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The effect of multi-vitamin/mineral supplementation on mortality during treatment of pulmonary tuberculosis: a randomised two-by-two factorial trial in Mwanza, Tanzania

Published online by Cambridge University Press:  08 March 2007

Nyagosya Range ,
John Changalucha ,
Henrik Krarup ,
Pascal Magnussen ,
Âse B. Andersen  and
Henrik Friis
Nyagosya Range
Affiliation:
National Institute for Medical Research, Muhimbili Research Station, PO Box 3436, Dar es Salaam, Tanzania
John Changalucha
Affiliation:
National Institute for Medical Research, Mwanza Medical Research Centre, PO Box 1462, Mwanza, Tanzania
Henrik Krarup
Affiliation:
Department of Clinical Biochemistry, Aalborg University Hospital, PO Box 561, 9100 Aalborg, Denmark
Pascal Magnussen
Affiliation:
DBL Institute for Health Research and Development, Jaegersborg Allé 1D, Charlottenlund, Denmark
Âse B. Andersen
Affiliation:
Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen ø, Denmark
Henrik Friis*
Affiliation:
Department of Epidemiology, Institute of Public Health, University of Copenhagen, øster Farimagsgade 5B, DK-1014 Copenhagen K, Denmark
*
*Corresponding author: Dr Henrik Friis, fax +45 35 32 73 83, email [email protected]
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Abstract

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Malnutrition is common in pulmonary tuberculosis (TB), and may impair survival. The objective of this study was to assess effects of multi-vitamin/mineral (MVM) and zinc (Zn) supplementation during TB treatment on mortality. Patients diagnosed with sputum-positive pulmonary TB in Mwanza, Tanzania, were randomised, using a two-by-two factorial design, to Zn (45mg) or placebo, and MVM (vitamins A, B, C, D, E, and selenium and copper) or placebo. Survival status was ascertained at the end of the 8-month TB treatment and supplementation period. Of 499 TB patients, 213 (43%) had HIV. The mean weight gain at 7 months was 6·88kg (95% CI 6·36, 7·41). Zn and MVM combined, but neither alone (interaction, p=0·03), increased weight gain by 2·37kg (95% CI 0·91, 3·83), irrespective of HIV status. Survival status at 8 months was determined for 422 patients (84·6%), of which fifty-two (12·3%) had died. Among fifty-two deaths, there were no effects of MVM (relative risk (RR) 0·73; 95% CI 0·43, 1·23) and Zn (RR 0·76; 95% CI 0·46, 1·28). However, among HIV co-infected patients, marginally significant effects of both MVM (RR 0·60; 95% CI 0·34, 1·05) and Zn (RR 0·63, 95% CI 0·37, 1·08) were seen, and MVM and Zn combined reduced mortality (RR 0·29; 95% CI 0·10, 0·80; interaction ratio 0·52). In conclusion, supplementation with MVM, including Zn, during treatment of pulmonary TB may reduce mortality in those co-infected with HIV. A randomised trial of the effect of the combined intervention used in this study should be conducted in a different setting to confirm the finding.

Keywords

TuberculosisHIVVitaminsMineralsWeightMortalityTanzania
Type
Research Article
Information
British Journal of Nutrition , Volume 95 , Issue 4 , April 2006 , pp. 762 - 770
Copyright
Copyright © The Nutrition Society 2006

References

Beisel, WRNutritionally acquired immune deficiency syndromes. In Micronutrients and HIV Infection, pp. 23–42 [Friis, H editor]. Boca RatonFL: CRC Press: (2001)Google Scholar
Bhutta, ZA, Bird, SM, Black, RE, et al.. Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials Am J Clin Nutr (2000) 72, 1516–1522.CrossRefGoogle ScholarPubMed
Zinc Investigators' Collaborative GroupBhutta, ZA, Black, REBrown, KH, et al.. Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. J Pediatr (1999) 135 689–697CrossRefGoogle ScholarPubMed
Cegielski, JP&McMurray, DNThe relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals. Int J Tuberc Lung Dis (2004) 8 286298Google ScholarPubMed
Fawzi, WW, Mbise, RL, Hertzmark, E, Fataki, MR,Herrera, MG,Ndossi, G&Spiegelman, DA randomized trial of vitamin A supplements in relation to mortality among human immunodefi- ciency virus-infected and uninfected children in Tanzania Pediatr Infect Dis J (1999) 18, 127–133CrossRefGoogle Scholar
Fawzi, WW, Msamanga, GI, Hunter, D, Renjifo, B, Antelman, G, Bang, H, Manji, K, Kapiga, S, Mwakagile, D, Essex, M & Spiegelman, DRandomized trial of vitamin supplements in relation to transmission of HIV-1 through breastfeeding and early child mortality. AIDS (2002) 16 1935–1944CrossRefGoogle ScholarPubMed
Fawzi, WW, Msamanga, GI, Spiegelman, Det al. A randomized trial of multivitamin supplements and HIV disease progression and mortality. N Engl J Med (2004) 351 23–32CrossRefGoogle ScholarPubMed
Food and Nutrition Board Vitamin C. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium and Carotenoids. Washington, DC: National Academy Press (2000)Google Scholar
Frieden, TR, Sterling, TR, Munsiff, SS, Watt, CJ & Dye, CTuberculosis. Lancet (2003) 362 887–899CrossRefGoogle ScholarPubMed
Friis, HMicronutrients and HIV Infection: A Review of Current Evidence. www.who.int/nutrition (2005)Google Scholar
Friis, H & Sandstrõm, BZinc and HIV infection. In Micronutrients and HIV Infection [Friis, H] Boca Raton, FL: CRC Press (2001) 159–181Google Scholar
Githui, W, Kitui, F, Juma, ES, Obwana, DO, Mwai, J & Kwamanga, DA comparative study on the reliability of the fluorescence microscopy and Ziehl-Neelsen method in the diagnosis of pulmonary tuberculosis. East Afr Med J (1993) 70 263–266Google ScholarPubMed
Golden, MHNNutritional deficiency as a cause of growth failure. In Human Growth: Basic and Clinical Aspects [Hernández, M and Argente, J] Amsterdam: Elsevier Science Publishers B.V. (1992) 175–182Google Scholar
Gomo, E, Vennervald, BJ, Ndhlovu, P, Kaestel, P, Nyazema, N & Friis, HPredictors and reference values of CD4 and CD8 T lymphocyte counts in pregnancy: a cross sectional study among HIV negative women in Zimbabwe. Cent Afr J Med (2004) 50 10–19Google ScholarPubMed
Harries, AD, Hargreaves, NJ, Kemp, J, Jindani, A, Enarson, DA, Maher, D & Salaniponi, FMDeaths from tuberculosis in sub-Saharan African countries with a high prevalence of HIV-1. Lancet (2001) 357 1519–1523CrossRefGoogle ScholarPubMed
Jiamton, S, Pepin, J, Suttent, R, Filteau, S, Mahakkanukrauh, B, Hanshaoworakul, W, Chaisilwattana, P, Suthipinittharm, P, Shetty, P & Jaffar, SA randomized trial of the impact of multiple micronutrient supplementation on mortality among HIV-infected individuals living in Bangkok. AIDS (2003) 17 2461–2469CrossRefGoogle ScholarPubMed
Karyadi, E, Schultink, W, Nelwan, RH, Gross, R, Amin, Z, Dolmans, WM, van der Meer, JW, Hautvast, JG & West, CEPoor micronutrient status of active pulmonary tuberculosis patients in Indonesia. J Nutr (2000) 130 2953–2958CrossRefGoogle ScholarPubMed
Kennedy, N, Ramsay, A, Uiso, L, Gutmann, J, Ngowi, FI & Gillespie, SHNutritional status and weight gain in patients with pulmonary tuberculosis in Tanzania. Trans R Soc Trop Med Hyg (1996) 90 162–166CrossRefGoogle ScholarPubMed
Krarup, HB, Drewes, AM & Madsen, PHA quantitative HCVPCR test for routine diagnostics. Scand J Clin Lab Invest (1998) 58 415–422CrossRefGoogle ScholarPubMed
McAlister, FA, Straus, SE, Sackett, DL & Altman, DGAnalysis and reporting of factorial trials: a systematic review. JAMA (2003) 289 2545–2553CrossRefGoogle ScholarPubMed
Ministry of Health Manual of the National Tuberculosis and Leprosy Programme (NTLP). Geneva: Ministry of Health (1991)Google Scholar
Mugusi, FM, Rusizoka, O, Habib, N & Fawzi, WVitamin A status of patients presenting with pulmonary tuberculosis and asymptomatic HIV-infected individuals. Dar es Salaam, Tanzania. Int J Tuberc Lung Dis (2003) 7 804–807Google ScholarPubMed
Paton, NI, Chua, YK, Earnest, A & Chee, CBERandomized controlled trial of nutritional supplementation in patients with newly diagnosed tuberculosis and wasting. Am J Clin Nutr (2004) 80 460–465CrossRefGoogle ScholarPubMed
Ramakrishnan, U & Huffman, SL Multiple micronutrient malnutrition. In Nutrition and Health in Developing Countries [Semba, RD andBloem, MW] Totowa, NJ: Humana Press (2001) 365–391CrossRefGoogle Scholar
Range, N, Andersen, AB, Magnussen, P, Mugomela, A & Friis, HThe effect of micronutrient supplementation on treatment outcome in patients with pulmonary tuberculosis: a randomized controlled trial in Mwanza. Tanzania. Trop Med Int Health (2005) 10 826–832CrossRefGoogle ScholarPubMed
Shankar, AH & Prasad, ASZinc and immune function: the biological basis of altered resistance to infection. Am J Clin Nutr (1998) 68 447S–463SCrossRefGoogle ScholarPubMed
Tang, AM, Graham, NM, Kirby, AJ, McCall, LD, Willett, WC & Saah, AJDietary micronutrient intake and risk of progression to acquired immunodeficiency syndrome (AIDS) in human immunodeficiency virus type 1 (HIV-1)-infected homosexual men. Am J Epidemiol (1993) 138 937–951CrossRefGoogle ScholarPubMed
Tang, AM, Graham, NM & Saah, AJEffects of micronutrient intake on survival in human immunodeficiency virus type 1 infection. Am J Epidemiol (1996) 143 1244–1256CrossRefGoogle ScholarPubMed
Thurnham, DIAn overview of interactions between micronutrients and of micronutrients with drugs, genes and immune mechanisms. Nutr Res Rev (2005) 17 211–240CrossRefGoogle Scholar
UNAIDS Report on the Global AIDS Epidemic: 4th Global Report. GenevaUNAIDS (2004)Google Scholar
Wilkinson, RJ, Llewelyn, M, Toossi, Z, Patel, P, Pasvol, G, Lalvani, A, Wright, D, Latif, M & Davidson, RNInfluence of vitamin D deficiency and vitamin D receptor polymorphisms on tuberculosis among Gujarati Asians in west London: a case-control study. Lancet (2000) 355 618–621CrossRefGoogle ScholarPubMed
World Health Organization Basic Laboratory Methods in Medical Parasitology. Geneva: WHO (1991)Google Scholar
World Health Organization Model Prescription Information:Drugs Used in Parasitic Diseases. Geneva: WHO. (1995)Google Scholar
World Health Organization Treatment of Tuberculosis:Guidelines for National Programmes. Geneva: WHO (2003)Google Scholar
World Health Organization WHO Report 2003.Global Tuberculosis Control: Surveillance, Financing and Planning. Geneva: WHO (2004)Google Scholar