Comparative Analysis of Serum Vitamin D Levels in Newly Diagnosed Tuberculosis Patients versus Healthy Individuals: Serum Vitamin D Levels in Newly Diagnosed TB Patients versus Healthy Individuals

Muhammad Aslam Rind; Maria Nazir; Iffat Jamal; Muhammad Saleem; Mubeen Ahmed Memon; Muhammad Zaid

doi:10.54393/pjhs.v6i2.2607

Authors

Muhammad Aslam Rind Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
Maria Nazir Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
Iffat Jamal Department of Medicine, Liaquat University Hospital, Hyderabad, Pakistan
Muhammad Saleem Department of Medicine, Peoples University of Medical and Health Sciences for Women, Shaheed Benazirabad, Pakistan
Mubeen Ahmed Memon Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
Muhammad Zaid Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i2.2607

Keywords:

Tuberculosis, Vitamin-D Deficiency, Health, Nutritional-Inflammatory Profile

Abstract

Vitamin D deficiency has been implicated in the susceptibility to tuberculosis due to its crucial role in immune regulation and host defense mechanisms. Objectives: To compare serum Vitamin D levels between newly diagnosed TB patients and healthy individuals and assess their association with the nutritional-inflammatory profile. Methods: This comparative cross-sectional study was conducted over 1 year from Dec 2021 to Dec 2022. A total of 224 participants, comprising 112 newly diagnosed tuberculosis patients as cases and 112 healthy individuals as controls, were recruited. Cases included patients aged over 18 years with confirmed tuberculosis diagnosis GeneXpert MTB/RIF assay. Controls were individuals without tuberculosis symptoms and with serum vitamin D levels available. Results: Vitamin D levels were found to be lesser in TB patients with median levels of 14.35 ng/mL (interquartile range (IQR): 8.65–25.48) versus 19.08 ng/mL (IQR: 13.92–26.17; p=0.029) in normal people. A higher proportion of TB patients exhibited severe deficiency (<10 ng/mL) at 35.7% compared to 13.4% in controls (p=0.002). Similarly, deficiency (10–20 ng/mL) was more prevalent among tuberculosis patients (42.9%) than controls (26.8%). Vitamin D levels in tuberculosis patients had a positive correlation with BMI and albumin levels. Conclusions: It was concluded that tuberculosis patients exhibited poorer nutritional status, with lower BMI, albumin, hemoglobin, and Vitamin D levels compared to healthy controls with a significantly higher proportion of tuberculosis patients having severe Vitamin D deficiency.

References

Alswailmi FK, Shah SI, Nawaz H, Al-Mazaideh GM. Molecular Mechanisms of Vitamin D-Mediated Immunomodulation. Galen Medical Journal. 2021; 10: E2097. doi: 10.31661/gmj.v10i0.2097.

Siddiqee MH, Bhattacharjee B, Siddiqi UR, Meshbahurrahman M. High Prevalence of Vitamin D Deficiency Among the South Asian Adults: A Systematic Review and Meta-Analysis. BioMed Central Public Health. 2021 Dec; 21: 1-8. doi: 10.1186/s12889-021-11888-1.

Amrein K, Scherkl M, Hoffmann M, Neuwersch-Sommeregger S, Köstenberger M, Tmava Berisha A et al. Vitamin D Deficiency 2.0: An Update on the Current Status Worldwide. European Journal of Clinical Nutrition. 2020 Nov; 74(11): 1498-513. doi: 10.1038/s41430-020-0558-y.

Bussi C and Gutierrez MG. Mycobacterium Tuberculosis Infection of Host Cells in Space and Time. Federation of European Microbiological Societies Microbiology Reviews. 2019 Jul; 43(4): 341-61. doi: 10.1093/femsre/fuz006.

Chai Q, Zhang Y, Liu CH. Mycobacterium Tuberculosis: An Adaptable Pathogen Associated with Multiple Human Diseases. Frontiers in Cellular and Infection Microbiology. 2018 May; 8: 158. doi: 10.3389/fcimb.2018.00158.

Cao Y, Wang X, Liu P, Su Y, Yu H, Du J. Vitamin D and the Risk of Latent Tuberculosis Infection: A Systematic Review and Meta-Analysis. BioMed Central Pulmonary Medicine. 2022 Jan; 22(1): 39. doi: 10.1186/s12890-022-01830-5.

Brighenti S, Bergman P, Martineau AR. Vitamin D and Tuberculosis: Where Next?. Journal of Internal Medicine. 2018 Aug; 284(2): 145-62. doi: 10.1111/joim.12777.

Junaid K and Rehman A. Impact of Vitamin D On Infectious Disease-Tuberculosis-A Review. Clinical Nutrition Experimental. 2019 Jun; 25: 1-0. doi: 10.1016/j.yclnex.2019.02.003.

Soeharto DA, Rifai DA, Marsudidjadja S, Roekman AE, Assegaf CK, Louisa M. Vitamin D as an Adjunctive Treatment to Standard Drugs in Pulmonary Tuberculosis Patients: An Evidence‐Based Case Report. Advances in Preventive Medicine. 2019; 2019(1): 5181847. doi: 10.1155/2019/5181847.

World Health Organization. Global tuberculosis report 2020. Geneva: WHO; 2020 [cited 2025 Jan 23]. Available from: https://www.who.int/publications-detail-redirect/9789240013131

Arshad S and Zaidi SJ. Vitamin D Levels Among Children, Adolescents, Adults, and Elders in Pakistani Population: A Cross-Sectional Study. BioMed Central Public Health. 2022 Nov; 22(1): 2040. doi: 10.1186/s12889-022-14526-6.

Salim N, Sattar MA, Adnan A. High Prevalence of Vitamin D Deficiency in Pakistan and Miscarriages: A Hazard to Pregnancies. Annals of Medicine and Surgery. 2022 Oct; 82. doi: 10.1016/j.amsu.2022.104634.

Nouri-Vaskeh M, Sadeghifard S, Saleh P, Farhadi J, Amraii M, Ansarin K. Vitamin D Deficiency Among Patients with Tuberculosis: A Cross-Sectional Study in Iranian-Azari Population. Tanaffos. 2019 Jan; 18(1): 11.

El Hoss K, Salla M, Khaled S, Krayem M, Hassan H, El Khatib S. Update on Vitamin D Deficiency and Its Impact On Human Health Major Challenges and Technical Approaches of Food Fortification. Journal of Agriculture and Food Research. 2023 Jun; 12: 100616. doi: 10.1016/j.jafr.2023.100616.

Mamadapur VK, Nagaraju S, Prabhu MM. Comparative Study of Vitamin D Levels in Newly Diagnosed Tuberculosis and a Normal Population. Medicina. 2024 Apr; 60(5): 685. doi: 10.3390/medicina60050685.

Płudowski P, Kos-Kudła B, Walczak M, Fal A, Zozulińska-Ziółkiewicz D, Sieroszewski P et al. Guidelines for Preventing and Treating Vitamin D Deficiency: A 2023 Update in Poland. Nutrients. 2023 Jan; 15(3): 695. doi: 10.3390/nu15030695

Balcells ME, Yokobori N, Hong BY, Corbett J, Cervantes J. The Lung Microbiome, Vitamin D, and the Tuberculous Granuloma: A Balance Triangle. Microbial Pathogenesis. 2019 Jun; 131: 158-63. doi: 10.1016/j.micpath.2019.03.041.

Chhabra S, Kashyap A, Bhagat M, Mahajan R, Sethi S. Anemia and Nutritional Status in Tuberculosis Patients. Internatioanl Journal of Applied Basic Medical Research. 2021 Dec;11(4):226-30. doi: 10.4103/ijabmr.ijabmr_76_21.

VanValkenburg A, Kaipilyawar V, Sarkar S, Lakshminarayanan S, Cintron C, Prakash Babu S et al. Malnutrition leads to increased inflammation and expression of tuberculosis risk signatures in recently exposed household contacts of pulmonary tuberculosis. Frontier Immunology. 2022 Sep 28;13:1011166. doi: 10.3389/fimmu.2022.1011166.

Cai L, Hou S, Huang Y, Liu S, Huang X, Yin X et al. The Potential Role of Vitamin D in the Development of Tuberculosis in Chinese Han Population: One Case-Control Study. Frontiers in Medicine. 2022 Jul; 9: 849651. doi: 10.3389/fmed.2022.849651.

Ongwae JM, Musyoki SK, Mongare S. Profile of haematological indices among pulmonary tuberculosis patients attending Kisii Teaching and Referral Hospital, Kenya. International Journal of Community Medicine and Public Health [Internet]. 2023 Aug;10(8):2669-2675. https://dx.doi.org/10.18203/2394-6040.ijcmph20232351

Dasaradhan T, Koneti J, Kalluru R, Gadde S, Priya Cherukuri S, Chikatimalla R. Tuberculosis- . Cureus. 2022 Aug; 14(8). doi: 10.7759/cureus.27746.

Papagni R, Pellegrino C, Di Gennaro F, Patti G, Ricciardi A, Novara R et al. Impact of Vitamin D in Prophylaxis and Treatment in Tuberculosis Patients. International Journal of Molecular Sciences. 2022 Mar; 23(7): 3860. doi: 10.3390/ijms23073860.

Afzal A, Rathore R, Butt NF, Randhawa FA. Efficacy of Vitamin D Supplementation in Achieving An Early Sputum Conversion in Smear Positive Pulmonary Tuberculosis. Pakistan Journal of Medical Sciences. 2018 Jul; 34(4): 849. doi: 10.12669/pjms.344.14397.

Lips P, de Jongh RT, van Schoor NM. Trends in Vitamin D Status Around the World. Journal of Bone and Mineral Research Plus. 2021 Dec; 5(12): e10585. doi: 10.1002/jbm4.10585.