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. 2004 Dec 21;4(1):61.
doi: 10.1186/1471-2334-4-61.

Micronutrient malnutrition and wasting in adults with pulmonary tuberculosis with and without HIV co-infection in Malawi

Monique van Lettow  1 , Anthony D Harries, Johnny J Kumwenda, Ed E Zijlstra, Tamara D Clark, Taha E Taha, Richard D Semba
Affiliations

Micronutrient malnutrition and wasting in adults with pulmonary tuberculosis with and without HIV co-infection in Malawi

Monique van Lettow et al. BMC Infect Dis. .

Abstract

Background: Wasting and micronutrient malnutrition have not been well characterized in adults with pulmonary tuberculosis. We hypothesized that micronutrient malnutrition is associated with wasting and higher plasma human immunodeficiency virus (HIV) load in adults with pulmonary tuberculosis.

Methods: In a cross-sectional study involving 579 HIV-positive and 222 HIV-negative adults with pulmonary tuberculosis in Zomba, Malawi, anthropometry, plasma HIV load and plasma micronutrient concentrations (retinol, alpha-tocopherol, carotenoids, zinc, and selenium) were measured. The risk of micronutrient deficiencies was examined at different severity levels of wasting.

Results: Body mass index (BMI), plasma retinol, carotenoid and selenium concentrations significantly decreased by increasing tertile of plasma HIV load. There were no significant differences in plasma micronutrient concentrations between HIV-negative individuals and HIV-positive individuals who were in the lowest tertile of plasma HIV load. Plasma vitamin A concentrations <0.70 micromol/L occurred in 61%, and zinc and selenium deficiency occurred in 85% and 87% respectively. Wasting, defined as BMI<18.5 was present in 59% of study participants and was independently associated with a higher risk of low carotenoids, and vitamin A and selenium deficiency. Severe wasting, defined as BMI<16.0 showed the strongest associations with deficiencies in vitamin A, selenium and plasma carotenoids.

Conclusions: These data demonstrate that wasting and higher HIV load in pulmonary tuberculosis are associated with micronutrient malnutrition.

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Figures

Figure 1
Figure 1
Log-transformed mean plasma retinol concentrations with 95% C.I. are depicted by severity of wasting and plasma HIV load. Among the not-wasted adults with pulmonary tuberculosis log mean plasma retinol concentration significantly decrease with the increase of plasma HIV load (P = 0.004). Among those with mild, moderate and severe wasting this linear trend did not reach significance. Among the HIV negative adults with pulmonary tuberculosis, log mean plasma retinol concentration significantly decrease with the increasing severity of wasting (P = 0.0001). The same trend appears among those in the 1st, 2nd and 3rd tertile of HIV load; P = 0.0001, P = 0.0001 and P = 0.01 respectively.
Figure 2
Figure 2
Log-transformed mean plasma total carotenoid concentrations with 95% C.I. are depicted by severity of wasting and plasma HIV load. Among not-wasted, mildly wasted, moderately wasted and severely wasted log mean plasma total carotenoid concentrations significantly decrease with the increase of plasma HIV load (P = 0.0001, P = 0.002, P = 0.001 and P = 0.001, respectively). Among the HIV negative adults, and those in the 1st and 2nd tertile of plasma HIV load, log mean plasma total carotenoid concentrations significantly decreased with the increasing severity of wasting (P = 0.007, P = 0.002 and P = 0.0001, respectively). This trend did not reach significance among those in the 3rd tertile of plasma HIV load.
Figure 3
Figure 3
Mean plasma selenium concentrations with 95% C.I. are depicted by severity of wasting and plasma HIV load. Among not-wasted and severely wasted adults, mean plasma selenium concentrations significantly decrease with the increase of plasma HIV load (P = 0.0001 and P = 0.03, respectively). This trend did not reach significance among those with mild and moderate wasting. Among the HIV negative adults, and those in the 1st and 2nd tertile of plasma HIV load, mean plasma selenium concentrations significantly decreased with the increasing severity of wasting (P = 0.02, P = 0.008 and P = 0.0001, respectively). This trend did not reach significance among those in the 3rd tertile of plasma HIV load.
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