Low serum vitamin D in North Indian multi-drug resistant pulmonary tuberculosis patients: the role of diet and sunlight

Abstract

Background: Tuberculosis (TB) and malnutrition are major global health problems, with multidrug-resistant (MDR) TB complicating international efforts. The role of vitamin D in susceptibility to and as an adjunctive treatment for TB is being studied extensively, although no study has included MDR-TB patients in context to dietary profile with vitamin D levels and sunlight exposure.

Objective: This study aimed to estimate vitamin D serum levels and examine their association with dietary intake of vitamin D and sun exposure in patients with MDR-TB.

Methods: North Indian participants were enrolled in three groups: MDR-TB, drug-susceptible pulmonary TB (DS-PTB), and healthy controls. All consenting participants underwent the estimation of macro- and micronutrient intake and sunlight exposure using structured questionnaires. Serum biochemistry, including 25-hydroxyvitamin D and calcium levels, was measured, and the correlation between variables was determined.

Results: 747 participants were enrolled. Significant differences among the three groups were found in mean serum 25-hydroxyvitamin D levels, body mass index, macronutrient intake, dietary vitamin D and calcium content, and sun exposure index (SEI). All except sun exposure (SEI was highest in DS-PTB patients) were found to follow the trend: MDR-TB < DS-PTB < healthy controls. The mean serum vitamin D levels of all groups were deficient and correlated positively with dietary intake and SEI.

Conclusion: In this study’s we found significant association of serum vitamin D concentrations, dietary intake and sunlight exposure in MDR-TB, DS-PTB patients and healthy controls. Dietary intake may be more important than sun exposure in determining serum levels. However, the significance of this finding is uncertain. Further studies are required to confirm the association, direction, and potential for vitamin D supplementation to treat or prevent MDR-TB infection.

Keywords:

• Multi-drug resistant tuberculosis
• nutritional deficiency
• sunlight
• vitamin D
• nutritional assessment

Acknowledgements

We thank all study participants and staff of the Department of Medicine, AIIMS, and RBIPMT, New Delhi, for enabling the study to run smoothly.

Authors’ contributions

Jaishriram Rathored: conceptualization, methodology, data collection, visualization, investigation, and writing of original draft and editing; Surendra Kumar Sharma: study supervision and review of the original draft and gave his expert advice during the study tenure. Aarti Chauhan: dietary and nutritional assessment. Bhagteshwar Singh: helps in writing the original draft and reviewing Jayant Nagesh Banavaliker: helps in providing the samples and reviewing the original draft; V Sreenivas: helps in statistical analysis; Abhay Krishna Srivastava: helps in biochemical investigation and reviewing the original draft. All authors have reviewed and approved the final draft of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author, [Dr Jaishriram Rathored], upon reasonable request.

Additional information

Funding

This study was funded by The Department of Biotechnology, Ministry of Science and Technology, Government of India, New Delhi, India (Grant No. T/PR/7898/Med/14/1179/2006).