title: Effect of micronutrient supplementation on treatment outcomes in children with intrathoracic tuberculosis: a randomized controlled trial.
abstract: BACKGROUND
  Micronutrients play an important role in immune function. To our knowledge, there have been no comprehensive studies on the role of micronutrient supplementation in children with tuberculosis.
  
  
  OBJECTIVE
  We assessed the effect of micronutrient supplementation in children treated with antituberculosis therapy (ATT).
  
  
  METHODS
  A randomized, double-blind, placebo-controlled trial that used a 2 × 2 factorial design was undertaken at 2 teaching hospitals in Delhi. Children with newly diagnosed intrathoracic tuberculosis were enrolled, and they received ATT together with daily supplementation for 6 mo with either zinc alone, micronutrients without zinc, micronutrients in combination with zinc, or a placebo. Main outcomes were weight gain and an improvement in a chest X-ray (CXR) lesion assessed at 6 mo of treatment.
  
  
  RESULTS
  A total of 403 children were enrolled and randomly assigned. A microbiological diagnosis of tuberculosis was confirmed in 179 children (44.4%). The median (95% CI) increase in weight-for-age z score at 6 mo was not significantly different between subjects who received micronutrients [0.75 (0.66, 0.84)] and those who did not receive micronutrients [0.76 (0.67, 0.85)] and between subjects who received zinc [0.76 (0.68, 0.85)] and those who did not receive zinc [0.75 (0.66, 0.83)]. An improvement in CXR was observed in 285 children, but there was no difference between those receiving zinc and no zinc or between those receiving micronutrients and no micronutrients after 6 mo of ATT. However, children who received micronutrients had a faster gain in height over 6 mo than did those who did not receive micronutrients (height-for-age z score Δ = 0.08; P = 0.014).
  
  
  CONCLUSIONS
  Micronutrient supplementation did not modify the weight gain or clearance of lesions on CXR in children with intrathoracic tuberculosis. However, micronutrient supplementation during treatment may improve height gain in children with intrathoracic tuberculosis. This trial was registered at clinicaltrials.gov as NCT00801606.
authors.affiliation: From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG).
authors.forename: Rakesh
authors.initials: R
authors.lastname: Lodha
authors.affiliation: From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG).
authors.forename: Aparna
authors.initials: A
authors.lastname: Mukherjee
authors.affiliation: From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG).
authors.forename: Varinder
authors.initials: V
authors.lastname: Singh
authors.affiliation: From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG).
authors.forename: Sarman
authors.initials: S
authors.lastname: Singh
authors.affiliation: From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG).
authors.forename: Henrik
authors.initials: H
authors.lastname: Friis
authors.affiliation: From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG).
authors.forename: Daniel
authors.initials: D
authors.lastname: Faurholt-Jepsen
authors.affiliation: From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG).
authors.forename: Shinjini
authors.initials: S
authors.lastname: Bhatnagar
authors.affiliation: From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG).
authors.forename: Savita
authors.initials: S
authors.lastname: Saini
authors.affiliation: From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG).
authors.forename: Sushil K
authors.initials: SK
authors.lastname: Kabra
authors.affiliation: From the Department of Pediatrics (RL, AM, SB, S Saini, and SKK) and Division of Clinical Microbiology & Molecular Medicine, Laboratory Medicine (S Singh), All India Institute of Medical Sciences, New Delhi, India; the Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India (VS); the Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark (HF and DF-J); and the Department of Clinical Science, Infection, University of Bergen, Bergen, Norway (HMSG).
authors.forename: Harleen M S
authors.initials: HM
authors.lastname: Grewal
mesh_terms: D000293:Adolescent; D000995:Antitubercular Agents / Q000008:administration & dosage; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D019587:Dietary Supplements; D004311:Double-Blind Method; D004977:Ethambutol / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007194:India; D007223:Infant; D007538:Isoniazid / Q000008:administration & dosage; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage*; D010349:Patient Compliance; D011718:Pyrazinamide / Q000008:administration & dosage; D012293:Rifampin / Q000008:administration & dosage; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy*; D015032:Zinc / Q000008:administration & dosage
chemical_list: D000995:Antitubercular Agents; D018977:Micronutrients; D011718:Pyrazinamide; D004977:Ethambutol; D015032:Zinc; D007538:Isoniazid; D012293:Rifampin