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Community and International Nutrition

Hypovitaminosis D Is Common among Pulmonary Tuberculosis Patients in Tanzania but Is Not Explained by the Acute Phase Response^1,2

³ Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, 1958 Frederiksberg, Denmark; ⁴ National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania; ⁵ National Institute for Medical Research, Mwanza Medical Research Centre, Mwanza, Tanzania; ⁶ Department of Clinical Biochemistry, Aalborg University Hospital, 9100 Aalborg, Denmark; ⁷ DBL–Centre for Health Research and Development, Department of Veterinary Pathobiology, Faculty of Life Sciences, University of Copenhagen, 1958 Frederiksberg, Denmark; and ⁸ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark

Vitamin D is essential to immune function, but little is known about the vitamin D status in equatorial populations. A cross-sectional study was conducted among pulmonary tuberculosis (PTB) patients in Mwanza, Tanzania to identify the predictors of their vitamin D status. Data on sociodemography, season, and intake of food, alcohol, tobacco, and soil were collected, anthropometric measurements taken, and serum ₁-antichymotrypsin (ACT), ferritin and soluble transferrin receptor (sTfR), and serum 25-hydroxy-(ergocalciferol+cholecalciferol) [25(OH)D] determined. Of the 655 patients studied, 79.7% (508/637) were culture-positive (PTB+) and 47.2% HIV infected. Mean serum ACT, an acute phase reactant, was 0.73 ± 0.25 g/L with 69.2% >0.6 g/L. Mean serum 25(OH)D was 86.6 ± 32.9 nmol/L, with 41.2% <75 nmol/L. Serum 25(OH)D was highest during the harvest season, May to July, compared with the remaining year. Single subjects had lower [10.4 (95% CI 4.0; 16.9) nmol/L] serum 25(OH)D concentrations than married subjects and PTB+ patients had concentrations lower [8.2 (95% CI 1.5; 14.9) nmol/L] than PTB– patients. Serum 25(OH)D increased with consumption of a large freshwater fish but not of small dried fish or other foods. BMI and serum TfR were positive predictors of serum 25(OH)D, whereas neither elevated serum ACT nor HIV were predictors. In conclusion, serum 25(OH)D is a valid measure of vitamin D status during the acute phase response. The lower concentrations in PTB+ patients may reflect lower sun exposure or increased utilization. The health consequences of hypovitaminosis D in low-income equatorial populations, at risk for both infectious and chronic diseases, should be studied.

^* To whom correspondence should be addressed. E-mail: hfr{at}life.ku.dk.

Manuscript received 8 July 2008. Initial review completed 16 August 2008. Revision accepted 2 October 2008.