Effect of malnutrition on radiographic findings and mycobacterial burden in pulmonary tuberculosis.
Adolescent
Adult
Aged
Aged, 80 and over
Bacteriological Techniques
Body Mass Index
Cohort Studies
Cross-Sectional Studies
Female
Humans
India
Lung
/ diagnostic imaging
Male
Malnutrition
/ complications
Middle Aged
Mycobacterium tuberculosis
/ growth & development
Prospective Studies
Tuberculosis, Pulmonary
/ complications
Young Adult
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
20
11
2018
accepted:
05
03
2019
entrez:
28
3
2019
pubmed:
28
3
2019
medline:
18
12
2019
Statut:
epublish
Résumé
The relationship between malnutrition and tuberculosis (TB) severity is understudied. We investigated the effect of malnutrition on radiographic findings and mycobacterial burden. Subjects included newly diagnosed, smear-positive, culture-confirmed, pulmonary TB cases enrolled in the Regional Prospective Observational Research for TB (RePORT) cohort. Multivariate regression models were used to evaluate the relationship at start of treatment between body mass index (BMI) and chest radiograph (CXR) findings of cavitation and percentage of lung affected and mycobacterial growth indicator tube (MGIT) time to positive (TTP). Severe malnutrition was defined as BMI<16 kg/m2, moderate malnutrition as 16-18.4kg/m2, and "normal"/overweight as ≥18.5 kg/m2. Of 173 TB cases with chest x-ray data, 131 (76%) were male. The median age was 45 years (range 16-82); 42 (24%) had severe malnutrition and 58 (34%) moderate malnutrition. Median percentage of lung affected was 32% (range 0-95), and 132 (76%) had cavitation. Individuals with severe malnutrition had, on average, 11.1% [95% CI: 4.0-13.3] more lung affected, compared to those with normal BMI, controlling for diabetes and cavitation. In multivariable analyses, cases with severe malnutrition had a 4.6-fold [95% CI, 1.5-14.1] increased odds of cavitation compared to those with normal BMI, controlling for smoking. Median MGIT TTP was 194.5 hours. Neither severe (aRR 0.99; 95% CI, 0.9-1.2) nor moderate (aRR 0.97; 95% CI, 0.8-1.1) malnutrition was associated with MGIT TTP. We found that malnutrition was associated with increased extent of disease and cavitation on CXR. These findings may reflect the immunomodulatory effect of malnutrition on pulmonary pathology.
Sections du résumé
BACKGROUND
The relationship between malnutrition and tuberculosis (TB) severity is understudied. We investigated the effect of malnutrition on radiographic findings and mycobacterial burden.
METHODS
Subjects included newly diagnosed, smear-positive, culture-confirmed, pulmonary TB cases enrolled in the Regional Prospective Observational Research for TB (RePORT) cohort. Multivariate regression models were used to evaluate the relationship at start of treatment between body mass index (BMI) and chest radiograph (CXR) findings of cavitation and percentage of lung affected and mycobacterial growth indicator tube (MGIT) time to positive (TTP). Severe malnutrition was defined as BMI<16 kg/m2, moderate malnutrition as 16-18.4kg/m2, and "normal"/overweight as ≥18.5 kg/m2.
RESULTS
Of 173 TB cases with chest x-ray data, 131 (76%) were male. The median age was 45 years (range 16-82); 42 (24%) had severe malnutrition and 58 (34%) moderate malnutrition. Median percentage of lung affected was 32% (range 0-95), and 132 (76%) had cavitation. Individuals with severe malnutrition had, on average, 11.1% [95% CI: 4.0-13.3] more lung affected, compared to those with normal BMI, controlling for diabetes and cavitation. In multivariable analyses, cases with severe malnutrition had a 4.6-fold [95% CI, 1.5-14.1] increased odds of cavitation compared to those with normal BMI, controlling for smoking. Median MGIT TTP was 194.5 hours. Neither severe (aRR 0.99; 95% CI, 0.9-1.2) nor moderate (aRR 0.97; 95% CI, 0.8-1.1) malnutrition was associated with MGIT TTP.
CONCLUSION
We found that malnutrition was associated with increased extent of disease and cavitation on CXR. These findings may reflect the immunomodulatory effect of malnutrition on pulmonary pathology.
Identifiants
pubmed: 30917170
doi: 10.1371/journal.pone.0214011
pii: PONE-D-18-33360
pmc: PMC6436704
doi:
Types de publication
Journal Article
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0214011Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Am J Clin Nutr. 2004 Aug;80(2):460-5
pubmed: 15277171
Int J Tuberc Lung Dis. 2002 Sep;6(9):780-8
pubmed: 12234133
Clin Infect Dis. 2018 Feb 10;66(5):699-705
pubmed: 29029077
Int J Tuberc Lung Dis. 2004 Feb;8(2):211-7
pubmed: 15139450
BMJ. 2016 Oct 12;355:i5407
pubmed: 27733343
PLoS One. 2017 Aug 23;12(8):e0183195
pubmed: 28832615
Scand J Infect Dis. 1997;29(4):355-9
pubmed: 9360249
Epidemiol Infect. 2011 Jan;139(1):113-20
pubmed: 20429966
Clin Exp Immunol. 2001 Dec;126(3):461-5
pubmed: 11737063
Respir Med. 1989 May;83(3):195-8
pubmed: 2595036
Nutrients. 2013 Feb 19;5(2):579-93
pubmed: 23429441
Annu Rev Immunol. 2009;27:393-422
pubmed: 19302046
J Exp Med. 2011 Aug 29;208(9):1863-74
pubmed: 21825018
J Korean Med Sci. 2011 Feb;26(2):268-73
pubmed: 21286020
Int J Tuberc Lung Dis. 2012 Nov;16(11):1477-84
pubmed: 22964038
Arch Intern Med. 1998 Sep 14;158(16):1789-95
pubmed: 9738608
Int J Epidemiol. 2010 Feb;39(1):149-55
pubmed: 19820104
Am Rev Respir Dis. 1974 Jan;109(1):162-3
pubmed: 4809157
Nutrition. 2003 Mar;19(3):265-9
pubmed: 12620532
Am J Epidemiol. 2012 Sep 1;176(5):409-22
pubmed: 22791739
Cochrane Database Syst Rev. 2016 Jun 29;(6):CD006086
pubmed: 27355911
Clin Respir J. 2017 May;11(3):285-295
pubmed: 28268242
Int J Tuberc Lung Dis. 2009 Mar;13(3):367-70
pubmed: 19275798
Clin Infect Dis. 2014 Oct 15;59(8):1123-9
pubmed: 24982034
PLoS One. 2015 Apr 23;10(4):e0124260
pubmed: 25905900
Int J Tuberc Lung Dis. 2001 May;5(5):455-61
pubmed: 11336277
Eur J Clin Nutr. 2006 Feb;60(2):163-71
pubmed: 16234841