanzania; D014376:Tuberculosis / Q000178:diet therapy / Q000503:physiopathology*; D015430:Weight Gain
chemical_list: D018977:Micronutrients