A randomized trial of multivitamin supplementation in children with tuberculosis in Tanzania

Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
Nutrition Journal (Impact Factor: 2.6). 10/2011; 10(1):120. DOI: 10.1186/1475-2891-10-120
Source: PubMed


Children with tuberculosis often have underlying nutritional deficiencies. Multivitamin supplementation has been proposed as a means to enhance the health of these children; however, the efficacy of such an intervention has not been examined adequately.
255 children, aged six weeks to five years, with tuberculosis were randomized to receive either a daily multivitamin supplement or a placebo in the first eight weeks of anti-tuberculous therapy in Tanzania. This was only 64% of the proposed sample size as the trial had to be terminated prematurely due to funding constraints. They were followed up for the duration of supplementation through clinic and home visits to assess anthropometric indices and laboratory parameters, including hemoglobin and albumin.
There was no significant effect of multivitamin supplementation on the primary endpoint of the trial: weight gain after eight weeks. However, significant differences in weight gain were observed among children aged six weeks to six months in subgroup analyses (n=22; 1.08 kg, compared to 0.46 kg in the placebo group; 95% CI=0.12, 1.10; p=0.01). Supplementation resulted in significant improvement in hemoglobin levels at the end of follow-up in children of all age groups; the median increase in children receiving multivitamins was 1.0 g/dL, compared to 0.4 g/dL in children receiving placebo (p<0.01). HIV-infected children between six months and three years of age had a significantly higher gain in height if they received multivitamins (n=48; 2 cm, compared to 1 cm in the placebo group; 95% CI=0.20, 1.70; p=0.01; p for interaction by age group=0.01).
Multivitamin supplementation for a short duration of eight weeks improved the hematological profile of children with tuberculosis, though it didn't have any effect on weight gain, the primary outcome of the trial. Larger studies with a longer period of supplementation are needed to confirm these findings and assess the effect of multivitamins on clinical outcomes including treatment success and growth failure. CLINICALTRIALS.GOV IDENTIFIER: NCT00145184.

Download full-text


Available from: Julia L. Finkelstein
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite the burden of both malnutrition and tuberculosis in children worldwide, there are few studies on the mechanisms that underlie this relationship. From available research, it appears that malnutrition is a predictor of tuberculosis disease and is associated with worse outcomes. This is supported through several lines of evidence, including the role of vitamin D receptor genotypes, malnutrition's effects on immune development, respiratory infections among malnourished children, and limited work specifically on pediatric tuberculosis and malnutrition. Nutritional supplementation has yet to suggest significant benefits on the course of tuberculosis in children. There is a critical need for research on childhood tuberculosis, specifically on how nutritional status affects the risk and progression of tuberculosis and whether nutritional supplementation improves clinical outcomes or prevents disease.
    Preview · Article · Oct 2012 · The Journal of Infectious Diseases
  • Source

    Full-text · Book · Jan 2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: Preschool children with tuberculosis (TB) often experience weight loss. Previously,underweight childrenhave been given a supplement of soy protein biscuits made from tempeh. However, the efficacy of tempeh dates biscuits on nutritional status on underweight TB children has not been previously done. This study aimed to assess the effects of tempeh dates biscuit supplementation on the nutritional status of underweight TB children. Methods: A quasi experimental study was conducted on 41 subjects from the intervention group (tempeh dates biscuit) and control groups (tempeh and placebo biscuits). Parameters such as anthropometric data, hemoglobin, albumin, and macromicronutrients intake were analysed before and after the intervention. Results: The three groups showed significant difference in weight, height, and albumin, except for hemoglobin, after six weeks. Tremendous weight and height gain was shown by the tempeh biscuit group (1 kg) and the placebo biscuit group (3.5 cm). The biggest positive change in nutritional status (weight for age) was recorded by the tempeh group (0.5 points). Hemoglobin level was increased by 0.4 point in the intervention group. The mean for blood albumin levels increased by 0.1 point among the intervention and the control groups. Conclusion: Although no evidence was found of a large gain in weight and height in the intervention group, the inclusion of the tempeh dates biscuits in the diet was able to increase hemoglobin level compared with the control group. A similar study in anemic children is necessary to assess the effect of tempeh dates biscuits on hemoglobin changes.
    No preview · Article · Jan 2013 · Malaysian Journal of Nutrition
Show more