title: Effects of a food supplement rich in arginine in patients with smear positive pulmonary tuberculosis--a randomised trial.
abstract: In tuberculosis (TB), the production of nitric oxide (NO) is confirmed but its importance in host defense is debated. Our aim was to investigate whether a food supplement rich in arginine could enhance clinical improvement in TB patients by increased NO production. Smear positive TB patients from Gondar, Ethiopia (n = 180) were randomized to a food supplementation rich in arginine (peanuts, equivalent to 1 g of arginine/day) or with a low arginine content (wheat crackers, locally called daboqolo) during four weeks. The primary outcome was cure rate according to the WHO classification and secondary outcomes were sputum smear conversion, weight gain, sedimentation rate, reduction of cough and chest X-ray improvement as well as levels of NO in urine (uNO) or exhaled air (eNO) at two months. There was no effect of the intervention on the primary outcome (OR 1.44, 95% CI: 0.69-3.0, p = 0.39) or secondary outcomes. In the subgroup analysis according to HIV status, peanut supplemented HIV+/TB patients showed increased cure rate (83.8% (31/37) vs 53.1% (17/32), p < 0.01). A low baseline eNO (<10 ppb) in HIV+/TB patients was associated with a decreased cure rate. We conclude that nutritional supplementation with a food supplement rich in arginine did not have any overall clinical effect. In the subgroup of HIV positive TB patients, it significantly increased the cure rate and as an additional finding in this subgroup, low initial levels of NO in exhaled air were associated with a poor clinical outcome but this needs to be confirmed in further studies.
authors.affiliation: Department of Medical Microbiology, Faculty of Health Sciences, Linköping University, 581 85 Linköping, Sweden. tschon@hotmail.com
authors.forename: T
authors.initials: T
authors.lastname: Schön
authors.forename: J
authors.initials: J
authors.lastname: Idh
authors.forename: A
authors.initials: A
authors.lastname: Westman
authors.forename: D
authors.initials: D
authors.lastname: Elias
authors.forename: E
authors.initials: E
authors.lastname: Abate
authors.forename: E
authors.initials: E
authors.lastname: Diro
authors.forename: F
authors.initials: F
authors.lastname: Moges
authors.forename: A
authors.initials: A
authors.lastname: Kassu
authors.forename: B
authors.initials: B
authors.lastname: Ayele
authors.forename: T
authors.initials: T
authors.lastname: Forslund
authors.forename: A
authors.initials: A
authors.lastname: Getachew
authors.forename: S
authors.initials: S
authors.lastname: Britton
authors.forename: O
authors.initials: O
authors.lastname: Stendahl
authors.forename: T
authors.initials: T
authors.lastname: Sundqvist
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001120:Arginine / Q000494:pharmacology; D017024:Chemotherapy, Adjuvant; D019587:Dietary Supplements; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000276:immunology* / Q000628:therapy; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000178:diet therapy / Q000276:immunology*; D009569:Nitric Oxide; D013902:Radiography, Thoracic; D013183:Sputum; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000276:immunology* / Q000628:therapy
chemical_list: D000995:Antitubercular Agents; D009569:Nitric Oxide; D001120:Arginine