MEAN DIFFERENCE OF ZINC AND SELENIUM LEVELS AND TUBERCULOSIS OUTCOMES IN CHILDREN RECEIVING TREATMENT IN INDONESIA
DOI:
https://doi.org/10.21010/Ajidv19n2S.9Keywords:
Tuberculosis, Zinc, Selenium, Treatment, OutcomeAbstract
Background: Tuberculosis (TB) remains a significant health issue, particularly among children in TB-endemic regions. Micronutrient deficiencies, such as zinc and selenium, may influence TB treatment outcomes. However, the relationship between these micronutrients and TB outcomes in children is not well-established in Indonesia. This study aimed to investigate the mean difference of zinc and selenium levels on TB treatment outcomes in children receiving treatment in Padang, Indonesia.
Materials and Methods: A cross-sectional study was conducted at the district level hospitals in Padang City, Indonesia, from April to October 2024. The study included children aged 1–14 years diagnosed with TB and receiving treatment. Serum zinc and selenium levels were measured using Chemiluminescent Immunoassay (ECLIA). The treatment outcomes were categorized as success (cured and completed treatment) or failure (death, treatment failure, or default).
Results: Zinc levels were significantly lower in the failure group (71.61±8.18 ng/mL) compared to the success group (79.72±8.12 ng/mL) (P<0.05). Similarly, selenium levels were lower in the failure group (89.56±23.47 ng/mL) compared to the success group (115.09±17.86 ng/mL) (P<0.05).
Conclusion: The study found a significant association between lower zinc and selenium levels and unsuccessful TB treatment outcomes in children. These findings suggest that addressing micronutrient deficiencies may play an important role in improving TB treatment outcomes in pediatric populations. Further research is needed to explore potential interventions to improve micronutrient status in TB patients.
References
Amare, B., Moges, B., Mulu, A., Yifru, S., and Kassu, A. (2015). Quadruple burden of HIV/AIDS, tuberculosis, chronic intestinal parasitoses, and multiple micronutrient deficiency in Ethiopia: a summary of available findings. BioMed Research International, 2015: 598605.
Bacelo, A.C., Ramalho, A., Brasil, P.E., Cople-Rodrigues, Cdos, S., Georg, I., and Paiva, E. (2015). Nutritional supplementation is a necessary complement to dietary counseling among tuberculosis and tuberculosis-HIV patients. PLoS One, 10(8): e0134785.
Botella, H., Peyron, P., Levillain, F., Poincloux, R., Poquet, Y., and Brandli, I. (2011). Mycobacterial P1-type ATPases mediate resistance to zinc poisoning in human macrophages. Cell Host & Microbe, 10: 248–259.
Campa, A., Baum, M.K., Bussmann, H., Martinez, S.S., Farahani, M., van Widenfelt, E., (2017). The effect of micronutrient supplementation on active TB incidence early in HIV infection in Botswana. Nutrition and Dietary Supplements, 9: 37–45.
Cintron, C., Dauphinais, M., Fiogbe, A. A., Dogo, M. F., Ate, S., Adjonou, C., (2025). Impact of Nutritional Support for Tuberculosis on Intermediate and Terminal Undernutrition and Treatment Outcomes (INSTITUT) study: a protocol for a quasi-experimental study to assess the impact of nutritional support on tuberculosis treatment outcomes in Benin and Togo. BMJ Open, 15(2): e088629.
Choi, R., Jeong, B.H., Koh, W.J., and Lee, S.Y. (2017). Recommendations for optimizing tuberculosis treatment: therapeutic drug monitoring, pharmacogenetics, and nutritional status considerations. Annals of laboratory Medicine, 37(2): 97–107.
Darnton-Hill, I., Mandal, P. P., de Silva, A., Bhatia, V., and Sharma, M. (2022). Opportunities to prevent and manage undernutrition to amplify efforts to end TB. The International Journal of Tuberculosis and Lung Disease : The Official Journal of The International Union Against Tuberculosis and Lung Disease, 26(1): 6–11.
Dharmaraj, R. B., Mohan, M., George, N., Hariharan, V. P., Swarna, C. B., Muniyapillai, T., (2025). Patterns of Quetelet Index (Body Mass Index) Improvement and Associated Clinical Factors During Initial Tuberculosis Treatment: A Prospective Analysis of Newly Diagnosed Tuberculosis Patients. Cureus, 17(3): e80446.
Grobler, L., Nagpal, S., Sudarsanam, T. D., and Sinclair, D. (2016). Nutritional supplements for people being treated for active tuberculosis. The Cochrane Database of Systematic Reviews, 2016(6): CD006086.
Hao, J. Q., Zhang, L., Yu, Y. Q., Hao, M. Y., Wang, A. X., and Feng, F. M. (2024). Analysis of Dietary and Nutritional Status of Tuberculosis Patients in Hulunbuir Region. Journal of Multidisciplinary Healthcare, 17: 1231–1240.
Hendriyani, H., Sudargo, T., Lusmilasari, L., Helmyati, S., Susetyowati, S., and Nindrea, R. D. (2020). Complementary feeding self-efficacy: a concept analysis. Open Access Macedonian Journal of Medical Sciences, 8(F): 11–22.
Janssen, S., Murphy, M., Upton, C., Allwood, B., and Diacon, A. H. (2025). Tuberculosis: An Update for the Clinician. Respirology (Carlton, Vic.), 30(3): 196–205.
Koethe, J.R., and von Reyn, C.F. (2016). Protein-calorie malnutrition, macronutrient supplements, and tuberculosis. The International Journal of Tuberculosis and Lung Disease : The Official Journal of The International Union Against Tuberculosis and Lung Disease, 20(7): 857–64.
Mendes, Y. C., Dourado, A. L. L., de Oliveira, P. V., Rezende, A. O., Sales, A. C. S., de Sousa, G. P., (2025). Nutritional Factors and Food and Nutrition Insecurity in Patients with Tuberculosis. Nutrients, 17(5): 878.
Nindrea, R. D., Sari, N. P., Harahap, W. A., Haryono, S. J., Kusnanto, H., Dwiprahasto, I., (2020). Survey data of COVID-19 awareness, knowledge, preparedness and related behaviors among breast cancer patients in Indonesia. Data in Brief, 32: 106145.
Nindrea, R. D., Aryandono, T., Lazuardi, L., and Dwiprahasto, I. (2019). Family History of breast cancer and breast cancer risk between malays ethnicity in Malaysia and Indonesia: A Meta-Analysis. Iranian Journal of Public Health, 48(2): 198–205.
Nindrea, R.D., Susanti, R., Indika, P.M., Maisa, B.A., Sukma, M., Rosalina, L., (2024). Modifiable and non-modifiable risk factors for tuberculosis among adults in Indonesia: a systematic review and meta-analysis. African Journal of Infectious Diseases, 18(2): 19–28.
Ramakrishnan, K., Shenbagarathai, R., Kavitha, K., Uma, A., Balasubramaniam, R., and Thirumalaikolundusubramanian, P. (2008). Serum zinc and albumin levels in pulmonary tuberculosis patients with and without HIV. Japanese Journal of Infectious Diseases, 61: 202.
Ramakrishnan, K., Shenbagarathai, R., Kavitha, K., Thirumalaikolundusubramanian, P., and Rathinasabapati, R. (2012). Selenium levels in persons with HIV/tuberculosis in India, Madurai City. Clinical Laboratory, 58(1–2): 165–168.
Ren, Z., Zhao, F., Chen, H., Hu, D., Yu, W., Xu, X., (2019). Nutritional intakes and associated factors among tuberculosis patients: a cross-sectional study in China. BMC Infectious Diseases, 19(1): 907.
Sepehri, Z., Mirzaei, N., Sargazi, A., Sargazi, A., Mishkar, A.P., Kiani, Z., Oskoee, H.O., Arefi, D., and Ghavami, S. (2017). Essential and toxic metals in serum of individuals with active pulmonary tuberculosis in an endemic region. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 6: 8–13.
Sinha, P., Bhargava, M., Carwile, M. E., Dauphinais, M. R., Tisile, P., Cintron, C., (2025). A roadmap for integrating nutritional assessment, counselling, and support into the care of people with tuberculosis. The Lancet. Global Health, 13(5): e967–e973.
Sinha, A. K., Debata, I., Pradhan, P. C., Panda, P. S., Behera, B. K., and Mukhopadhyay, A. (2024). A study to assess the nutritional status and dietary gap among pulmonary tuberculosis patients in Raipur city. Journal of Family Medicine and Primary Care, 13(5): 2138–2142.
Su, L.P., Lian, S.Q., Li, X.G., Hu, Y.F., Wang, Q.Z., Wang, Y., (2013). Investigation of tuberculosis patients' food diversification levels and nutrient intake in Wuwei City. Progress in Modern Biomedicine, 13(33): 6566–71.
Stensland, I., Kim, J.C., Bowring, B., Collins, A.M., Mansfield, J.P., and Pluske, J.R. (2015). A comparison of diets supplemented with a feed additive containing organic acids, cinnamaldehyde and a permeabilizing complex, or zinc oxide, on post-weaning diarrhea, selected bacterial populations, blood measures, and performance in weaned pigs experimentally infected with enterotoxigenic E. coli. Animals, 5: 1147–1168.
Tenforde, M. W., Yadav, A., Dowdy, D. W., Gupte, N., Shivakoti, R., Yang, W. T., (2017). Vitamin A and D Deficiencies Associated With Incident Tuberculosis in HIV-Infected Patients Initiating Antiretroviral Therapy in Multinational Case-Cohort Study. Journal of Acquired Immune Deficiency Syndromes (1999), 75(3): e71–e79.
Yang, Y., Cai, J., Wang, X., Zhao, K., Lei, Z., Han, W., (2025). Nutritional supplementation during tuberculosis treatment to improve clinical symptoms: a double-blinded placebo-controlled randomized trial. Food & Function, 16(1): 102–111.
Zheng, Y., Chen, H., Zhang, C., Hu, D., Zhao, F., Piao, W., (2024). A community-based cross-sectional study of dietary composition and associated factors among tuberculosis patients in China. Scientific Reports, 14(1): 2676.
Nindrea, R.D., Chiau, M. L., Rahman, A. D. (2025). Family support, motivation, and patient adherence to tuberculosis treatment: insights from Indonesia. African Journal of Infectious Diseases, 19(2): 43–49
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