Lower vitamin D level is associated with higher prevalence of pulmonary tuberculosis in under-five children actively living in tropical countries

Abstract

Objective: Indonesia accounted for 845.000 tuberculosis (TB) cases, ranked as the second-highest TB incidence in the world. Various studies in childhood TB and vitamin D has overgrown in recent years, but there is no study for vitamin D status in under-five children with pulmonary tuberculosis in Indonesia as tropical country that has an abundant sun exposure. This study evaluates the vitamin D level in under-five children with pulmonary TB compared with healthy children control group. Materials and Methods: This comparative study with a cross-sectional design was conducted in outpatient clinic from February 2019 – February 2020. We selected children ≤5 years old, diagnosed with pulmonary TB; the control group was the random siblings or neighbors who did not have tuberculosis. Differences in 25-hydroxyvitamin D levels in both groups were statistically analyzed with independent t-test. The vitamin D cutoff values were determined using receiver operating characteristic (ROC) curve analysis. Results: A total of 70 patients aged ≤5 years old met the inclusion criteria, 35 childrens were assigned for each group. The 25-hydroxy vitamin D mean level in the TB group was 42.72 nmol/L and 97.74 nmol/L in control group. The TB group has significantly lower 25-hydroxy vitamin D levels than control group (p<0.001). With sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100%, 97.1%, 97.2%, and 100%, respectively, the optimal cutoff point level for 25-hydroxy vitamin D was 80nmol/L. Conclusion: Serum levels of 25-hydroxy vitamin D in children with pulmonary TB are significantly lower than in healthy children. Further study should be conducted to determine the efficacy of vitamin D supplementation in the treatment of children with tuberculosis.