Interaction of nutritional status and diabetes on active and latent tuberculosis: a cross-sectional analysis.
Adult
Body Mass Index
Cross-Sectional Studies
Diabetes Mellitus
/ epidemiology
Family Characteristics
Female
Humans
Hyperglycemia
/ epidemiology
India
/ epidemiology
Latent Tuberculosis
/ epidemiology
Male
Middle Aged
Nutritional Status
Overweight
/ epidemiology
Prevalence
Risk Factors
Thinness
/ epidemiology
Tuberculosis
/ epidemiology
Body mass index
Cross-sectional analysis
Diabetes mellitus
India
Latent tuberculosis
Prevalence
Tuberculosis
Underweight
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
16 Jul 2019
16 Jul 2019
Historique:
received:
09
03
2019
accepted:
30
06
2019
entrez:
18
7
2019
pubmed:
18
7
2019
medline:
18
10
2019
Statut:
epublish
Résumé
Malnutrition and diabetes are risk factors for active tuberculosis (TB), possible risk factors for latent TB infection (LTBI), and may interact to alter their effect on these outcomes. Studies to date have not investigated this interaction. We enrolled 919 newly diagnosed active TB patients and 1113 household contacts at Primary Health Centres in Puducherry and Tamil Nadu, India from 2014 to 2018. In cross-sectional analyses, we used generalized estimating equations to measure additive and multiplicative interaction of body mass index (BMI) and diabetes on two outcomes, active TB and LTBI. Among overweight or obese adults, active TB prevalence was 12-times higher in diabetic compared to non-diabetic participants, 2.5-times higher among normal weight adults, and no different among underweight adults (P for interaction < 0.0001). Diabetes was associated with 50 additional active TB cases per 100 overweight or obese participants, 56 per 100 normal weight participants, and 17 per 100 underweight participants (P for interaction < 0.0001). Across BMI categories, screening 2.3-3.8 active TB patients yielded one hyperglycemic patient. LTBI prevalence did not differ by diabetes and BMI*diabetes interaction was not significant. BMI and diabetes are associated with newly diagnosed active TB, but not LTBI. Diabetes conferred the greatest risk of active TB in overweight and obese adults whereas the burden of active TB associated with diabetes was similar for normal and overweight or obese adults. Hyperglycemia was common among all active TB patients. These findings highlight the importance of bi-directional diabetes-active TB screening in India.
Sections du résumé
BACKGROUND
BACKGROUND
Malnutrition and diabetes are risk factors for active tuberculosis (TB), possible risk factors for latent TB infection (LTBI), and may interact to alter their effect on these outcomes. Studies to date have not investigated this interaction.
METHODS
METHODS
We enrolled 919 newly diagnosed active TB patients and 1113 household contacts at Primary Health Centres in Puducherry and Tamil Nadu, India from 2014 to 2018. In cross-sectional analyses, we used generalized estimating equations to measure additive and multiplicative interaction of body mass index (BMI) and diabetes on two outcomes, active TB and LTBI.
RESULTS
RESULTS
Among overweight or obese adults, active TB prevalence was 12-times higher in diabetic compared to non-diabetic participants, 2.5-times higher among normal weight adults, and no different among underweight adults (P for interaction < 0.0001). Diabetes was associated with 50 additional active TB cases per 100 overweight or obese participants, 56 per 100 normal weight participants, and 17 per 100 underweight participants (P for interaction < 0.0001). Across BMI categories, screening 2.3-3.8 active TB patients yielded one hyperglycemic patient. LTBI prevalence did not differ by diabetes and BMI*diabetes interaction was not significant.
CONCLUSIONS
CONCLUSIONS
BMI and diabetes are associated with newly diagnosed active TB, but not LTBI. Diabetes conferred the greatest risk of active TB in overweight and obese adults whereas the burden of active TB associated with diabetes was similar for normal and overweight or obese adults. Hyperglycemia was common among all active TB patients. These findings highlight the importance of bi-directional diabetes-active TB screening in India.
Identifiants
pubmed: 31311495
doi: 10.1186/s12879-019-4244-4
pii: 10.1186/s12879-019-4244-4
pmc: PMC6636094
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
627Subventions
Organisme : NIDDK NIH HHS
ID : P30 DK017047
Pays : United States
Organisme : NCATS NIH HHS
ID : TL1 TR002318
Pays : United States
Organisme : CRDF Global
ID : USB1-31150-XX-13
Organisme : National Science Foundation
ID : OISE-9531011
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