Nutritional status and vitamin A and zinc levels in patients with kala-azar in Piauí, Brazil

Abstract INTRODUCTION: Malnutrition and kala-azar (or visceral leishmaniasis) are significant public health problems in different parts of the world. Immunity and susceptibility to infectious and parasitic diseases are directly linked to the host’s nutritional state, but little is known about the interaction between nutrition and kala-azar. This study aimed to evaluate nutritional status with kala-azar and correlate these findings with the clinical and laboratory manifestations of the disease, and zinc and retinol levels. METHODS: This was a cross-sectional study of 139 patients with kala-azar. Nutritional status classification was performed according to international recommendations. Parametric or nonparametric tests were applied whenever indicated in a two-sided test with a 5% significance level. RESULTS: Weight loss and malnutrition were more frequent in adults. Body mass index-for-age, fat area of the arm, and upper arm muscle area were significantly associated with probability of death. The presence of human immunodeficiency virus, hepatomegaly, and splenomegaly was correlated with nutritional assessment. Blood leukocyte and lymphocyte, serum creatine, and vitamin A levels were significantly higher in adult men. Vitamin A levels were highly associated with the level of hemoglobin and C-reactive protein (CRP) in multivariate analysis. All patients had reduced plasma zinc levels, but this finding had no association with the outcome variables. CONCLUSIONS: Malnutrition was correlated with severe disease and was more prevalent in older people with kala-azar. Vitamin A deficiency was associated with hemoglobin and CRP. Zinc levels were reduced in patients with kala-azar.

摘要 引言：营养不良与黑热病（kala-azar，又称内脏利什曼病（visceral leishmaniasis））是全球多个地区的重大公共卫生问题。宿主的营养状况与其对感染性、寄生虫性疾病的免疫应答及易感性直接相关，但目前关于营养与黑热病之间的相互作用机制仍知之甚少。本研究旨在评估黑热病患者的营养状况，并将相关结果与疾病的临床、实验室表现以及血清锌与视黄醇（retinol）水平进行关联分析。方法：本研究为针对139名黑热病患者的横断面研究。营养状况分类依据国际推荐标准实施。根据研究设计需求采用参数检验或非参数检验，检验类型为双侧检验，显著性水平设定为5%。结果：成人患者中体重下降与营养不良的发生率更高。年龄别体重指数、上臂脂肪面积及上臂肌肉面积与患者的死亡风险存在显著关联。人类免疫缺陷病毒（human immunodeficiency virus）感染、肝大及脾大情况与营养评估结果存在相关性。成年男性的血白细胞计数、淋巴细胞计数、血清肌酸及维生素A水平显著高于其他研究对象。多因素分析显示，维生素A水平与血红蛋白及C反应蛋白（C-reactive protein，CRP）水平高度相关。所有患者均存在血浆锌水平降低的情况，但该指标与研究的结局变量无显著关联。结论：营养不良与黑热病的重症表现相关，且在老年黑热病患者中更为普遍。维生素A缺乏与血红蛋白及C反应蛋白水平异常存在关联。黑热病患者的血清锌水平普遍降低。