Nutritional status and vitamin D3 during antimicrobial treatment.

摘要

We welcome the study by Adrian Martineau and colleagues (Jan 15, p 242), which assessed the potential of 10 mg supplemental vitamin D_3 in four divided doses to accelerate rates of sputum culture conversion in pulmonary tuberculosis. Although Martineau and colleagues did not find a significant difference between treatment groups, a small subset of patients with the tt Taql vitamin D receptor genotype seemed to have enhanced sputum culture conversion rates with vitamin D. Might poor adherence to the vitamin-D_3containing vigantol oil have obscured a larger-significant-ffect? On the other hand, is Martineau and colleagues' supplementation schedule safe? They noted hypercalcaemia in two of 71 patients. Moreover, other treatment effects such as nutritional factors might have confounded the outcome. Severe weight loss in untreated tuberculosis is common. In Martineau and colleagues' study, a weight gain of 6% in the vitamin D_3 group and 5% in the placebo group was seen at day 56. Low gain in bodyweight and low serum creatinine (reflected a low protein mass) are associated with treatment failure. Low serum 25-hydroxyvitamin D might be a common feature of the acute-phase response, occurring separately from true dietary deficiency. Perhaps data on nutrition and inflammation should be included in future regression models to estimate the full potential of vitamin D_3.