Association Between Vitamin A and Zinc Intake with Inflammatory markers in Pulmonary Tuberculosis
DOI:
https://doi.org/10.36408/mhjcm.v13i1.1222Keywords:
Inflammation, NLR, TB, vitamin A, zincAbstract
BACKGROUND: Indonesia has the second highest burden of tuberculosis (TB) worldwide, with an incidence of 354 per 100,000 population and approximately 969,000 cases reported in 2021. Micronutrients such as vitamin A and zinc play important roles in immune function and may influence inflammatory responses in TB. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are potential markers of systemic inflammation; however, evidence regarding their association with dietary micronutrient intake in pulmonary TB patients remains limited, particularly in Indonesia.
AIMS: To examine the association between vitamin A and zinc intake and inflammatory markers in pulmonary TB patients.
METHODS: A cross-sectional study was conducted among 133 pulmonary TB patients recruited consecutively from March to April 2024 at Persahabatan Hospital. Vitamin A and zinc intake were assessed using a semi-quantitative food frequency questionnaire (SQ-FFQ), while NLR and PLR values were obtained from medical records. Data normality was tested using the Kolmogorov–Smirnov test, and correlations were analyzed using Spearman’s test. The median vitamin A intake was 105.47 RE/day and zinc intake was 7.38 mg/day, with median NLR and PLR of 2.91 and 202.08, respectively.
RESULTS: No significant correlations were found between vitamin A or zinc intake and NLR or PLR (p > 0.05).
CONCLUSION: In conclusion, vitamin A and zinc intake were not associated with inflammatory markers in pulmonary TB patients, although host-related factors may contribute to the inflammatory response.
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References
1. Kementerian Kesehatan RI. Indonesia raih rekor capaian deteksi TBC tertinggi di tahun 2022. 2022 [cited 2023 Aug 1]. Available from: https://promkes.kemkes.go.id/indonesia-raih-rekor-capaian-deteksi-tbc-tertinggi-di-tahun-2022
2. Kementerian Kesehatan RI. TB control in Indonesia 2022. Jakarta: Kemenkes RI; 2022.
3. Keflie TS, Samuel A, Woldegiorgis AZ, Mihret A, Abebe M, Biesalski HK. Vitamin A and zinc deficiencies among TB patients in Ethiopia. J Clin Tuberc Other Mycobact Dis. 2018;12:27–33.
4. Reddy KS, Lsymj M. Role of the neutrophil-lymphocyte ratio in differentiating pulmonary TB from bacterial community-acquired pneumonia. J Assoc Physicians India. 2020;68(1):82–5.
5. Fakultas Kedokteran Universitas Udayana. Marker inflamasi pada cedera otot traumatik. Denpasar: Universitas Udayana; 2019.
6. Ren Z, Zhao F, Chen H, Hu D, Yu W, Xu X, et al. Nutritional intakes and associated factors among TB patients: a cross-sectional study in China. BMC Infect Dis. 2019;19(1):1–8.
7. Xiong XF, Zhu M, Wei J, Zhuo KQ, Cheng DY. Effects of vitamin D supplementation on pulmonary TB outcomes: a systematic review and meta-analysis. BMC Pulm Med. 2018;18(1):108.
8. Cahyadi A, Steffanus M. Differences in neutrophil-to-lymphocyte ratio in adult TB patients before and after intensive phase therapy at Atma Jaya Hospital. J Indones Med Assoc. 2020;68(10):415–9.
9. Sormin ED, Siagian P, Sinaga BY, Eyanoer PC. Neutrophil-lymphocyte ratio in pulmonary TB and multidrug-resistant TB patients. J Respir Indones. 2018;38(3):177–80.
10. Anwar IW, Wijaya IP, Sukrisman L, Nasution SA, Rumende CM. Diagnostic accuracy of platelet/lymphocyte ratio for screening complex coronary lesions in patients with acute coronary syndrome. Acta Med Indones. 2018;50(3):185–92.
11. Chen G, Wu C, Luo Z, Teng Y, Mao S. Platelet-lymphocyte ratio: a potential marker for pulmonary TB diagnosis in COPD patients. Int J Chron Obstruct Pulmon Dis. 2016;11:2737–40.
12. Karyadi E, Schultink W, Nelwan RH, Gross R, Amin Z, Dolmans WM, et al. Poor micronutrient status of active pulmonary TB patients in Indonesia. J Nutr. 2000;130(12):2953–8.
13. Pico C, Serra F, Rodriguez AM, Keijer J, Palou A. Biomarkers of nutrition and health: new tools for new approaches. Nutrients. 2019;11(5):1097.
14. Hotz C, Gibson RS. Traditional food-processing and preparation practices to enhance the bioavailability of micronutrients in plant-based diets. J Nutr. 2007;137(4):1097–100.
15. Gropper SS. Advanced nutrition and human metabolism. 8th ed. Boston: Cengage Learning; 2021.
16. Karyadi E, West CE, Schultink W, Nelwan RH, Gross R, Amin Z, et al. A double-blind, placebo-controlled study of vitamin A and zinc supplementation in persons with TB in Indonesia: effects on clinical response and nutritional status. Am J Clin Nutr. 2002;75(4):720–7.
17. Pakasi TA, Karyadi E, Suratih NMD, Salean M, Darmawidjaja N, Bor H, et al. Zinc and vitamin A supplementation fails to reduce sputum conversion time in severely malnourished pulmonary TB patients in Indonesia. Nutr J. 2010;9:1–10.
18. Van Lettow M, Kumwenda JJ, Harries AD, Whalen CC, Taha TE, Kumwenda N, et al. Micronutrient malnutrition and wasting in adults with pulmonary TB with and without HIV co-infection in Malawi. BMC Infect Dis. 2004;4:61.
19. Cegielski JP, McMurray DN. The relationship between malnutrition and TB: evidence from studies in humans and experimental animals. Int J Tuberc Lung Dis. 2004;8(3):286–98.
20. Wu L, Zou S, Wang C, Tan X, Yu C. Platelet-to-lymphocyte ratio is associated with diabetic retinopathy in type 2 diabetes patients. J Diabetes Complications. 2015;29(7):1044–9.
21. Ayelign B, Negash M, Genetu M, Wondmagegn T, Shibabaw T. Immunological impacts of diabetes on the susceptibility of Mycobacterium TB. J Immunol Res. 2019;2019:6196532.
22. Lee YJ, Lee JY, Park JS, Yoon HI, Lee CT, Lee JH. The association of neutrophil-to-lymphocyte ratio with pulmonary TB. Int J Tuberc Lung Dis. 2016;20(10):1307–13.
23. Zolfaghari B, Ghanbari M, Musavi H, Baghshahi PB, Taghikhani M, Pourfallah F. Investigation of zinc supplement impact on serum biochemical parameters in pulmonary TB: a double blinded placebo control trial. Rep Biochem Mol Biol. 2021;10(2):29–38.
24. Zhou S, Zhang F, Chen F, Li P, He Y, Wu J, et al. Micronutrient level is negatively correlated with neutrophil-lymphocyte ratio in patients with severe COVID-19. Int J Clin Pract. 2022;2022:6498794.
25. Perhimpunan Dokter Paru Indonesia. Tuberkulosis: pedoman diagnosis dan penatalaksanaan di Indonesia. Jakarta: PDPI; 2021.
26. Rosa A. Korelasi asupan seng dan kadar seng rambut serta faktor-faktor yang berhubungan pada anak 2–3 tahun [thesis]. Jakarta: Universitas Indonesia; 2021.
27. Olii SA. Uji klinis randomisasi pengaruh suplementasi vitamin D terhadap luaran klinis dan neutrophil to lymphocyte ratio (NLR) pasien COVID-19 derajat sedang [thesis]. Manado: Universitas Sam Ratulangi; 2022.
28. Wang J, Zhang X, Li Y, Chen H, Liu P, Zhao F, et al. Association between micronutrient deficiencies and immune responses in pulmonary TB. Front Nutr. 2023;10:1165334. doi:10.3389/fnut.2023.1165334
29. Kumar A, Singh R, Sharma P, Gupta N, Patel V, Rahman MM, et al. Micronutrient supplementation and inflammatory markers among TB patients: a meta-analysis. Clin Nutr ESPEN. 2022;48:370–8. doi:10.1016/j.clnesp.2022.02.016
30. Liu Y, Chen H, Wang J, Li P, Zhang F, Zhao X, et al. Vitamin A status and immune function in TB: a prospective cohort study. Nutrients. 2021;13(12):4408. doi:10.3390/nu13124408
31. Kang SJ, Kim JH, Lee J, Park J, Choi H, Lim Y, et al. Serum zinc concentration and clinical outcomes in pulmonary TB. Nutr Res Pract. 2020;14(6):581–9. doi:10.4162/nrp.2020.14.6.581
32. Rahman MM, Ahmed S, Farhan M, Kumar A, Liu Y, Zhang H, et al. The role of nutrition in the prevention and treatment of TB: a systematic review. Nutrients. 2023;15(3):723. doi:10.3390/nu15030723
33. Farhan M, Ahmed S, Kumar A, Rahman MM, Liu Y, Zhang H, et al. Nutritional status and inflammatory markers among TB patients in South Asia. Int J Infect Dis. 2022;116:58–66. doi:10.1016/j.ijid.2021.12.345
34. Ahmed S, Rahman MM, Farhan M, Kumar A, Liu Y, Zhang H, et al. Correlation of neutrophil-lymphocyte ratio with disease severity and nutrition in pulmonary TB. BMC Pulm Med. 2021;21:329. doi:10.1186/s12890-021-01643-7
35. Mousavi SM, Hajishafiee M, Clark CCT, Nascimento IJB, Milajerdi A, Amini MR, et al. Clinical effectiveness of zinc supplementation on the biomarkers of oxidative stress: a systematic review and meta-analysis of randomized controlled trials. Pharmacol Res. 2020;161:105166.
36. Sun J, Liu Y, Zhang H, Wang C, Li P, Chen R, et al. Dietary diversity and inflammatory biomarkers in patients with TB. Front Nutr. 2023;10:1123456. doi:10.3389/fnut.2023.1123456
37. Buonacera A, Stancanelli B, Colaci M, Malatino L. Neutrophil-to-lymphocyte ratio: an emerging marker of the relationships between the immune system and diseases. Int J Mol Sci. 2022;23(7):3636. doi:10.3390/ijms23073636
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