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Zinc and vitamin A supplementation fails to reduce sputum conversion time in severely malnourished pulmonary tuberculosis patients in Indonesia

Trevino A Pakasi12*, Elvina Karyadi18, Ni Made Desy Suratih3, Michael Salean4, Nining Darmawidjaja5, Hans Bor6, Koos van der Velden6, Wil MV Dolmans7 and Jos WM van der Meer7

Author affiliations

1 South East Asia Minister of Education Organization Tropical Medicine (SEAMEO TROPMED) Regional Center for Community Nutrition, University of Indonesia, Jl. Salemba Raya no.6, Jakarta Pusat 10420, Indonesia

2 Department of Community Medicine Faculty of Medicine University of Indonesia, Jl. Pegangsaan Timur no.16, Jakarta Pusat 10302, Indonesia

3 Department of General Medicine, WZ Johannes General Hospital Jl. Mohammad Hatta no.19, Kupang, Indonesia

4 Department of Radiology WZ Johannes General Hospital, Jl. Mohammad Hatta no.19, Kupang, Indonesia

5 Kefamenanu General Hospital, North Middle Timor District (TTU) Jl. Letjend Suprapto, Kefamenanu, Indonesia

6 Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen International Center for Health Systems Research and Education, Geert Grooteplein Noord 21, Nijmegen 6525 EZ, the Netherlands

7 Department of Internal Medicine, Radboud University Nijmegen Medical Center and Nijmegen Center for Infection, Inflammation and Immunity (N4I), Geert Grooteplein Zuid 8, Nijmegen 6525 GA, the Netherlands

8 Micronutrient Initiative, Gedung Wirausaha Lt. 2 Jl. HR. Rasuna Said Kav C5, Jakarta 12920, Indonesia

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Citation and License

Nutrition Journal 2010, 9:41  doi:10.1186/1475-2891-9-41

Published: 28 September 2010



A previous study showed that combination of zinc and vitamin A reduced sputum conversion time in pulmonary tuberculosis (TB) patients.


We studied the efficacy of which single micronutrient contributed more to the sputum conversion time.


In a double-blind randomized community trial, newly sputum smear positive pulmonary TB patients were assigned randomly to receive zinc, vitamin A, zinc + vitamin A or placebo on top of TB treatment. Patients were asked to deliver their sputum on weekly basis to measure positivity of the bacteria. Nutritional status, chest x-ray, hemoglobin, C-reactive protein (CRP), retinol and zinc level were examined prior to, after 2 and 6 months of treatment.


Initially, 300 patients were enrolled, and 255 finished the treatment. Most patients were severely malnourished (mean BMI 16.5 ± 2.2 Kg/m2). Patients in the zinc + vitamin A group showed earlier sputum conversion time (mean 1.9 weeks) compared with that in the other groups; however the difference was not significant. Also, no benefit could be demonstrated of any of the used supplementations on clinical, nutritional, chest x-ray, or laboratory findings.


This study among severely malnourished TB patients, did not confirm that single or combined supplementation of zinc and vitamin A significantly reduced sputum conversion time or had other significant benefit.