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Articles

Poor Micronutrient Status of Active Pulmonary Tuberculosis Patients in Indonesia¹

Elvina Karyadi^*,, Werner Schultink^2,**, Ronald H. H. Nelwan, Rainer Gross^**, Zulkifli Amin, Wil M. V. Dolmans, Jos W. M. van der Meer, Joseph G. A. J Hautvast and Clive E. West^,3

^* SEAMEO-TROPMED Regional Center for Community Nutrition University of Indonesia, Indonesia; ^** Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH, Eschborn, Germany; Department of General Internal Medicine, Faculty of Medicine, University of Indonesia, Indonesia; Departments of General Internal Medicine and Gastroenterology, University Medical Centre, Nijmegen, The Netherlands; and Division of Human Nutrition and Epidemiology, Wageningen University, The Netherlands

³To whom correspondence should be addressed.

Malnutrition is observed frequently in patients with pulmonary tuberculosis (TB), but their nutritional status, especially of micronutrients, is still poorly documented. The objective of this study was to investigate the nutritional status of patients with active TB compared with that of healthy controls in Jakarta, Indonesia. In a case-control study, 41 out-patients aged 15–55 y with untreated active pulmonary TB were compared with 41 healthy controls selected from neighbors of the patients and matched for age and sex. Cases had clinical and radiographic abnormalities consistent with pulmonary TB and at least two sputum specimens showing acid-fast bacilli. Anthropometric and micronutrient status data were collected. Compared with the controls, TB patients had significantly lower body mass index, skinfold thicknesses (triceps, biceps, subscapular, suprailiac), mid-upper arm circumference, proportion of fat, and concentrations of serum albumin, blood hemoglobin, plasma retinol and plasma zinc, whereas plasma zinc protoporphyrin concentration, as a measure of free erythrocyte protoporphyrin concentration, was greater. When patients and controls were subdivided on the basis of nutritional status, concentrations of serum albumin, blood hemoglobin, and zinc and retinol in plasma were lower in malnourished TB patients than in well-nourished healthy controls, well-nourished TB patients and malnourished healthy controls. In conclusion, the nutritional status of patients with active pulmonary TB was poor compared with healthy subjects, i.e., significantly more patients were anemic and more had low plasma concentrations of retinol and zinc. Low concentrations of hemoglobin, and of retinol and zinc in plasma were more pronounced in malnourished TB patients.

KEY WORDS: • malnutrition • tuberculosis • vitamin A • zinc • micronutrient • humans

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