Contents lists available at ScienceDirect Complementary Therapies in Medicine journal homepage: www.elsevier.com/locate/ctim Efectiveness of micronutrients supplement in patients with active tuberculosis on treatment: Systematic review/Meta-analysis Betty Katherin Cabrera Andrade a, *, Herney Andrés Garcia-Perdomo (MD, MSc, EdD, PhD, FACS) b,c a Universidad del Valle and Phisycal therapist in Intensive Care Unit in Centro Médico Imbanaco, Cra 38bis # 5b-152 Centro Médico Imbanaco, Second Floor UCI, Adult, Cali, Colombia b School of Public Health, Universidad del Valle - Cl. 4b #36b3, Cali, Colombia c Universidad del Valle Director "UROGIV" Research Group, Colombia ARTICLEINFO Keywords: Micronutrients Tuberculosis Pulmonary Trace elements Vitamins Nutrients Meta-analysis Systematic review ABSTRACT Background: Multiple researchers have suggested the infuence of micronutrients in the cure and survival of tuberculosis. Objective: To determine the efectiveness of micronutrients in the cure and treatment of pulmonary tuberculosis. Methods: Systematic search of randomized controlled trials (RCTs) in databases of people under treatment for active pulmonary tuberculosis, that must have received oral micronutrients for at least four weeks compared with placebo. The synthesis of the variables was shown in standardized mean diference (MD) and/or risk diference (RD). The random efects model was used and was reported in forest plot of the estimates of the efect with a 95 % CI. Results: Sixteen of 246 studies were included, in total 4398 people. Zinc showed (RD, 0.04; 95 % CI, 0.00–0.08) in mortality, increases muscle mass index (MD, 1.20; 95 % CI, 0.04–2.36) and gains weight (MD, 3.10; 95 % CI, 0.66–5.54). Zinc plus vitamin A increases the weight (MD, 3.10; 95 % CI, 2.78–3.42), improving karnofsky scale (MD, 2.50; 95 % CI, 2.22–2.78). Additionally, vitamin D accelerate the sputum conversión time (RD, 0.38; 95 % CI, 0.03–0.73). Hemoglobin (Hb) with vitamin A and zinc achieves statistically signifcant changes (MD, 0.69; 95 % CI, 0.28–1.09) and (MD, 0.52; 95 % CI, 0.21–0.83) and reduces area of cavitations in chest X-ray (MD, -0.33; 95 % CI, -0.60–-0.06). Conclusions: The consumption of micronutrients could achieve weight gain, hemoglobin, accelerated sputum conversion and improvement in quality of life. There are no changes in mortality that may be attributable to the suboptimal dose, larger studies are suggested with adequate doses. 1. Introduction Currently, tuberculosis (TB) is a problem of global magnitude. In 2017, mortality was 1.3 million, being one of the main causes of death and its incidence was 10 million. More than 95 % of new cases occur in low and middle income countries, associated with malnutrition and poverty, which worsen its prognosis. The most common TB is the pul- monary type and its recovery takes long time. 1 , 2 Micronutrients are essential nutrients (vitamins and minerals) ob- tained through food, essential for optimal functioning of the body; an adequate dose has the potential to improve the TB treatment results through the restoration of the cell-mediated immunity, increasing the ability of individuals to fght infection. 3 , 4 Nutritional monitoring during the therapeutic and recovery phase of TB is almost null; in fact, at a global level research and evidence about nutritional support in these patients is limited and shows low quality. 5 One of the primary objectives of health promotion is to maintain an adequate diet and preserve optimal nutritional status that guarantees a physical ftness capable of preventing diseases and accelerating re- covery. 6 According to World Health Organization guidelines and interna- tional standards, when malnutrition is identifed, it is considered a causal factor that must be managed. Promoting nutritional recovery is very important during the TB treatment to facilitate patients their https://doi.org/10.1016/j.ctim.2019.102268 Received 26 August 2019; Received in revised form 15 October 2019; Accepted 26 November 2019 Abbreviations: DRI, dietary reference intake; IC, confdence intervals; MD, mean diference; RD, risk diference; TB, tuberculosis; WHO, World Health Organization ⁎ Corresponding author at: Cra 38bis # 5b2-04, Centro Médico Imbanaco, Second Floor UCI, Adult, Cali, Colombia. E-mail addresses: betty.cabrera@correounivalle.edu.co (B.K. Cabrera Andrade), herney.garcia@correounivalle.edu.co (H.A. Garcia-Perdomo). Complementary Therapies in Medicine 48 (2020) 102268 Available online 06 December 2019 0965-2299/ © 2019 Elsevier Ltd. All rights reserved. T