***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To assess the effect of micronutrient supplementation on tuberculosis ( TB ) patient outcomes . MATERIAL AND METHODS The r and omized , double-blinded , placebo-controlled study was conducted in pulmonary TB patients undergoing directly observed treatment short course/ tratamiento acortado estrictamente supervisado ( TAES/ DOTS ) at IMSS in Ciudad Juarez , Chihuahua , Mexico , who were recruited during August 2005-July 2006 . Consecutive patients received zinc and vitamin A supplements or matched placebo for four months . Dietary intake , blood zinc and vitamin A , immune response ( IFN-gamma , TNF-alpha , and IL-10 mRNA ) , and sputum smear conversion were measured . RESULTS The proportion of micronutrient compared to placebo group subjects with a negative sputum smear by month 3 was significantly increased ( p= 0.03 ) . This occurred subsequent to increased TNF-alpha and IFN-gamma and decreased IL-10 observed at month 2 . Micronutrient supplementation appeared to accelerate the beneficial therapeutic effect of chemotherapy . CONCLUSIONS The earlier elimination of bacilli from sputum was associated with improved zinc status and Th1 immune response . The therapeutic effect of vitamin A was less evident RATIONALE Vitamin D has been shown to be involved in the host immune response toward Mycobacterium tuberculosis . OBJECTIVES To test whether vitamin D supplementation of patients with tuberculosis ( TB ) improved clinical outcome and reduced mortality . METHODS We conducted a r and omized , double-blind , placebo-controlled trial in TB clinics at a demographic surveillance site in Guinea-Bissau . We included 365 adult patients with TB starting antituberculosis treatment ; 281 completed the 12-month follow-up . The intervention was 100,000 IU of cholecalciferol or placebo at inclusion and again 5 and 8 months after the start of treatment . MEASUREMENTS AND MAIN RESULTS The primary outcome was reduction in a clinical severity score ( TBscore ) for all patients with pulmonary TB . The secondary outcome was 12-month mortality . No serious adverse effects were reported ; mild hypercalcemia was rare and present in both arms . Reduction in TBscore and sputum smear conversion rates did not differ among patients treated with vitamin D or placebo .  Overall mortality was 15 % ( 54 of 365 ) at 1 year of follow-up and similar in both arms ( 30 of 187 for vitamin D treated and 24 of 178 for placebo ; relative risk , 1.19 [ 0.58 - 1.95 ] ) . HIV infection was seen in 36 % ( 131 of 359 ) : 21 % ( 76 of 359 ) HIV-1 , 10 % ( 36 of 359 ) HIV-2 , and 5 % ( 19 of 357 ) HIV-1 + 2 . CONCLUSIONS Vitamin D does not improve clinical outcome among patients with TB and the trial showed no overall effect on mortality in patients with TB ; it is possible that the dose used was insufficient . Clinical trial registered with www.controlled-trials.com/is rct n ( IS RCT N35212132 ) Background The association between pulmonary tuberculosis ( PTB ) and diabetes mellitus ( DM ) has been previously attracted much attention . Diabetes alters immunity to tuberculosis , leading to more frequent treatment failure in TB patients with DM . Moreover , TB and DM often coincide with micronutrients deficiencies , such as retinol and vitamin D , which are especially important to immunity of the body and may influence pancreas β-cell function . However , the effects of retinol and vitamin D supplementation in active TB patients with diabetes on treatment outcomes , immune and nutrition state are still uncertain . We are conducting a r and omized controlled trial of vitamin A and /or D in active PTB patients with DM in a network of 4 TB treatment clinics to determine whether the supplementation could improve the outcome in the patients . Methods / design This is a 2 × 2 factorial trial . We plan to enroll 400 active PTB patients with DM , and r and omize them to VA ( 2000 IU daily retinol ) ; VD ( 400 IU daily cholecalciferol ) ; VAD ( 2000 IU daily retinol plus 400 IU cholecalciferol ) or control ( placebo ) group . Our primary outcome measure is the efficacy of anti-tuberculosis treatment and ameliorating of glucose metabolism , and the secondary outcome measure being immune and nutrition status of the subjects . Of the first 37 subjects enrolled : 8 have been r and omized to VA , 10 to VD , 9 to VAD and 10 to control . To date , the sample is 97.3 % Han Chinese and 91.9 % female . The average fasting plasma glucose level is 12.19 mmol/L. Discussion This paper describes the design and rationale of a r and omized clinical trial comparing VA and /or VD supplementation to active pulmonary TB patients with DM . Our trial will allow rigorous evaluation of the efficacy of the supplementation to active TB and DM therapy for improving clinical outcomes and immunological condition . This detailed description of trial methodology can serve as a template for the development of future treatment scheme for active TB patient with DM.Trial registration In tuberculosis ( TB ) , the production of nitric oxide ( NO ) is confirmed but its importance in host defense is debated . Our aim was to investigate whether a food supplement rich in arginine could enhance clinical improvement in TB patients by increased NO production . Smear positive TB patients from Gondar , Ethiopia ( n = 180 ) were r and omized to a food supplementation rich in arginine ( peanuts , equivalent to 1 g of arginine/day ) or with a low arginine content ( wheat crackers , locally called daboqolo ) during four weeks . The primary outcome was cure rate according to the WHO classification and secondary outcomes were sputum smear conversion , weight gain , sedimentation rate , reduction of cough and chest X-ray improvement as well as levels of NO in urine ( uNO ) or exhaled air ( eNO ) at two months . There was no effect of the intervention on the primary outcome ( OR 1.44 , 95 % CI : 0.69 - 3.0 , p = 0.39 ) or secondary outcomes . In the subgroup analysis according to HIV status , peanut supplemented HIV+/TB patients showed increased cure rate ( 83.8 % ( 31/37 ) vs 53.1 % ( 17/32 ) , p < 0.01 ) . A low baseline eNO ( < 10 ppb ) in HIV+/TB patients was associated with a decreased cure rate . We conclude that nutritional supplementation with a food supplement rich in arginine did not have any overall clinical effect . In the subgroup of HIV positive TB patients , it significantly increased the cure rate and as an additional finding in this subgroup , low initial levels of NO in exhaled air were associated with a poor clinical outcome but this needs to be confirmed in further studies Background . Dietary supplementation has been used as a mechanism to augment the immune system . Adjunctive therapy with L-arginine has the potential to improve outcomes in active tuberculosis . Methods . In a r and omized clinical trial 63 participants with smear-positive pulmonary tuberculosis in Markazi Province of Iran were given arginine or placebo for 4 weeks in addition to conventional chemotherapy . The final treatment success , sputum conversion , weight gain , and clinical symptoms after one and two months were considered as primary outcomes and secondary outcomes were ESR , CRP , and Hg . Data were collected and analyzed with SPSS software ( ver . 18 ) . Results . Arginine supplementation reduced constitutional symptoms ( P = 0.032 ) in patients with smear-positive TB at the end of the first month of treatment . Arginine treated patients had significantly increased BMI at the end of the first and second months of treatment ( P = 0.032 and P = 0.04 ) and a reduced CRP at the end of the first month of treatment ( P = 0.03 ) versus placebo group . Conclusion . Arginine is useful as an adjunctive therapy in patients with active tuberculosis , in which the effects are more likely mediated by the increased production of nitric oxide and improved constitutional symptoms and weight gain . This trial is registered with Clinical Trials Registry of Iran : I RCT 201211179855N2 Background Vitamin D ( vitD ) and L-arginine have important antimycobacterial effects in humans . Adjunctive therapy with these agents has the potential to improve outcomes in active tuberculosis ( TB ) . Methods In a 4-arm r and omised , double-blind , placebo-controlled factorial trial in adults with smear-positive pulmonary tuberculosis ( PTB ) in Timika , Indonesia , we tested the effect of oral adjunctive vitD 50,000 IU 4-weekly or matching placebo , and L-arginine 6.0 g daily or matching placebo , for 8 weeks , on proportions of participants with negative 4-week sputum culture , and on an 8-week clinical score ( weight , FEV1 , cough , sputum , haemoptysis ) . All participants with available endpoints were included in analyses according to the study arm to which they were originally assigned . Adults with new smear-positive PTB were eligible . The trial was registered at Clinical Trials.gov NCT00677339 . Results 200 participants were enrolled , less than the intended sample size : 50 received L-arginine + active vitD , 49 received L-arginine + placebo vit D , 51 received placebo L-arginine + active vitD and 50 received placebo L-arginine + placebo vitD. According to the factorial model , 99 people received arginine , 101 placebo arginine , 101 vitamin D , 99 placebo vitamin D. Results for the primary endpoints were available in 155 ( 4-week culture ) and 167 ( clinical score ) participants . Sputum culture conversion was achieved by week 4 in 48/76 ( 63 % ) participants in the active L-arginine versus 48/79 ( 61 % ) in placebo L-arginine arms ( risk difference −3 % , 95 % CI −19 to 13 % ) , and in 44/75 ( 59 % ) in the active vitD versus 52/80 ( 65 % ) in the placebo vitD arms ( risk difference 7 % , 95 % CI −9 to 22 % ) . The mean clinical outcome score also did not differ between study arms . There were no effects of the interventions on adverse event rates including hypercalcaemia , or other secondary outcomes . Conclusion Neither vitD nor L-arginine supplementation , at the doses administered and with the power attained , affected TB outcomes . Registry Clinical Trials.gov . Registry number : BACKGROUND The results of cross-sectional studies indicate that micronutrient deficiencies are common in patients with tuberculosis . No published data exist on the effect of vitamin A and zinc supplementation on antituberculosis treatment . OBJECTIVE Our goal was to investigate whether vitamin A and zinc supplementation increases the efficacy of antituberculosis treatment with respect to clinical response and nutritional status . DESIGN In this double-blind , placebo-controlled trial , patients with newly diagnosed tuberculosis were divided into 2 groups . One group ( n = 40 ) received 1500 retinol equivalents ( 5000 IU ) vitamin A ( as retinyl acetate ) and 15 mg Zn ( as zinc sulfate ) daily for 6 mo ( micronutrient group ) . The second group ( n = 40 ) received a placebo . Both groups received the same antituberculosis treatment recommended by the World Health Organization . Clinical examinations , assessment s of micronutrient status , and anthropometric measurements were carried out before and after 2 and 6 mo of antituberculosis treatment . RESULTS At baseline , 64 % of patients had a  body mass index ( in kg/m(2 ) ) < 18.5 , 32 % had plasma retinol concentrations < 0.70 micromol/L , and 30 % had plasma zinc concentrations < 10.7 micromol/L. After antituberculosis treatment , plasma zinc concentrations were not significantly different between groups . Plasma retinol concentrations were significantly higher in the micronutrient group than in the placebo group after 6 mo ( P < 0.05 ) . Sputum conversion ( P < 0.05 ) and resolution of X-ray lesion area ( P < 0.01 ) occurred earlier in the micronutrient group . CONCLUSION Vitamin A and zinc supplementation improves the effect of tuberculosis medication after 2 mo of antituberculosis treatment and results in earlier sputum smear conversion BACKGROUND Nutritional support is often recommended as part of the treatment of tuberculosis , but it has never been properly tested . OBJECTIVE We assessed the effects of early nutritional intervention on lean mass and physical function in patients with tuberculosis and wasting . DESIGN Patients who started antituberculous therapy within the previous 2 wk were r and omly assigned to receive st and ard nutritional counseling ( control group ) or nutritional counseling to increase their intake through diet and high-energy supplements ( nut 
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However , supplementation may have little or no effect on weight gain during treatment ( data not pooled ; five trials , 2940 participants , low quality evidence ) , and no studies have assessed the effect on quality of life .
Plasma levels of vitamin A appear to increase following initiation of tuberculosis treatment regardless of supplementation .
In contrast , supplementation probably does improve plasma levels of zinc , vitamin D , vitamin E , and selenium , but this has not been shown to have clinical ly important benefits .
Of note , despite multiple studies of vitamin D supplementation in different doses , statistically significant benefits on sputum conversion have not been demonstrated .
Authors ' conclusions There is currently insufficient research to know whether routinely providing free food , or energy supplements improves tuberculosis treatment outcomes , but it probably improves weight gain in some setting s. Although blood levels of some vitamins may be low in people starting treatment for active tuberculosis , there is currently no reliable evidence that routinely supplementing above recommended daily amounts has clinical benefits .