Soy, Catfish, Anchovy, and Rice Supplementation Increases 25(OH)D Serum Levels in Tuberculosis Patients With Complications
Phase: NA
Conditions: Tuberculosis
Sponsor: Universitas Sumatera Utara

Soy, Catfish, Anchovy, and Rice Supplementation Increases 
25(OH)D Serum Levels in Tuberculosis Patients with 
Complications 
 
Dina Keumala Sari1*, Ridha Dharmajaya2, Mutiara Indah Sari3, Dewi Masyithah4 
1Tropical Medicine Study Program, Faculty of Medicine, Universitas Sumatera Utara 
2Neurosurgery Department, Faculty of Medicine, Universitas Sumatera Utara 
3Biochemistry Department, Faculty of Medicine, Universitas Sumatera Utara 
4Parasitology Department, Faculty of Medicine, Universitas Sumatera Utara 
*corresponding author: dina@usu.ac.id; Tel.: +62-813-971-77-693 
 
 
Keywords: polymorphis, porridge, vitamin D, biomolecular 
Abstract. Tuberculosis patients that have complications (e.g., diabetes mellitus and human immunodeficiency virus 
(HIV)/acquired immunodeficiency syndrome (AIDS)) who live in tropical regions experience vitamin D deficiency, 
especially in North Sumatra, Indonesia. The presence of vitamin D receptor (VDR) polymorphism genes, TaqI and 
FokI, is one of the predisposing factors, as is high levels of inflammatory markers, also indicating disease 
progression and malnutrition. This study aims to assess the effect of 50 g of soy-catfish-anchovy-rice (SCAR) 
porridge per day for 14 days on 25(OH)D, calcium, and biomolecular serum levels in patients with VDR gene 
polymorphisms (TaqI or FokI). The study was a parallel, open, clinical trial. A total of 43 subjects with the VDR 
gene polymorphisms were selected. The subjects were divided into two groups using block randomization. There 
were 22 subjects in the intervention group (I) who received 50 g of SCAR porridge once per day, along with dietary 
counseling, and 21 subjects in the control group (C) who only received dietary counseling. All subjects in both 
groups completed the study. After 14 days of intervention, there was a significant increase in 25(OH)D serum levels 
in the I group, and no change was observed in the C group (p = 0.01). There were no significant differences in 
biomolecular levels, such as albumin, Hs CRP, blood glucose, and calcium. The results show that in patients who 
have tuberculosis with complications, VDR gene polymorphism, and are supplemented with 50 g of SCAR porridge 
per day for 14 days experience a significant increase in 25(OH)D serum levels. 
 
 
1 
Introduction 
Tuberculosis (TB) is a major health problem around the world, with the prevalence rising each 
year, and is one of the main causes of mortality in Indonesia. Governments of various countries 
with the highest prevalence have implemented the directly observed treatment, short-course 
(DOTS) strategy, as well as the Stop TB strategy; however, new cases continually appear and 
cases relapse due to emerging resistance 1. This condition is worsened by factors (e.g., 
environmental, nutritional, and genetic) that increase a person’s susceptibility to Mycobacterium 
tuberculosis infection 2-4. Previous studies showed that vitamin D receptor gene polymorphism 
significantly increases the risk of tuberculosis disease and comorbidities such as diabetes mellitus 
or human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) 2. 
Vitamin D receptor gene polymorphism is related to both vitamin D deficiency and an 
increased risk of tuberculosis disease. Related genes, such as FokI and TaqI, are related to low 
levels of vitamin D, and play a role in the immune regulation in the body 2, 4, 5. Vitamin D 
supports the induction of pleiotropic antimicrobial response in tuberculosis patients 6, 7. Vitamin 

D supplements may accelerate sputum conversion and help to improve the clinical condition of 
tuberculosis patients. Vitamin D promotes an increase in immune cells by activating 25-
hydroxyvitamin D receptor 7, 8. Food sources that contain high levels of vitamin D, such as 
catfish and mushrooms, could be used as a natural supplementation to address low vitamin D 
levels. Soy, catfish, anchovy, and rice are food sources that contain high levels of calcium, 
vitamin D, protein, and carbohydrates. Consuming these ingredients as a porridge could increase 
vitamin D and calcium levels in the blood.  
Vitamin D deficiency is common in tropical areas like Indonesia, occurring even in 
healthy individuals, despite an abundance of sunlight hours. It is thought that a sun-evading 
lifestyle, in addition to a lack of vitamin D intake, causes an increase in the prevalence of vitamin 
D deficiency. Vitamin D deficiency may impact calcium levels, although various studies stated 
that this is not the case. Calcium plays a role in the regulation of tuberculosis infection via 
cellular activity. 
Vitamin D modulates the body’s immune response by increasing vitamin D receptor 
(VDR) activity, then activating monocytes 7, 9, 10. Another mechanism is the active form of 
vitamin D, 1,25(OH)2D3, which hinders the proliferation of T cells and increases the abilities of 
pathogen-activated macrophages 10, 11. 
VDR is a member of the nuclear receptor of transcription factors. VDR, along with the 
activation of 1.25(OH)2D3, binds the DNA response element and forms a heterodimer with the 
retinoic acid receptor (RXR). This heterodimer links the relationship between vitamin D and 
vitamin A or carotenoids, including beta carotene. 
We performed a randomized clinical trial to study the impact of soy, catfish, anchovy, 
and rice (SCAR) porridge for 14 days on new patients diagnosed with both tuberculosis and 
associated complications. We used public health centers as the source of tuberculosis cases in the 
City of Medan. We tested the levels of 25(OH)D, calcium, and other biomolecular parameters 
such as albumin, Hs CRP, and blood glucose serum levels before and after treatment. 
2 
METHODS 
We aimed to determine the effect of soy, catfish, anchovy, and rice (SCAR) porridge 
supplementation for 14 days along with nutritional counseling on vitamin D, calcium, and 
biomolecular parameters on new patients diagnosed with tuberculosis and associated 
complications who visited two public health centers: Teladan Public Health Center and Amplas 
Public Health Center, located in Medan, North Sumatra, Indonesia. The sample was collected on 
Sumatra Island, at latitude 3.57 N and longitude 98.65 E, with enough sunlight and a temperature 
of ± 32 °C (90 °F). The study was performed from May to September 2019. This study was a 
controlled randomized clinical trial. After applying the inclusion and exclusion criteria, 43 
patients participated in the study. These patients were divided into two groups: 22 patients were 
put into the treatment group (I) and 21 into the control group (C).  

 
Research subjects were men or women and met the inclusion criteria, chosen through a 
purposive sampling technique. The inclusion criteria were: newly diagnosed with lung 
tuberculosis with an acid fast bacilli (AFB) result (+), aged 18–60 years, with a heterozygote 
genotype test performed on one of the genes TaqI and FokI, willing to participate in the study, 
and provided informed consent. The exclusion criteria were: being pregnant and/or a 
breastfeeding mother. Research subjects were excluded if they failed to consume the porridge for 
more than 7 days and if they experienced a worsening of their clinical condition, although they 
were still included when blood samples were drawn at the end of the study (intention to treat). 
Randomization Process 
The sample size was determined using a formula based on the tuberculosis prevalence in 
Medan. To avoid bias in the study, this was a double blind trial. Randomization was performed 
through block randomization. To further remove selection bias, the names of research subjects 
were assigned codes, and later, a block randomization process was performed using a block table 
and divided using the closed envelope method to divide treatment and control groups.  
 
SCAR porridge, based on 100 g of the dry product, contained 60 g of soy powder, 10 g of 
catfish powder, 5 g of anchovy powder, and 25 g of rice powder, all of which contained high 
levels of vitamin D and calcium (Table 1).  
Treatment 
The treatment group was given SCAR porridge supplementation in the form of a soft 
porridge (a mixture of 50 g dry powder porridge added to 200 mL of hot water) along with 
nutritional counseling. The control group only received nutritional counseling and no SCAR 
porridge supplementation. A 50 g portion of SCAR porridge was provided once a day for 14 
days. The SCAR porridge was monitored and administered by a researcher once a week to 
inquire about adherence to the supplementation consumption and perceived side effects. All 
research subjects went through a clearance period of one week and were requested not to 
consume any supplements. Afterward, measurements were recorded before and after treatment, 
including tests for 25(OH)D, calcium, biomolecular parameters (i.e., albumin, Hs CRP, and 
blood glucose serum levels).  
Laboratory Examinations for Vitamin D, Calcium, and Biomolecular Parameters 
At the end of the study, samples were stored at –80 °C, and the sample data were analyzed. 
Laboratory examiners did not know which specimens were case or control samples, as the 
samples were randomly assigned codes. 25(OH)D serum level was measured using a 
chemiluminescent immunoassay (CLIA) (Diasorin, Stillwater, MN, USA) device, and the 
measurement range was between 4.0 and 150 ng/mL. The lowest level was 4.0 ng/mL based on 
an inter-assay precision of 3.90% CV. Vitamin D levels were categorized as: <20 ng/mL 
(deficiency), 20–30 ng/mL (insufficiency), and 30–100 ng/mL (sufficiency) 12. Serum calcium 
levels were measured using the ADVIA Bayer Assayed Chemistry Controls with a reaction 

measurement of 545/658 nm; normal calcium serum levels were considered to be 8.3–10.6 
mg/dL. Albumin levels were measured using an Architect c8000; normal albumin serum levels 
were considered to be 3.4–4.8 g/dL. Hs CRP levels were measured using an Immulite 2000; 
normal Hs CRP serum levels were considered to be less than 10 mg/dL. Blood glucose was 
measured using an Architect c8000; normal blood glucose serum levels were considered to be 
less than 140 mg/dL. 
Continuous variables were expressed as continuous variables using means ± SDs. To find 
the differences in all the parameters between the two groups before and after the treatment, an 
analysis was performed by using an independent t-test. Categorical variables are expressed as 
percentage proportions and, to show the relationships between vitamin D deficiency between two 
groups, a Chi-square test was used, and the Fischer test if the data did not meet the criteria. A p-
value of <0.05 was considered statistically significant. We used the SPSS program (version 11.5; 
SPSS Inc, Chicago, IL, USA) to perform the analysis. This study was conducted after ethical 
approval was obtained from the Health Research Ethics Committee of Sumatra Utara University 
Medical School (No. 135/TGL/KEPK FK USU-RSUP HAM/2019) and all participants provided 
written informed consent for the study procedures. 
3 
RESULTS  
This study had 43 research subjects after completing the screening process, through inclusion and 
exclusion criteria, from a total of 57 research subjects. After signing an informed consent form 
and undergoing block randomization, they were divided into two groups, which were the 
treatment (22 research subjects) and control groups (21 research subjects). During the study 
period, one research subject could not participate until the end of the period because they had 
experienced nausea and did not routinely consume the porridge, although one research subject 
had problems but still participated in having their blood drawn at the end of the study as part of 
the research (intention to treat). 
Baseline Characteristics 
The baseline characteristics of all research subjects showed that most of the tuberculosis 
prevalence was experienced by those who were: younger, married, male, and normal body 
weight (Table 2). Statistic testing did not show any differences between the groups and did not 
indicate any significant differences between the treatment and the control groups. For baseline 
characteristics, both groups were homogeneous. 
Categories and Laboratory Parameter Levels 
For the intervention group, vitamin D levels were found to be the most significantly increased of 
all the studied nutrients (Table 3). Before the study, the percentage of vitamin D deficiency and 
insufficiency were found in higher numbers in all research subjects (Table 4). No research 
subjects were categorized as normal; the highest levels were categorized as sufficient. However, 

when compared to data collected before the study, vitamin D and calcium levels were 
homogeneous. There was also no categorical difference in all groups, except for the laboratory 
parameter vitamin D levels, in which we observed a significant difference when compared to 
data collected before the study commenced. This indicated that laboratory parameter levels 
increased, though they were still below normal values (Table 4). Table 4 shows that before the 
treatment, the data were homogeneous for 25(OH)D, calcium, albumin, Hs CRP, and blood 
glucose serum levels. There were significant differences between both groups in 25(OH)D serum 
levels; the average 25(OH)D serum level was low in the treatment group, but high in the control 
group. Table 4 shows a significant difference in 25(OH)D serum levels before and after 
treatment. This indicates that the supplementation of SCAR porridge resulted in a significant 
increase in the intervention group compared to the control group, although other factors resulted 
in no research subjects being placed in the normal vitamin D category. This is probably caused 
by VDR gene polymorphism. 
4 
DISCUSSION 
Polymorphism of the VDR gene influences 25(OH)D serum levels in the body. Two widely 
studied VDR genes are TaqI and FokI, especially concerning tuberculosis. We included VDR 
gene polymorphism testing for all research subjects, searching for the heterozygote genotypes on 
the VDR gene, which are TaqI (rs731236) or FokI (rs10735810). Hopefully, SCAR porridge 
supplementation, providing all necessary vitamins and minerals, especially vitamin D and 
calcium, would result in the improvement of the clinical condition of tuberculosis patients 
experiencing complications. In previous studies, FokI receptor gene polymorphism was related to 
an increased risk of tuberculosis 2, 4, 5, 13-15. This study showed that patients with VDR gene 
polymorphism would exhibit vitamin D deficiency and insufficiency. The administration of 
SCAR porridge increased vitamin D levels, but still did not significantly increase other vitamin 
and mineral serum levels compared to the control group. Vitamin D levels in the intervention 
group were significantly higher than the control group; therefore, the administration of vitamin D 
supplementation is highly necessary for tuberculosis patients with VDR gene polymorphism. At 
the end of this study, a significant improvement in sputum conversion was observed.  
Other factors to be considered were body fat mass and profession. In this study, patients 
mostly had low levels of body fat. Although a high level of fat was found in some patients, 
vitamin D levels were still categorized as either deficient or insufficient. Low vitamin D levels at 
the start of the study were probably caused by VDR gene polymorphism, aside from other 
possibilities such as disease progressivity, a sun-evading lifestyle, and lack of high vitamin D and 
calcium intake 16-19. A patient's profession also affected vitamin D levels. Professions that 
involve less sunlight (e.g., indoor jobs) cause more pronounced vitamin D deficiency 20-23. 
Other vitamins (e.g., vitamin A) that impact vitamin D levels or function could 
potentially help with the clinical improvement of tuberculosis patients 24, 25. Vitamin A acts 

through retinoic acid, in which retinoic acid would be converted into 9-cis retinoic acid and into 
ligands, which could activate RXR. RXR would then interact with VDR. The resulting 
heterodimer then changes protein conformation, which may activate or repress molecules 
through gene transcription 18.  
The dimer forms of VDR–RXR would then bind to a specific sequence in the target 
promoter region called vitamin D response elements (VDRE). Several genes involved in the 
regulation of calcium, phosphor homeostasis, and vitamin D metabolism are related to VDRE. 
This transcription process affects enzyme production related to vitamin D metabolism, such as 
enzymes involved in vitamin D synthesis. Increased vitamin D levels in the circulation would 
affect VDR activities in T lymphocytes, macrophages, and thymus tissues. 
Counseling regarding the increase of vitamin D food sources was also provided. Vitamin 
D food sources are often expensive food products, such as codfish oil, salmon, or mushrooms. 
Fortification of vitamin D in milk is a good choice for increasing vitamin D intake. Sunlight is a 
renewable source in tropical areas, although jobs in which the workers are mostly covered from 
sunlight might result in inadequate sunlight exposure for vitamin D production. Vitamin D 
supplementation in tuberculosis patients may provide more optimal synergistic effects by 
increasing  carotene food sources12, 26-28.  
We did not find any relationship between calcium and vitamin D. Calcium intake also did 
not increase in this study. Dietary sources of calcium such as milk, sour milk, or cheese are food 
products not commonly a part of daily meals for tuberculosis patients. This lack of calcium may 
be caused by the lack of consumption of such products by tuberculosis patients. This may be 
caused by the high prices of food, or milk not being a commonly consumed food product. Other 
calcium food sources include fish consumed along with their bones, such as anchovies29, 30. This 
form is a kind of food product that may be provided to tuberculosis patients to fulfill calcium 
requirements. 
We did not find low serum calcium levels in the blood, even though the mean of 
25(OH)D serum levels was low. In tuberculosis patients, low levels of 25(OH)D were found, 
which should have an interaction between vitamin D and calcium. If the level of vitamin D in the 
blood is high, calcium absorption will increase; however, this mechanism did not occur in this 
study. Although 1000 IU of vitamin D was administered per day for 28 days and vitamin D 
levels increased (though not increasing enough for any patient to be categorized as sufficient), 
this did not affect calcium levels in the blood. Calcium plays a vital role in bone remodeling and 
is supported by vitamin D, which is converted to calcitriol and would help in the absorption of 
calcium in the intestine.  
About 300–500 mg of calcium is sourced from 900 mg of extracellular calcium to aid the 
process of bone remodeling. This increases the required calcium intake from food sources, so 
calcium intake requirements range from 1000 to 1500 mg 31-33. This puts the serum calcium into 
a homeostatic (balanced) state. Phosphorus also plays a role in the balance of calcium levels in 

the blood and the rate of calcium storage in the intestine. The process of calcium absorption with 
the support of vitamin D is significant for the metabolism of calcium and phosphorus34. Calcium 
absorption by the digestive tract increases as calcium and phosphorus from the bone mobilizes 
and vitamin D controls the expenditure and balance of minerals in the blood 33. Although calcium 
and vitamin D metabolism appear to be altered in tuberculosis patients, we found no association 
between vitamin D and calcium categorization in this study. Previous studies confirmed that 
although serum calcium is raised in tuberculosis patients, the effect may be reduced by a low 
calcium intake 35. 
With the length of this study, the administration of vitamin D along with nutritional 
counseling, including a high intake of  carotene food, would show improved sputum conversion 
in both groups. A significant increase in vitamin D levels, despite the lack of difference between 
the treatment and control group observed at the end of this study, still showed clinical 
improvement of tuberculosis patients.  
This study has several limitations, such as not measuring parathyroid hormone levels and 
other clinical parameters of tuberculosis improvement, such as chest X-ray and blood 
inflammation parameters. 
5 
CONCLUSION 
Based on the results of this study, we concluded that tuberculosis patients with the VDR 
polymorphism genes, FokI and TaqI, may experience an increase in vitamin D levels from the 
supplementation of SCAR porridge along with nutritional counseling for 14 days. 
ACKNOWLEDGMENTS 
The authors gratefully acknowledge that the present research was supported by the Ministry of 
Research and Technology and the Higher Education Republic of Indonesia, Research and 
Community Service, Universitas Sumatra Utara. The support is under the research grant DRPM 
KEMENRISTEKDIKTI of the Year 2019 Contract Number: 11/UN5.2.3.1/PPM/KP-
DRPM/2019. Patent number certificate: S00201900847. 
The authors would also like to thank all research subjects, the Head of the Health Office of the 
City of Medan, Heads of the Public Health Centers of Teladan, Drs. Kus Puji Astuti and Amplas, 
Dr. Henni Safitri, the medical-paramedical team, and the students who supported this research. 
COMPETING INTERESTS 
There are no funding or other conflicts of interest to declare for this research. 
 
 

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Table 1. Nutrition facts of soy, catfish, anchovy, and rice (SCAR) porridge. 
Nutrient per 100 grams 
Nutrient analysis 
Results  
Unit  
Total calories 
396,60 
Kcal/100 g 
Carbohydrates 
62,49 
% 
Protein  
18,12 
% 
Total fat 
8,24 
% 
Saturated fatty acids 
1,64 
% 
Monounsaturated fatty acids 
2,12 
% 
Polyunsaturated fatty acids 
4,48 
% 
Sugar  
5,62 
% 
Fiber  
7,72 
% 
Vitamin D 
137,02 
mcg/100 g 
Calcium 
367,32 
mg/100 g 
Natrium 
180,35 
mg/100 g 
Kalium  
366,84 
mg/100 g 
Vitamin E 
0,89 
mg/100 g 
Vitamin A 
13,84 
mcg/100 g 
Vitamin B6 
10,35 
mg/100 g 
Cholesterol  
10,35 
mg/100 g 
 
 
 

 
Table 2. Demographic characteristics of all subjects. 
 
Characteristic 
n (%) 
Mean ± standard deviation 
 
Age (year) 
20–30 
30–40 
40–50 
50–60 
>60 
 
 
18 (40,9) 
4 (11,4) 
8 (18,2) 
6 (13,6) 
7 (15,9) 
 
41.4 ± 16.1 
 
Gender  
Female 
Male  
 
20 (46.5) 
23 (53.5) 
 
 
BMI (kg/m2) 
BMI categorized 
Underweight 
Normal 
Overweight 
Obese 1 
Obese 2 
 
 
 
10 (22,7) 
22 (50,0) 
1 (4,5) 
8 (18,2) 
2 (4,5) 
 
21.0 ± 3.9 
 
 
Marital status 
Married 
Single 
 
 
26 (59,1) 
17 (40,9) 
 
 
Occupation  
Employeed 
Businessman  
Housewife  
Unemployed 
Student 
 
 
22 (50,0) 
9 (20,5) 
4 (9,1) 
1 (4,5) 
7 (15,9) 
 
 
Smoking status 
Smokers  
Non-smokers 
 
 
24 (54,5) 
19 (45,5) 
 
 
Sunlight exposure 
<30 minutes 
≥30 minutes 
 
 
11 (57.9) 
7 (42.1) 
 
 
Physical activity 
High 
Moderate 
Low  
Medium 
 
 
- 
- 
32 (72,7) 
11 (27,3) 
 
 
Scar BCG 
Clear  
Dubious 
None 
 
 
32 (72,7) 
5 (13,6) 
6 (13,6) 
 
Data are shown in mean ± SD or number of subjects (percentage). 
 
 
 
 
 

 
Table 3. 
Energy and nutrient intake of subjects before and after intervention period 1. 
Nutrient intake 
Intervention group (n = 22) 
Control group (n = 21) 
Before 
After 
p-value 
Before 
After 
p-
value 
Energy (kcal) 
702.1±73.4 
751.9±85.4 
0.25 
768.1±76.2 
726.8±69.7 
0.63 
Protein (g) 
22.4±5.6 
27.2±8.3 
0.10 
25.1±6.8 
24.5±9.7 
0.85 
Fat (g) 
19.1±3.2 
20.5±6.7 
0.61 
18.8±5.7 
18.3±5.4 
0.85 
Carbohydrate (g)  110.2±34.7 
115.9±23.5 
0.39 
124.5±54.3 
116.1±55.6 
0.55 
Cholesterol (mg) 
95.1±15.6 
139.3±21.1 
0.22 
83.9±14.3 
83.8±18.5 
0.99 
Fiber (g) 
5.2±1.2 
6.8±1.4 
0.03 
4.9±2.3 
4.8±1.6 
0.94 
Vitamin A (µg) 
485.9±155.8 769.2±212.2 0.07 
582.6±221.2 448.8±201.4 
0.44 
Carotene (mg) 
0.1±0.01 
0.1±0.02 
0.55 
1.2±0.4 
0.1±0.04 
0.17 
Calcium (mg) 
229.1±78.3 
195.4±55.2 
0.47 
272.4±65.4 
181.5±66.7 
0.14 
Vitamin D (µg) 
3.4±0.6 
30.2±8.7 
0.01 
3.6±0.8 
2.9±1.1 
0.12 
Data are shown in mean ± SD.  
1Analysis using dependent t-test. 
Significance value: p < 0.05. 
 
 
 
 

 
Table 4. Vitamin D, calcium, and biomolecular serum levels before and after intervention. 
Variable 
Baseline 
Day 0 
Endpoint 
Day 14 
p-value 
(dependent t-test) 
Mean (SD) 
25(OH)D serum (ng/mL) 
 
 
 
D group (n = 22) 
24.6±9.4 
32.5±5.9 
0.01 
C group (n = 22) 
25.6±9.7 
27.5±8.8 
0.01 
p-value (independent t-test) 
0.74 
0.03 
 
 
 
 
 
Calcium serum (mg/dL) 
 
 
 
D group (n = 22) 
9.6±0.5 
9.8±0.7 
0.13 
C group (n = 22) 
9.4±0.5 
9.6±0.8 
0.27 
p-value (independent t-test) 
0.17 
0.05 
 
 
 
 
 
Albumin serum (mg/dL) 
 
 
 
D group (n = 22) 
3.91±0.4 
3.86±0.3 
0.57 
C group (n = 22) 
3.86±0.3 
3.81±0.4 
0.71 
p-value (independent t-test) 
0.09 
0.54 
 
 
 
 
 
Hs CRP serum (mg/dL) 
 
 
 
D group (n = 22) 
24.0±7.7 
12.1±2.7 
0.02 
C group (n = 22) 
17.0±4.3 
11.0±9.4 
0.27 
p-value (independent t-test) 
0.21 
0.32 
 
 
 
 
 
Blood 
Glucose 
serum 
(mg/dL) 
 
 
 
D group (n = 22) 
184.6±88.7 
182±90.3 
0.93 
C group (n = 22) 
139.05±28.1 
139.7±23.9 
0.93 
p-value (independent t-test) 
0.22 
0.15 
 
 
 
 
 
 
 
 
 
Data are shown in mean ± SD. 
Significance value: p < 0.05.