The Effect of Suplementation Omega-3 on Sputum Conversion, Body Mass Index, Interleukin-6 and Monocyte Lymphocyte Ratio in the Treatment of Pulmonary Tuberculosis

Ferryansyah Ferryansyah; Mohamad  Isa; Juhairina Juhairina; Haryati Haryati; Ali  Assagaf; Erna  Kusumawardhani

doi:10.37899/journallamedihealtico.v6i3.2041

Ferryansyah Faculty of Medicine and Health Sciences, Lambung Mangkurat Univeristy- Hospital Ulin Banjarmasin
Mohamad Isa Faculty of Medicine and Health Sciences, Lambung Mangkurat Univeristy- Hospital Ulin Banjarmasin
Juhairina Faculty of Medicine and Health Sciences, Lambung Mangkurat Univeristy- Hospital Ulin Banjarmasin
Haryati Faculty of Medicine and Health Sciences, Lambung Mangkurat Univeristy- Hospital Ulin Banjarmasin
Ali Assagaf Faculty of Medicine and Health Sciences, Lambung Mangkurat Univeristy- Hospital Ulin Banjarmasin
Erna Kusumawardhani Faculty of Medicine and Health Sciences, Lambung Mangkurat Univeristy- Hospital Ulin Banjarmasin

DOI: https://doi.org/10.37899/journallamedihealtico.v6i3.2041

Keywords: Body Mass Index, Interleukin-6, Conversion, Sputum, Omega-3

Abstract

Tuberculosis (TB) is a disease caused by Mycobacteriun Tuberculosis. Its cases continue to increase both in Indonesia, and in the world. Efforts to increase the success rate of TB treatment and reduce the level of transmission need to continue to be developed, one of which is with additional therapy in its treatment. Omega-3 has anti-inflammatory and anti-bacterial potential, which is predicted to increase the success of TB treatment, as seen from sputum conversion, increased body mass index (BMI) and important inflammatory parameters in TB infection namely interleukin-6 (IL-6), monocyte lymphocyte ratio (MLR) values. This study was conducted to determine the effect of Omega-3 addition on sputum conversion, BMI, IL-6 levels and MLR values in pulmonary tuberculosis treatment. Experimental study with consecutive sampling in drug-sensitive pulmonary TB patients who were given additional Omega-3 dose of 1,200 mg (@600mg/capsule), compared with the control group. Each sample was monitored for sputum conversion, BMI, IL-6 levels and MLR values at week 0 (m0), week 4 (m4) and week 8 (m8). In this study, there was a significant effect of adding Omega-3 on reducing IL-6 levels (p= 0.013), reducing MLR values (p= 0.005) and increasing BMI (p= 0.047) but no significant effect on sputum conversion (p= 1,000). The addition of Omega-3 had a significant effect on reducing IL-6 levels, reducing MLR values and increasing BMI, but did not have a significant effect on sputum conversion in pulmonary TB treatment.

References

Akkerman, O. W., Ter Beek, L., Centis, R., Maeurer, M., Visca, D., Muñoz-Torrico, M., ... & Migliori, G. B. (2020). Rehabilitation, optimized nutritional care, and boosting host internal milieu to improve long-term treatment outcomes in tuberculosis patients. International Journal of Infectious Diseases, 92, S10-S14. https://doi.org/10.1016/j.ijid.2020.01.029

Alshatwi, A. A., & Subash-Babu, P. (2018). Effects of increasing ratios of dietary omega-6/omega-3 fatty acids on human monocyte immunomodulation linked with atherosclerosis. Journal of Functional Foods, 41, 258-267. https://doi.org/10.1016/j.jff.2017.12.020

Bieber, K., & Autenrieth, S. E. (2015). Insights how monocytes and dendritic cells contribute and regulate immune defense against microbial pathogens. Immunobiology, 220(2), 215-226. https://doi.org/10.1016/j.imbio.2014.10.025

Boni, F. G., Hamdi, I., Koundi, L. M., Shrestha, K., & Xie, J. (2022). Cytokine storm in tuberculosis and IL-6 involvement. Infection, Genetics and Evolution, 97, 105166. https://doi.org/10.1016/j.meegid.2021.105166

Calder, P. C. (2010). Omega-3 fatty acids and inflammatory processes. Nutrients, 2(3), 355-374. https://doi.org/10.3390/nu2030355

COGHILL, A. E., SCHENK, J. M., MAHKOUL, Z., OREM, J., PHIPPS, W., & CASPER, C. (2018). Omega-3 decreases interleukin-6 levels in HIV and HHV-8 co-infected patients: results from a randomized supplementation trial in Uganda. AIDS (London, England), 32(4), 505. https://doi.org/10.1097/QAD.0000000000001722

Damsbo-Svendsen, S., Rønsholdt, M. D., & Lauritzen, L. (2013). Fish oil-supplementation increases appetite in healthy adults. A randomized controlled cross-over trial. Appetite, 66, 62-66. https://doi.org/10.1016/j.appet.2013.02.019

Domingo-Gonzalez, R., Prince, O., Cooper, A., & Khader, S. A. (2016). Cytokines and chemokines in Mycobacterium tuberculosis infection. Microbiology spectrum, 4(5), 10-1128. https://doi.org/10.1128/microbiolspec.tbtb2-0018-2016

Giorda, C. B., Avogaro, A., Maggini, M., Lombardo, F., Mannucci, E., Turco, S., ... & Diabetes and Informatics Study Group. (2008). Recurrence of cardiovascular events in patients with type 2 diabetes: epidemiology and risk factors. Diabetes care, 31(11), 2154-2159. https://doi.org/10.2337/dc08-1013

Gunasekaran, H., Ranganathan, U. D., & Bethunaickan, R. (2025). The importance of inflammatory biomarkers in detecting and managing latent tuberculosis infection. Frontiers in Immunology, 16, 1538127. https://doi.org/10.3389/fimmu.2025.1538127

Hayford, F. E., Ozturk, M., Dolman, R. C., Blaauw, R., Nienaber, A., Loots, D. T., ... & Malan, L. (2021). Longer-term Omega-3 LCPUFA more effective adjunct therapy for tuberculosis than ibuprofen in a C3HeB/FeJ tuberculosis mouse model. Frontiers in Immunology, 12, 659943. https://doi.org/10.3389/fimmu.2021.659943

Holtz, T. H., Sternberg, M., Kammerer, S., Laserson, K. F., Riekstina, V., Zarovska, E., ... & Leimane, V. (2006). Time to sputum culture conversion in multidrug-resistant tuberculosis: predictors and relationship to treatment outcome. Annals of internal medicine, 144(9), 650-659. https://doi.org/10.7326/0003-4819-144-9-200605020-00008

Inui, T., Hanley, B., Tee, E. S., Nishihira, J., Tontisirin, K., Van Dael, P., & Eggersdorfer, M. (2021). The role of micronutrients in ageing Asia: what can be implemented with the existing insights. Nutrients, 13(7), 2222. https://doi.org/10.3390/nu13072222

King, S. (2021). The effect of omega-3 fatty acid status on lung inflammation in tuberculosis-infected mice (Doctoral dissertation, North-West University (South-Africa)).

Mahendrani, C. R. M., Subkhan, M., Nurida, A., Prahasanti, K., & Levani, Y. (2020). Analisis faktor yang berpengaruh terhadap konversi sputum basil tahan asam pada penderita tuberkulosis. Al-Iqra Medical Journal: Jurnal Berkala Ilmiah Kedokteran, 3(1), 1-9.

Meital, L. T., Windsor, M. T., Perissiou, M., Schulze, K., Magee, R., Kuballa, A., ... & Russell, F. D. (2019). Omega-3 fatty acids decrease oxidative stress and inflammation in macrophages from patients with small abdominal aortic aneurysm. Scientific reports, 9(1), 12978. https://doi.org/10.1038/s41598-019-49362-z

Moradi, S., Alivand, M., KhajeBishak, Y., AsghariJafarabadi, M., Alipour, M., Chilibeck, P. D., & Alipour, B. (2022). The effect of short-term omega-3 fatty acids supplementation on appetite in healthy men: A randomized double-blinded controlled clinical trial. Nutrition Clinique et Métabolisme, 36(1), 46-53. https://doi.org/10.1016/j.nupar.2021.08.004

Murthy, S. E., Chatterjee, F., Crook, A., Dawson, R., Mendel, C., Murphy, M. E., ... & Gillespie, S. H. (2018). Pretreatment chest x-ray severity and its relation to bacterial burden in smear positive pulmonary tuberculosis. BMC medicine, 16, 1-11. https://doi.org/10.1186/s12916-018-1053-3

Nienaber, A., Hayford, F. E., Variava, E., Martinson, N., & Malan, L. (2021). The manipulation of the lipid mediator metabolism as adjunct host-directed therapy in tuberculosis. Frontiers in Immunology, 12, 623941. https://doi.org/10.3389/fimmu.2021.623941

Nienaber, A., Ozturk, M., Dolman, R. C., Zandberg, L., Hayford, F. E., Brombacher, F., ... & Malan, L. (2021). Beneficial effect of long-chain n-3 polyunsaturated fatty acid supplementation on tuberculosis in mice. Prostaglandins, Leukotrienes and Essential Fatty Acids, 170, 102304. https://doi.org/10.1016/j.plefa.2021.102304

Ramirez-Ramirez, V., Macias-Islas, M. A., Ortiz, G. G., Pacheco-Moises, F., Torres-Sanchez, E. D., Sorto-Gomez, T. E., ... & Celis De La Rosa, A. J. (2013). Efficacy of fish oil on serum of TNFα, IL‐1β, and IL‐6 oxidative stress markers in multiple sclerosis treated with interferon beta‐1b. Oxidative medicine and cellular longevity, 2013(1), 709493. https://doi.org/10.1155/2013/709493

Tama, T. D., Adisasmita, A. C., & Burhan, E. (2016). Indeks massa tubuh dan waktu terjadinya konversi sputum pada pasien tuberkulosis paru BTA positif di RSUP Persahabatan tahun 2012. Jurnal Epidemiologi Kesehatan Indonesia, 1(1), 1-8.

Wagnew, F., Alene, K. A., Kelly, M., & Gray, D. (2023). The effect of undernutrition on sputum culture conversion and treatment outcomes among people with multidrug-resistant tuberculosis: a systematic review and meta-analysis. International Journal of Infectious Diseases, 127, 93-105. https://doi.org/10.1016/j.ijid.2022.11.043

Wahyudi, D. (2022). Hubungan Kadar Interleukin 6 Terhadap Konversi Sputum Pada Pengobatan Tuberkulosis Paru= Relation Of Interleukin 6 Levels With Sputum Conversion In The Pulmonary Tuberculosis Treatment (Doctoral dissertation, Universitas Hasanuddin).

Wang, W., Wang, L. F., Liu, Y. Y., Yang, F., Zhu, L., & Zhang, X. H. (2019). Value of the ratio of monocytes to lymphocytes for monitoring tuberculosis therapy. Canadian Journal of Infectious Diseases and Medical Microbiology, 2019(1), 3270393. https://doi.org/10.1155/2019/3270393

Zimmer, A. J., Lainati, F., Aguilera Vasquez, N., Chedid, C., McGrath, S., Benedetti, A., ... & Kohli, M. (2022). Biomarkers that correlate with active pulmonary tuberculosis treatment response: a systematic review and meta-analysis. Journal of clinical microbiology, 60(2), e01859-21. https://doi.org/10.1128/JCM.01859-21