Vitamin A and zinc deficiencies among tuberculosis patients in Ethiopia

Tibebeselassie Seyoum Keflie; Aregash Samuel; Ashagrie Zewdu Woldegiorgis; Adane Mihret; Markos Abebe; Hans Konrad Biesalski

doi:10.1016/j.jctube.2018.05.002

Vitamin A and zinc deficiencies among tuberculosis patients in Ethiopia

J Clin Tuberc Other Mycobact Dis. 2018 Jun 14:12:27-33. doi: 10.1016/j.jctube.2018.05.002. eCollection 2018 Aug.

Authors

Tibebeselassie Seyoum Keflie^{1

2}, Aregash Samuel³, Ashagrie Zewdu Woldegiorgis⁴, Adane Mihret⁵, Markos Abebe⁵, Hans Konrad Biesalski^{1

2}

Affiliations

¹ Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany.
² Food Security Centre, University of Hohenheim, Stuttgart, Germany.
³ Ethiopian Public Health Institute, Addis Abeba, Ethiopia.
⁴ Centre for Food Science and Nutrition, College of Natural Sciences, Addis Ababa University, Addis Abeba, Ethiopia.
⁵ Armauer Hansen Research Institute, Addis Abeba, Ethiopia.

Abstract

Background: The link between tuberculosis (TB) and malnutrition has long been recognized. Vitamin A and zinc deficiencies may reduce the host defenses and increase the risk for diseases.

Objective: The aim of the present study was to estimate the difference in vitamin A and zinc deficiencies together with dietary intakes among pulmonary TB patients and controls.

Materials and methods: A case-control study design was employed to undertake this study in North Shewa, Ethiopia. Sputum smear examination, high-performance liquid chromatography (HPLC), flame atomic absorption spectrometry (FAAS), and enzyme-linked immunosorbent assay (ELISA) were used to analyse acid fast bacilli (AFB), vitamin A, zinc, and C-reactive protein (CRP), respectively. Dietary intake was assessed using a 24-h recall questionnaire. Mann-Whitney U test, Kruskal-Wallis test, Chi-square, odds ratio (OR), Spearman correlation, and multinomial logistic regression model were computed for data analyses.

Results: In this study, 62 TB cases and 59 controls were included. The proportions of vitamin A deficiency among TB cases and controls were 56.4% and 39.0%, respectively. All TB cases and 92.5% controls were zinc deficient. The odds of TB cases with deficiencies of vitamin A and zinc was 2.3 (95% CI: 1.1 to 4.8)times more likely as compared to the controls. More than 80% of all participants had below average fulfilment of energy and vitamin A intakes.

Conclusion: Vitamin A and zinc deficiencies are severe problems among TB patients. Moreover, undernutrition determines the development of TB. Therefore, the management programs of TB need to address the problems of vitamin A and zinc deficiencies together with protein-energy malnutrition.

Keywords: AFB, Acid Fast Bacilli; BMI, Body Mass Index; CI, Confidence Interval; CRP, C-Reactive Protein; DDS, Dietary Diversity Score; ELISA, Enzyme-Linked Immunosorbent Assay; Ethiopia; FAAS, Flame Atomic Absorption Spectrometry; HPLC, High Performance Liquid Chromatography; IQR, Inter Quartile Range; IZiNCG, International Zinc Nutrition Consultative Group; MUAC, Mid Upper Arm Circumference; SD, Standard Deviation; TB, Tuberculosis; Tuberculosis; VIF, Variance Inflation Factor; Vitamin A; Zinc.