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Ockenga J, Fuhse K, Chatterjee S, Malykh R, Rippin H, Pirlich M, Yedilbayev A, Wickramasinghe K, Barazzoni R. Tuberculosis and malnutrition: The European perspective. Clin Nutr 2023; 42:486-492. [PMID: 36857957 DOI: 10.1016/j.clnu.2023.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 02/12/2023]
Abstract
Tuberculosis (TB) is a leading infectious cause of death worldwide, despite ongoing efforts to limit its incidence and mortality. Although the European Region has made gains in TB incidence and mortality, it now contends with increasing numbers of multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB). Malnutrition is a major contributor to the burden of TB and may also be directly caused or enhanced by the onset of TB. The presence of malnutrition may worsen TB and MDR/RR-TB related treatment outcomes and contribute to growing TB drug-resistance. Preventing and treating all forms of malnutrition is an important tool to limit the spread of TB worldwide and improve TB outcomes and treatment efficacy. We carried out a scoping review of the existing evidence that addresses malnutrition in the context of TB. Our review found malnutrition increased the risk of developing TB in high-burden settings and increased the likelihood of developing unfavorable treatment outcomes, including treatment failure, loss to follow-up, and death. The potential impact of nutritional care and improved nutritional status on patient prognosis was more difficult to evaluate due to heterogeneity of patient populations, treatment protocols, and treatment durations and goals. High-quality trials that consider malnutrition as a major risk factor and relevant treatment target when designing effective strategies to limit TB spread and mortality are needed to inform evidence-based practice. In TB patients, we suggest that widespread and regular nutritional screening, assessment, and counselling, has the potential to increase effectiveness of TB management strategies and improve patient quality of life, overall outcomes, and survival.
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Affiliation(s)
- J Ockenga
- Department of Gastroenterology, Endocrinology and Clinical Nutrition, Klinikum Bremen Mitte, Bremen, Germany.
| | - K Fuhse
- Department of Gastroenterology, Endocrinology and Clinical Nutrition, Klinikum Bremen Mitte, Bremen, Germany.
| | - S Chatterjee
- Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - R Malykh
- Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - H Rippin
- Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - M Pirlich
- Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology and Clinical Nutrition, Berlin, Germany.
| | - A Yedilbayev
- Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - K Wickramasinghe
- Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - R Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
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Wagnew F, Alene KA, Eshetie S, Wingfield T, Kelly M, Gray D. Effects of zinc and vitamin A supplementation on prognostic markers and treatment outcomes of adults with pulmonary tuberculosis: a systematic review and meta-analysis. BMJ Glob Health 2022; 7:bmjgh-2022-008625. [PMID: 36130775 PMCID: PMC9490634 DOI: 10.1136/bmjgh-2022-008625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 08/07/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Undernutrition is a major risk factor for tuberculosis (TB), which is estimated to be responsible for 1.9 million TB cases per year globally. The effectiveness of micronutrient supplementation on TB treatment outcomes and its prognostic markers (sputum conversion, serum zinc, retinol and haemoglobin levels) has been poorly understood. This study aimed to determine the effect of zinc and vitamin A supplementation on prognostic markers and TB treatment outcomes among adults with sputum-positive pulmonary TB. METHODS A systematic literature search for randomised controlled trials (RCTs) was performed in PubMed, Embase and Scopus databases. Meta-analysis with a random effect model was performed to estimate risk ratio (RR) and mean difference (MD), with a 95% CI, for dichotomous and continuous outcomes, respectively. RESULTS Our search identified 2195 records. Of these, nine RCTs consisting of 1375 participants were included in the final analyses. Among adults with pulmonary TB, zinc (RR: 0.94, 95% CI: 0.86 to 1.03), vitamin A (RR: 0.90, 95% CI: 0.80 to 1.01) and combined zinc and vitamin A (RR: 0.98, 95% CI: 0.89 to 1.08) supplementation were not significantly associated with TB treatment success. Combined zinc and vitamin A supplementation was significantly associated with increased sputum smear conversion at 2 months (RR: 1.16, 95% CI: 1.03 to 1.32), serum zinc levels at 2 months (MD: 0.86 μmol/L, 95% CI: 0.14 to 1.57), serum retinol levels at 2 months (MD: 0.06 μmol/L, 95% CI: 0.04 to 0.08) and 6 months (MD: 0.12 μmol/L, 95% CI: 0.10 to 0.14) and serum haemoglobin level at 6 months (MD: 0.29 μg/dL, 95% CI: 0.08 to 0.51), among adults with pulmonary TB. CONCLUSIONS Providing zinc and vitamin A supplementation to adults with sputum-positive pulmonary TB during treatment may increase early sputum smear conversion, serum zinc, retinol and haemoglobin levels. However, the use of zinc, vitamin A or both was not associated with TB treatment success. PROSPERO REGISTRATION NUMBER CRD42021248548.
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Affiliation(s)
- Fasil Wagnew
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kefyalew Addis Alene
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Geospatial Health and Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Setegn Eshetie
- College of Health Science, University of Gondar, Gondar, Ethiopia
- Allied health performance Academic Unit, University of South Australia, Adelaide, South Australia, Australia
| | - Tom Wingfield
- Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- WHO Collaborating Centre for Social Medicine and Tuberculosis, Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Matthew Kelly
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Darren Gray
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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Vonasek BJ, Radtke KK, Vaz P, Buck WC, Chabala C, McCollum ED, Marcy O, Fitzgerald E, Kondwani A, Garcia-Prats AJ. Tuberculosis in children with severe acute malnutrition. Expert Rev Respir Med 2022; 16:273-284. [PMID: 35175880 PMCID: PMC9280657 DOI: 10.1080/17476348.2022.2043747] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION With growing attention globally to the childhood tuberculosis epidemic after decades of neglect, and with the burden of severe acute malnutrition (SAM) remaining unacceptably high worldwide, the collision of these two diseases is an important focus for improving child health. AREAS COVERED This review describes the clinical and public health implications of the interplay between tuberculosis and SAM, particularly for children under the age of five, and identifies priority areas for improved programmatic implementation and future research. We reviewed the literature on PubMed and other evidence known to the authors published until August 2021 relevant to this topic. EXPERT OPINION To achieve the World Health Organization's goal of eliminating deaths from childhood tuberculosis and to improve the abysmal outcomes for children with SAM, further research is needed to 1) better understand the epidemiologic connections between child tuberculosis and SAM, 2) improve case finding of tuberculosis in children with SAM, 3) assess unique treatment considerations for tuberculosis when children also have SAM, and 4) ensure tuberculosis and SAM are strongly addressed in decentralized, integrated models of providing primary healthcare to children.
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Affiliation(s)
- Bryan J Vonasek
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA,Corresponding Author: Bryan Vonasek, , University of Wisconsin School of Medicine & Public Health, Department of Pediatrics, 600 Highland Ave, Madison, WI, USA 53792-4108, Phone: +1-763-333-8071, Fax: +1-608-265-9243
| | - Kendra K Radtke
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - Paula Vaz
- Fundação Ariel Glaser, Maputo, Mozambique
| | - W Chris Buck
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Chishala Chabala
- Children’s Hospital, University Teaching Hospitals, Lusaka, Zambia
| | - Eric D McCollum
- Global Program in Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Olivier Marcy
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux, France
| | - Elizabeth Fitzgerald
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Alexander Kondwani
- Centre of Excellence for Nutrition, North West University, Potchefstroom, South Africa
| | - Anthony J Garcia-Prats
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Tamara L, Kartasasmita CB, Alam A, Gurnida DA. Effects of Vitamin D supplementation on resolution of fever and cough in children with pulmonary tuberculosis: A randomized double-blind controlled trial in Indonesia. J Glob Health 2022; 12:04015. [PMID: 35198149 PMCID: PMC8855907 DOI: 10.7189/jogh.12.04015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Various studies in adults have shown a strong association between vitamin D and tuberculosis (TB), both in terms of vitamin D status and the benefits of vitamin D in managing TB. Studies on vitamin D and its relationship with childhood TB still lack in Indonesia as a country with the second-highest TB incidence globally. This study evaluated the effect of vitamin D supplementation on resolution of cough and fever in Indonesian children with pulmonary TB. Methods We conducted a randomized controlled trial of vitamin D supplementation in children with pulmonary TB and vitamin D insufficiency. Patients were randomly allocated with 1:1 ratio to receive either 1000 IU vitamin D or placebo daily after starting standard TB treatment. The primary outcome in this study was the resolution of fever and cough symptoms reviewed weekly after starting the treatment until the symptoms are resolved. The secondary outcome in this study was 25-hydroxyvitamin D serum level and nutritional status which was reviewed at the end of the trial. Intention to treat analyses were applied. Differences in clinical outcomes between two groups were calculated using Mann-Whitney U test or χ2 test, where appropriate. Findings A total of 84 patients met the inclusion criteria, aged 6 to 18 years old, newly diagnosed with pulmonary TB and vitamin D insufficiency. Eighty patients (95,2%) completed the six months follow-up. Faster resolution of fever, cough, improved malnutrition status, and higher vitamin D level were found in the intervention group compared to the placebo group (all P < 0.001). Conclusions Vitamin D is beneficial in improving fever and cough resolution, and improving nutritional status in children with pulmonary TB and vitamin D insufficiency. Determination of adequate supplementation levels of more than 1000 IU requires further research to achieve normal vitamin D levels during the duration of treatment for pulmonary TB in children. Trial registration ClinicalTrials.gov (NCT05073965).
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Affiliation(s)
- Lianda Tamara
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Bethesda Serukam Hospital, Bengkayang, West Borneo, Indonesia
| | - Cissy B Kartasasmita
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Anggraini Alam
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Dida A Gurnida
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
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Thompson AL. Greater male vulnerability to stunting? Evaluating sex differences in growth, pathways and biocultural mechanisms. Ann Hum Biol 2022; 48:466-473. [PMID: 35105202 DOI: 10.1080/03014460.2021.1998622] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
CONTEXT Child stunting has increasingly become the focus of large-scale global health efforts with the inclusion of stunting eradication as one of the Sustainable Development Goals of the United Nations. Child sex has been identified as a biological risk factor for stunting, and sex-specific approaches to stunting prevention have been proposed. OBJECTIVE This paper examines four pathways, developmental sensitivity, energetics, caretaking and measurement, proposed to contribute to sex differences in linear growth faltering and stunting risk. METHODS Anthropological, public health and clinical literature on sex differences in stunting and the mechanisms contributing to variability across contexts are reviewed. RESULTS The direction of sex differences in stunting prevalence varies across countries and between households. Sex differences in growth trajectories and immune function beginning prenatally place boys at greater risk of infection and undernutrition, but these biological differences are interpreted by parents and within household contexts that are shaped by social and cultural norms which, in turn, influence care and feeding practices. CONCLUSION A perspective that incorporates an examination of the social and environmental factors shaping child growth in specific contexts is needed to understand sex-based vulnerability to stunting and to develop context-appropriate interventions.
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Affiliation(s)
- Amanda L Thompson
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Haiqing Cai, Chen L, Yin C, Liao Y, Meng X, Lu C, Tang S, Li X, Wang X. The effect of micro-nutrients on malnutrition, immunity and therapeutic effect in patients with pulmonary tuberculosis: A systematic review and meta-analysis of randomised controlled trials. Tuberculosis (Edinb) 2020; 125:101994. [PMID: 33049436 DOI: 10.1016/j.tube.2020.101994] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/20/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Micro-nutrients are closely related to pulmonary tuberculosis (PTB). Most patients with PTB suffer from micro-nutrients deficiency. We aimed to evaluate the efficacy of micro-nutrients support on clinical therapy and chronic inflammation in patients with PTB. METHODS We searched Pubmed, Springer link, Web of Science, Cochrane, Wan Fang and CNKI databases for randomised controlled trials (RCTs). The patients with anti-TB treatments were divided into two groups, the control group with nutritional advice or placebo, and the experimental group with micro-nutrients support for more than 2 weeks. Two reviewers conducted data extraction and quality assessment of the studies independently, and ReviewManager 5.2 software was used to input and analyse the data. The dichotomous variable was expressed in the risk ratios (RRS) and 95% CI, the continuous data were expressed in the mean difference (MD) and 95% CI, and the heterogeneity of subgroup was evaluated by I (Kerantzas and Jacobs, Jr., 2017) [2] test. RESULTS A total of 13 trials (2847 participants) were included. First, micro-nutrients improved sputum smears or culture negative conversion rates (OR 0.16 0.03-0.77, 2.29; MD -2.36, -4.72~-0.01, z = 1.97). Meanwhile, micro-nutrients support increased lymphocytes and decreased leukocytes, neutrophils, CRP and ESR (MD 0.20, 0.06-0.35, z = 2.78; MD -0.42, -0.65~-0.18, z = 3.48; MD -0.66, -1.12~-0.20, z = 2.82). However it had not impact on body weight, MUAC, haemoglobin, albumin or monocytes (p > 0.05). CONCLUSION Micro-nutrients support can reduce chronic inflammation and improve sputum smears or culture conversions to contribute to anti-TB treatment.
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Affiliation(s)
- Haiqing Cai
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China; The Fourth People's Hospital of Nanning, HIV/AIDS Clinical Treatment Center of Guangxi, 530023, China
| | - Lulin Chen
- The Second Nanning People's Hospital, 530031, China
| | - Chunlian Yin
- The Fourth People's Hospital of Nanning, HIV/AIDS Clinical Treatment Center of Guangxi, 530023, China
| | - Yanying Liao
- The Fourth People's Hospital of Nanning, HIV/AIDS Clinical Treatment Center of Guangxi, 530023, China
| | - Xingxing Meng
- The Fourth People's Hospital of Nanning, HIV/AIDS Clinical Treatment Center of Guangxi, 530023, China
| | - Cailing Lu
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Shen Tang
- School of Preclinic Medical, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Xiyi Li
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China.
| | - Xinhang Wang
- School of Preclinic Medical, Guangxi Medical University, Nanning, Guangxi, 530021, China.
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Huey SL, Jiang L, Fedarko MW, McDonald D, Martino C, Ali F, Russell DG, Udipi SA, Thorat A, Thakker V, Ghugre P, Potdar RD, Chopra H, Rajagopalan K, Haas JD, Finkelstein JL, Knight R, Mehta S. Nutrition and the Gut Microbiota in 10- to 18-Month-Old Children Living in Urban Slums of Mumbai, India. mSphere 2020; 5:e00731-20. [PMID: 32968008 PMCID: PMC7568645 DOI: 10.1128/msphere.00731-20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/03/2020] [Indexed: 12/20/2022] Open
Abstract
In this cross-sectional study, we describe the composition and diversity of the gut microbiota among undernourished children living in urban slums of Mumbai, India, and determine how nutritional status, including anthropometric measurements, dietary intakes from complementary foods, feeding practices, and micronutrient concentrations, is associated with their gut microbiota. We collected rectal swabs from children aged 10 to 18 months living in urban slums of Mumbai participating in a randomized controlled feeding trial and conducted 16S rRNA sequencing to determine the composition of the gut microbiota. Across the study cohort, Proteobacteria dominated the gut microbiota at over 80% relative abundance, with Actinobacteria representation at <4%, suggesting immaturity of the gut. Increased microbial α-diversity was associated with current breastfeeding, greater head circumference, higher fat intake, and lower hemoglobin concentration and weight-for-length Z-score. In redundancy analyses, 47% of the variation in Faith's phylogenetic diversity (Faith's PD) could be accounted for by age and by iron and polyunsaturated fatty acid intakes. Differences in community structure (β-diversity) of the microbiota were observed among those consuming fats and oils the previous day compared to those not consuming fats and oils the previous day. Our findings suggest that growth, diet, and feeding practices are associated with gut microbiota metrics in undernourished children, whose gut microbiota were comprised mainly of Proteobacteria, a phylum containing many potentially pathogenic taxa.IMPORTANCE The impact of comprehensive nutritional status, defined as growth, nutritional blood biomarkers, dietary intakes, and feeding practices, on the gut microbiome in children living in low-resource settings has remained underreported in microbiome research. Among undernourished children living in urban slums of Mumbai, India, we observed a high relative abundance of Proteobacteria, a phylum including many potentially pathogenic species similar to the composition in preterm infants, suggesting immaturity of the gut, or potentially a high inflammatory burden. We found head circumference, fat and iron intake, and current breastfeeding were positively associated with microbial diversity, while hemoglobin and weight for length were associated with lower diversity. Findings suggest that examining comprehensive nutrition is critical to gain more understanding of how nutrition and the gut microbiota are linked, particularly in vulnerable populations such as children in urban slum settings.
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Affiliation(s)
- Samantha L Huey
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Lingjing Jiang
- Division of Biostatistics, University of California, San Diego, California, USA
| | - Marcus W Fedarko
- Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, California, USA
| | - Daniel McDonald
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Cameron Martino
- Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA
- Bioinformatics and Systems Biology Program, University of California San Diego, La Jolla, California, USA
| | - Farhana Ali
- Department of Bioengineering, University of California, San Diego, California, USA
| | - David G Russell
- Department of Microbiology and Immunology, Cornell University, Ithaca, New York, USA
| | - Shobha A Udipi
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - Aparna Thorat
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - Varsha Thakker
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - Padmini Ghugre
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - R D Potdar
- Centre for the Study of Social Change, Mumbai, India
| | - Harsha Chopra
- Centre for the Study of Social Change, Mumbai, India
| | - Kripa Rajagopalan
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Jere D Haas
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Julia L Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
- Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, New York, USA
| | - Rob Knight
- Department of Bioengineering, University of California, San Diego, California, USA
- Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, California, USA
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
- Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, New York, USA
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Cabrera Andrade BK, Garcia-Perdomo HA. Effectiveness of micronutrients supplement in patients with active tuberculosis on treatment: Systematic review/Meta-analysis. Complement Ther Med 2019; 48:102268. [PMID: 31987251 DOI: 10.1016/j.ctim.2019.102268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/15/2019] [Accepted: 11/26/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multiple researchers have suggested the influence of micronutrients in the cure and survival of tuberculosis. OBJECTIVE To determine the effectiveness of micronutrients in the cure and treatment of pulmonary tuberculosis. METHODS Systematic search of randomized controlled trials (RCTs) in databases of people under treatment for active pulmonary tuberculosis, that must have received oral micronutrients for at least four weeks compared with placebo. The synthesis of the variables was shown in standardized mean difference (MD) and/or risk difference (RD). The random effects model was used and was reported in forest plot of the estimates of the effect with a 95 % CI. RESULTS Sixteen of 246 studies were included, in total 4398 people. Zinc showed (RD, 0.04; 95 % CI, 0.00-0.08) in mortality, increases muscle mass index (MD, 1.20; 95 % CI, 0.04-2.36) and gains weight (MD, 3.10; 95 % CI, 0.66-5.54). Zinc plus vitamin A increases the weight (MD, 3.10; 95 % CI, 2.78-3.42), improving karnofsky scale (MD, 2.50; 95 % CI, 2.22-2.78). Additionally, vitamin D accelerate the sputum conversión time (RD, 0.38; 95 % CI, 0.03-0.73). Hemoglobin (Hb) with vitamin A and zinc achieves statistically significant changes (MD, 0.69; 95 % CI, 0.28-1.09) and (MD, 0.52; 95 % CI, 0.21-0.83) and reduces area of cavitations in chest X-ray (MD, -0.33; 95 % CI, -0.60--0.06). CONCLUSIONS The consumption of micronutrients could achieve weight gain, hemoglobin, accelerated sputum conversion and improvement in quality of life. There are no changes in mortality that may be attributable to the suboptimal dose, larger studies are suggested with adequate doses.
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Affiliation(s)
- Betty Katherin Cabrera Andrade
- Universidad del Valle and Phisycal therapist in Intensive Care Unit in Centro Médico Imbanaco, Cra 38bis # 5b-152 Centro Médico Imbanaco, Second Floor UCI, Adult, Cali, Colombia.
| | - Herney Andrés Garcia-Perdomo
- School of Public Health, Universidad del Valle - Cl. 4b #36b3, Cali, Colombia; Universidad del Valle Director "UROGIV" Research Group, Colombia.
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Huey SL, Finkelstein JL, Venkatramanan S, Udipi SA, Ghugre P, Thakker V, Thorat A, Potdar RD, Chopra HV, Kurpad AV, Haas JD, Mehta S. Prevalence and Correlates of Undernutrition in Young Children Living in Urban Slums of Mumbai, India: A Cross Sectional Study. Front Public Health 2019; 7:191. [PMID: 31355176 PMCID: PMC6639755 DOI: 10.3389/fpubh.2019.00191] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 06/24/2019] [Indexed: 02/04/2023] Open
Abstract
Background: Young children living in urban slums are vulnerable to malnutrition and subsequently poor health outcomes, but data on the correlates of stunting, underweight, wasting, and anemia specifically among 10-18 month-old children in India remain limited. Objective: In this analysis, we sought to describe the prevalence of and examine correlates for different markers of undernutrition, including stunting, underweight, and anemia among 10-18 month-old children living in urban slums, an understudied vulnerable group. Methods: Children and their mothers (n = 323) were screened for anthropometry, demographics, and complete blood counts for hemoglobin concentration between March and November 2017 (Clinicaltrials.gov ID: NCT02233764). Correlates included child and mother's age, sex, birth order, birth weight, illness episodes, hemoglobin concentration, family income, maternal height, and maternal education level. Risk ratios (RR, 95% CI) for binary outcomes (stunting, underweight, wasting and anemia) and mean differences (β, 95% CI) for continuous outcomes (anthropometric Z-scores, hemoglobin concentration) were calculated using multivariate binomial and linear regression (SAS 9.4). Results: The prevalence of stunting was 31.2%, underweight 25.1%, wasting (9.0%), and anemia (76%) among all children. Male children had a higher prevalence of poor growth indices and lower anthropometric Z-scores than females. Male sex, low birthweight, shorter maternal height, report of ≥1 episodes of illness within the past month, older maternal age, and birth order ≥2 were also associated with poor growth and anemia in multivariate models. Correlates of undernutrition were different among females and males. Female children had a 40% (20, 60%) higher risk of anemia associated with diarrhea, and male children who were firstborn had a 20% (0, 70%) lower risk of anemia. Conclusions: These results show that poor growth and anemia among young children is prevalent in urban slums of Mumbai, and that sex of the child may play an important role in informing interventions to address undernutrition.
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Affiliation(s)
- Samantha Lee Huey
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Julia Leigh Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
- Institute for Nutritional Sciences, Global Health, and Technology (INSIGHT), Cornell University, Ithaca, NY, United States
| | - Sudha Venkatramanan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Shobha A. Udipi
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - Padmini Ghugre
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - Varsha Thakker
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - Aparna Thorat
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | | | | | - Anura V. Kurpad
- Department of Physiology, St. John's Research Institute, Bangalore, India
| | - Jere Douglas Haas
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
- Institute for Nutritional Sciences, Global Health, and Technology (INSIGHT), Cornell University, Ithaca, NY, United States
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Abstract
The global impact of childhood malnutrition is staggering. The synergism between malnutrition and infection contributes substantially to childhood morbidity and mortality. Anthropometric indicators of malnutrition are associated with the increased risk and severity of infections caused by many pathogens, including viruses, bacteria, protozoa, and helminths. Since childhood malnutrition commonly involves the inadequate intake of protein and calories, with superimposed micronutrient deficiencies, the causal factors involved in impaired host defense are usually not defined. This review focuses on literature related to impaired host defense and the risk of infection in primary childhood malnutrition. Particular attention is given to longitudinal and prospective cohort human studies and studies of experimental animal models that address causal, mechanistic relationships between malnutrition and host defense. Protein and micronutrient deficiencies impact the hematopoietic and lymphoid organs and compromise both innate and adaptive immune functions. Malnutrition-related changes in intestinal microbiota contribute to growth faltering and dysregulated inflammation and immune function. Although substantial progress has been made in understanding the malnutrition-infection synergism, critical gaps in our understanding remain. We highlight the need for mechanistic studies that can lead to targeted interventions to improve host defense and reduce the morbidity and mortality of infectious diseases in this vulnerable population.
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Campa A, Baum MK, Bussmann H, Martinez SS, Farahani M, van Widenfelt E, Moyo S, Makhema J, Essex M, Marlink R. The effect of micronutrient supplementation on active TB incidence early in HIV infection in Botswana. NUTRITION AND DIETARY SUPPLEMENTS 2017; 2017:37-45. [PMID: 29187783 PMCID: PMC5703420 DOI: 10.2147/nds.s123545] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Coinfection with active tuberculosis (TB) is one of the leading causes of death in people living with HIV (PLWH) in Africa. This investigation explores the role of micronutrient supplementation in preventing active TB in PLWH. METHODS A randomized trial of nutritional supplementation was conducted among antiretroviral- naïve (without previous antiretroviral treatment [ART]) HIV-infected people in Botswana between 2004 and 2009. The study had a factorial design with four arms: the selenium (Se) alone arm, the multivitamins (MVT) alone arm that contained vitamin B complex and vitamins C and E, the combined Se+MVT group and the placebo group. Those participants with prior or current active TB were excluded, as were participants with advanced HIV disease (CD4 <250 cells/μL) or who had already qualified for ART. HIV-positive adults (N=878) were followed monthly for study pill dispensation, every 3 months for CD4 cell count and every 6 months for viral load during 24 months or until they were started on ART. RESULTS The participants' characteristics were not significantly different among the four groups at baseline. Supplementation with Se alone (hazard ratio =0.20, 95% confidence interval: 0.04, 0.95, P=0.043) and the two combined SE groups (Se and Se+MVT) had significantly lower risk of developing incident TB disease compared with placebo in multivariate adjusted models (hazard ratio=0.32, 95% confidence interval: 0.11, 0.93, P=0.036). Multivitamins alone did not affect the incidence of TB. Isoniazid preventive therapy was received by 12.2% of participants, a rate that was not significantly different among the four study arms (P=0.122) and the newly diagnosed cases. CONCLUSION Se supplementation, alone and with MVT, decreased the incidence of TB disease in PLWH who were ART-naïve. Supplementation with these micronutrients should be considered in HIV infection, prior to ART, in areas where TB and malnutrition are endemic.
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Affiliation(s)
- Adriana Campa
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Marianna K Baum
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | | | - Sabrina Sales Martinez
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | | | | | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- The Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Max Essex
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- The Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Richard Marlink
- The Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Dodd PJ, Prendergast AJ, Beecroft C, Kampmann B, Seddon JA. The impact of HIV and antiretroviral therapy on TB risk in children: a systematic review and meta-analysis. Thorax 2017; 72:559-575. [PMID: 28115682 PMCID: PMC5520282 DOI: 10.1136/thoraxjnl-2016-209421] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Children (<15 years) are vulnerable to TB disease following infection, but no systematic review or meta-analysis has quantified the effects of HIV-related immunosuppression or antiretroviral therapy (ART) on their TB incidence. OBJECTIVES Determine the impact of HIV infection and ART on risk of incident TB disease in children. METHODS We searched MEDLINE and Embase for studies measuring HIV prevalence in paediatric TB cases ('TB cohorts') and paediatric HIV cohorts reporting TB incidence ('HIV cohorts'). Study quality was assessed using the Newcastle-Ottawa tool. TB cohorts with controls were meta-analysed to determine the incidence rate ratio (IRR) for TB given HIV. HIV cohort data were meta-analysed to estimate the trend in log-IRR versus CD4%, relative incidence by immunological stage and ART-associated protection from TB. RESULTS 42 TB cohorts and 22 HIV cohorts were included. In the eight TB cohorts with controls, the IRR for TB was 7.9 (95% CI 4.5 to 13.7). HIV-infected children exhibited a reduction in IRR of 0.94 (95% credible interval: 0.83-1.07) per percentage point increase in CD4%. TB incidence was 5.0 (95% CI 4.0 to 6.0) times higher in children with severe compared with non-significant immunosuppression. TB incidence was lower in HIV-infected children on ART (HR: 0.30; 95% CI 0.21 to 0.39). Following initiation of ART, TB incidence declined rapidly over 12 months towards a HR of 0.10 (95% CI 0.04 to 0.25). CONCLUSIONS HIV is a potent risk factor for paediatric TB, and ART is strongly protective. In HIV-infected children, early diagnosis and ART initiation reduces TB risk. TRIAL REGISTRATION NUMBER CRD42014014276.
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Affiliation(s)
- P J Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - A J Prendergast
- Blizard Institute, Queen Mary University of London, London, UK
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - C Beecroft
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - B Kampmann
- Centre of International Child Health, Department of Paediatrics, Imperial College London, London, UK
- Vaccines & Immunity Theme, MRC Unit The Gambia, The Gambia
| | - J A Seddon
- Centre of International Child Health, Department of Paediatrics, Imperial College London, London, UK
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Jenum S, Bakken R, Dhanasekaran S, Mukherjee A, Lodha R, Singh S, Singh V, Haks MC, Ottenhoff THM, Kabra SK, Doherty TM, Ritz C, Grewal HMS. BLR1 and FCGR1A transcripts in peripheral blood associate with the extent of intrathoracic tuberculosis in children and predict treatment outcome. Sci Rep 2016; 6:38841. [PMID: 27941850 PMCID: PMC5150239 DOI: 10.1038/srep38841] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/08/2016] [Indexed: 02/07/2023] Open
Abstract
Biomarkers reflecting the extent of Mycobacterium tuberculosis-induced pathology and normalization during anti-tuberculosis treatment (ATT) would considerably facilitate trials of new treatment regimens and the identification of patients with treatment failure. Therefore, in a cohort of 99 Indian children with intrathoracic tuberculosis (TB), we performed blood transcriptome kinetic analysis during ATT to explore 1) the association between transcriptional biomarkers in whole blood (WB) and the extent of TB disease at diagnosis and treatment outcomes at 2 and 6 months, and 2) the potential of the biomarkers to predict treatment response at 2 and 6 months. We present the first data on the association between transcriptional biomarkers and the extent of TB disease as well as outcome of ATT in children: Expression of three genes down-regulated on ATT (FCGR1A, FPR1 and MMP9) exhibited a positive correlation with the extent of TB disease, whereas expression of eight up-regulated genes (BCL, BLR1, CASP8, CD3E, CD4, CD19, IL7R and TGFBR2) exhibited a negative correlation with the extent of disease. Baseline levels of these transcripts displayed an individual capacity >70% to predict the six-month treatment outcome. In particular, BLR1 and FCGR1A seem to have a potential in monitoring and perhaps tailoring future antituberculosis therapy.
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Affiliation(s)
- Synne Jenum
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Rasmus Bakken
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - S. Dhanasekaran
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Aparna Mukherjee
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sarman Singh
- Division of Clinical Microbiology & Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Varinder Singh
- Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India
| | - Marielle C. Haks
- Department of Infectious Diseases Group, Immunology and Immunogenetics of Bacterial Infectious Disease, Leiden University Medical Center, The Netherland
| | - Tom H. M. Ottenhoff
- Department of Infectious Diseases Group, Immunology and Immunogenetics of Bacterial Infectious Disease, Leiden University Medical Center, The Netherland
| | - S. K. Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Harleen M. S. Grewal
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- Department of Microbiology, Haukeland university hospital, University of Bergen, N-5021, Norway
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Grobler L, Nagpal S, Sudarsanam TD, Sinclair D. Nutritional supplements for people being treated for active tuberculosis. Cochrane Database Syst Rev 2016; 2016:CD006086. [PMID: 27355911 PMCID: PMC4981643 DOI: 10.1002/14651858.cd006086.pub4] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Tuberculosis and malnutrition are linked in a complex relationship. Tuberculosis may cause undernutrition through increased metabolic demands and decreased intake, and nutritional deficiencies may worsen the disease, or delay recovery by depressing important immune functions. At present, there is no evidence-based nutritional guidance for adults and children being treated for tuberculosis. OBJECTIVES To assess the effects of oral nutritional supplements in people being treated with antituberculous drug therapy for active tuberculosis. SEARCH METHODS We searched the Cochrane Infectious Disease Group Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL; Issue 1, 2016), MEDLINE (from 1946 to 4 February 2016), EMBASE (from 1980 to 4 February 2016), LILACS (from 1982 to 4 February 2016), the metaRegister of Controlled Trials (mRCT), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and the Indian Journal of Tuberculosis up to 4 February 2016, and checked the reference lists of all included studies. SELECTION CRITERIA Randomized controlled trials that compared any oral nutritional supplement given for at least four weeks with no nutritional intervention, placebo, or dietary advice only for people being treated for active tuberculosis. The primary outcomes of interest were all-cause death, and cure at six and 12 months. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, and extracted data and assessed the risk of bias in the included trials. We presented the results as risk ratios (RR) for dichotomous variables, and mean differences (MD) for continuous variables, with 95% confidence intervals (CIs). Where appropriate, we pooled data from trials with similar interventions and outcomes. We assessed the quality of the evidence using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS Thirty-five trials, including 8283 participants, met the inclusion criteria of this review. Macronutrient supplementationSix trials assessed the provision of free food, or high-energy supplements. Only two trials measured total dietary intake, and in both trials the intervention increased calorie consumption compared to controls.The available trials were too small to reliably prove or exclude clinically important benefits on mortality (RR 0.34, 95% CI 0.10 to 1.20; four trials, 567 participants, very low quality evidence), cure (RR 0.91, 95% CI 0.59 to 1.41; one trial, 102 participants, very low quality evidence), or treatment completion (data not pooled; two trials, 365 participants, very low quality evidence).Supplementation probably produces a modest increase in weight gain during treatment for active tuberculosis, although this was not seen consistently across all trials (data not pooled; five trials, 883 participants, moderate quality evidence). Two small studies provide some evidence that quality of life may also be improved but the trials were too small to have much confidence in the result (data not pooled; two trials, 134 participants, low quality evidence). Micronutrient supplementationSix trials assessed multi-micronutrient supplementation in doses up to 10 times the dietary reference intake, and 18 trials assessed single or dual micronutrient supplementation.Routine multi-micronutrient supplementation may have little or no effect on mortality in HIV-negative people with tuberculosis (RR 0.86, 95% CI 0.46 to 1.6; four trials, 1219 participants, low quality evidence), or HIV-positive people who are not taking antiretroviral therapy (RR 0.92, 95% CI 0.69 to 1.23; three trials, 1429 participants, moderate quality evidence). There is insufficient evidence to know if supplementation improves cure (no trials), treatment completion (RR 0.99, 95% CI 0.95 to 1.04; one trial, 302 participants, very low quality evidence), or the proportion of people who remain sputum positive during the first eight weeks (RR 0.92, 95% CI 0.63 to 1.35; two trials, 1020 participants, very low quality evidence). However, supplementation may have little or no effect on weight gain during treatment (data not pooled; five trials, 2940 participants, low quality evidence), and no studies have assessed the effect on quality of life.Plasma levels of vitamin A appear to increase following initiation of tuberculosis treatment regardless of supplementation. In contrast, supplementation probably does improve plasma levels of zinc, vitamin D, vitamin E, and selenium, but this has not been shown to have clinically important benefits. Of note, despite multiple studies of vitamin D supplementation in different doses, statistically significant benefits on sputum conversion have not been demonstrated. AUTHORS' CONCLUSIONS There is currently insufficient research to know whether routinely providing free food, or energy supplements improves tuberculosis treatment outcomes, but it probably improves weight gain in some settings.Although blood levels of some vitamins may be low in people starting treatment for active tuberculosis, there is currently no reliable evidence that routinely supplementing above recommended daily amounts has clinical benefits.
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Affiliation(s)
- Liesl Grobler
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesPO Box 241TygerbergCape TownWestern CapeSouth Africa8000
| | - Sukrti Nagpal
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesLiverpoolUK
| | - Thambu D Sudarsanam
- Christian Medical CollegeMedicine Unit 2 and Clinical Epidemiology UnitIda Scudder RoadVelloreTamil NaduIndia632 004
| | - David Sinclair
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesLiverpoolUK
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Lodha R, Mukherjee A, Singh V, Singh S, Friis H, Faurholt-Jepsen D, Bhatnagar S, Saini S, Kabra SK, Grewal HMS. Effect of micronutrient supplementation on treatment outcomes in children with intrathoracic tuberculosis: a randomized controlled trial. Am J Clin Nutr 2014; 100:1287-97. [PMID: 25332327 DOI: 10.3945/ajcn.113.082255] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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). DESIGN 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.
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Affiliation(s)
- Rakesh Lodha
- 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)
| | - Aparna Mukherjee
- 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)
| | - Varinder Singh
- 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)
| | - Sarman Singh
- 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)
| | - Henrik Friis
- 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)
| | - Daniel Faurholt-Jepsen
- 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)
| | - Shinjini Bhatnagar
- 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)
| | - Savita Saini
- 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)
| | - Sushil K Kabra
- 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)
| | - Harleen M S Grewal
- 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)
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Ahmed S, Finkelstein JL, Stewart AM, Kenneth J, Polhemus ME, Endy TP, Cardenas W, Mehta S. Micronutrients and dengue. Am J Trop Med Hyg 2014; 91:1049-56. [PMID: 25200269 DOI: 10.4269/ajtmh.14-0142] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Dengue virus infection is the most widespread mosquito-borne viral infection in humans and has emerged as a serious global health challenge. In the absence of effective treatment and vaccine, host factors including nutritional status, which may alter disease progression, need investigation. The interplay between nutrition and other infections is well-established, and modulation of nutritional status often presents a simple low-cost method of interrupting transmission, reducing susceptibility, and/or ameliorating disease severity. This review examines the evidence on the role of micronutrients in dengue virus infection. We found critical issues and often inconsistent results across studies; this finding along with the lack of sufficient literature in this field have limited our ability to make any recommendations. However, vitamins D and E have shown promise in small supplementation trials. In summary, the role of micronutrients in dengue virus infection is an exciting research area and needs to be examined in well-designed studies with larger samples.
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Affiliation(s)
- Sundus Ahmed
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, New York; Division of Infectious Diseases, St. John's Research Institute, Bangalore, India; Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Julia L Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, New York; Division of Infectious Diseases, St. John's Research Institute, Bangalore, India; Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Anna M Stewart
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, New York; Division of Infectious Diseases, St. John's Research Institute, Bangalore, India; Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - John Kenneth
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, New York; Division of Infectious Diseases, St. John's Research Institute, Bangalore, India; Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Mark E Polhemus
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, New York; Division of Infectious Diseases, St. John's Research Institute, Bangalore, India; Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Timothy P Endy
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, New York; Division of Infectious Diseases, St. John's Research Institute, Bangalore, India; Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Washington Cardenas
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, New York; Division of Infectious Diseases, St. John's Research Institute, Bangalore, India; Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, New York; Division of Infectious Diseases, St. John's Research Institute, Bangalore, India; Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
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Abstract
The 2010 Dietary Guidelines Advisory Committee was charged with the task of investigating the effects of multivitamin/mineral supplements on healthy populations and also on those with chronic disease. The evidence from which the committee prepared its conclusions was graded on 5 fundamental criteria: quality, consistency, quantity, clinical impact, and generalizability. The committee concluded that for the general healthy population, evidence was insufficient to make a multivitamin/mineral recommendation. On the other hand, the committee noted the value of some supplemental nutrients for at-risk populations such as iron, folic acid, and vitamin B-12. However, most of the studies referenced for the research used the conventional, all-encompassing, and oversimplified definition of a multivitamin/mineral as being a supplement containing 3 or more vitamins with or without minerals. In the few years since the committee released its 2010 report, several randomized clinical trials showing the benefits of daily multivitamin/mineral supplementation have been completed using supplements containing at least 10 or more vitamins and/or minerals, but there also continues to be some reports that do not find benefit from such supplements. Furthermore, several steps have been taken to advance the science behind these supplements so that consumers, physicians, and government agencies can all have more confidence in understanding the role of supplemental nutrition in the American diet. This review provides new evidence from 2010 onward addressing the committee's primary concerns about multivitamin/mineral research in regard to improving public health. It also includes several recent studies that may be of interest to future committees indicating the potential benefits of these supplements on improving the cognitive performance and mental well-being of healthy populations.
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Abstract
PURPOSE OF REVIEW Multiple micronutrient deficiencies are still common worldwide and often occur at an early age, negatively affecting both physical and cognitive development. Even though specific effects of a variety of different micronutrients have been studied extensively, it is understood that a combination of multiple micronutrients may be more beneficial in most instances, as deficiencies usually do not occur in isolation. The aim of this review was to summarize the most recent evidence of the effects of micronutrient interventions on growth, mental, and physical performance as well as morbidity in children. RECENT FINDINGS For growth, cognitive or motor function, and morbidity, it appears that providing sufficient amounts of micronutrients especially to the most vulnerable and deficient groups of children can make a difference, but also that the intervention has to be planned carefully. However, findings are still variable, more particularly with reference to morbidity. Two reports of increased diagnoses of infection with micronutrient supplementation are also of concern. SUMMARY There are still difficulties in coming to a universal conclusion about benefit in all populations, because reports vary in study design, population, and so on. Although micronutrients have a role in depleted groups, it is also important to not only consider the group of children targeted, but also the regime of administration.
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Affiliation(s)
- Anura V Kurpad
- Division of Nutrition, St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, India.
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Jaganath D, Mupere E. Childhood tuberculosis and malnutrition. J Infect Dis 2012; 206:1809-15. [PMID: 23033147 PMCID: PMC3502375 DOI: 10.1093/infdis/jis608] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 07/13/2012] [Indexed: 01/05/2023] Open
Abstract
Despite the burden of both malnutrition and tuberculosis in children worldwide, there are few studies on the mechanisms that underlie this relationship. From available research, it appears that malnutrition is a predictor of tuberculosis disease and is associated with worse outcomes. This is supported through several lines of evidence, including the role of vitamin D receptor genotypes, malnutrition's effects on immune development, respiratory infections among malnourished children, and limited work specifically on pediatric tuberculosis and malnutrition. Nutritional supplementation has yet to suggest significant benefits on the course of tuberculosis in children. There is a critical need for research on childhood tuberculosis, specifically on how nutritional status affects the risk and progression of tuberculosis and whether nutritional supplementation improves clinical outcomes or prevents disease.
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Affiliation(s)
- Devan Jaganath
- David Geffen School of Medicine at the University of California, Los Angeles
- Tuberculosis Research Unit (TBRU), Case Western Reserve University, Cleveland, Ohio
| | - Ezekiel Mupere
- Makerere University, Kampala, Uganda
- Tuberculosis Research Unit (TBRU), Case Western Reserve University, Cleveland, Ohio
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