Impact of Undernutrition on Tuberculosis Treatment Outcomes in India: A Multicenter, Prospective, Cohort Analysis.
India
malnutrition
outcomes
tuberculosis
undernutrition
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
17 04 2023
17 04 2023
Historique:
received:
26
08
2022
medline:
19
4
2023
pubmed:
26
11
2022
entrez:
25
11
2022
Statut:
ppublish
Résumé
Undernutrition is the leading risk factor for tuberculosis (TB) globally. Its impact on treatment outcomes is poorly defined. We conducted a prospective cohort analysis of adults with drug-sensitive pulmonary TB at 5 sites from 2015-2019. Using multivariable Poisson regression, we assessed associations between unfavorable outcomes and nutritional status based on body mass index (BMI) nutritional status at treatment initiation, BMI prior to TB disease, stunting, and stagnant or declining BMI after 2 months of TB treatment. Unfavorable outcome was defined as a composite of treatment failure, death, or relapse within 6 months of treatment completion. Severe undernutrition (BMI <16 kg/m2) at treatment initiation and severe undernutrition before the onset of TB disease were both associated with unfavorable outcomes (adjusted incidence rate ratio [aIRR], 2.05; 95% confidence interval [CI], 1.42-2.91 and aIRR, 2.20; 95% CI, 1.16-3.94, respectively). Additionally, lack of BMI increase after treatment initiation was associated with increased unfavorable outcomes (aIRR, 1.81; 95% CI, 1.27-2.61). Severe stunting (height-for-age z score <-3) was associated with unfavorable outcomes (aIRR, 1.52; 95% CI, 1.00-2.24). Severe undernutrition at treatment initiation and lack of BMI increase during treatment were associated with a 4- and 5-fold higher rate of death, respectively. Premorbid undernutrition, undernutrition at treatment initiation, lack of BMI increase after intensive therapy, and severe stunting are associated with unfavorable TB treatment outcomes. These data highlight the need to address this widely prevalent TB comorbidity. Nutritional assessment should be integrated into standard TB care.
Sections du résumé
BACKGROUND
Undernutrition is the leading risk factor for tuberculosis (TB) globally. Its impact on treatment outcomes is poorly defined.
METHODS
We conducted a prospective cohort analysis of adults with drug-sensitive pulmonary TB at 5 sites from 2015-2019. Using multivariable Poisson regression, we assessed associations between unfavorable outcomes and nutritional status based on body mass index (BMI) nutritional status at treatment initiation, BMI prior to TB disease, stunting, and stagnant or declining BMI after 2 months of TB treatment. Unfavorable outcome was defined as a composite of treatment failure, death, or relapse within 6 months of treatment completion.
RESULTS
Severe undernutrition (BMI <16 kg/m2) at treatment initiation and severe undernutrition before the onset of TB disease were both associated with unfavorable outcomes (adjusted incidence rate ratio [aIRR], 2.05; 95% confidence interval [CI], 1.42-2.91 and aIRR, 2.20; 95% CI, 1.16-3.94, respectively). Additionally, lack of BMI increase after treatment initiation was associated with increased unfavorable outcomes (aIRR, 1.81; 95% CI, 1.27-2.61). Severe stunting (height-for-age z score <-3) was associated with unfavorable outcomes (aIRR, 1.52; 95% CI, 1.00-2.24). Severe undernutrition at treatment initiation and lack of BMI increase during treatment were associated with a 4- and 5-fold higher rate of death, respectively.
CONCLUSIONS
Premorbid undernutrition, undernutrition at treatment initiation, lack of BMI increase after intensive therapy, and severe stunting are associated with unfavorable TB treatment outcomes. These data highlight the need to address this widely prevalent TB comorbidity. Nutritional assessment should be integrated into standard TB care.
Identifiants
pubmed: 36424864
pii: 6845775
doi: 10.1093/cid/ciac915
pmc: PMC10319769
doi:
Types de publication
Multicenter Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1483-1491Subventions
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : NIAID NIH HHS
ID : K99 AI151094
Pays : United States
Organisme : NIAID NIH HHS
ID : T32 AI052074
Pays : United States
Organisme : NIAID NIH HHS
ID : K23 AI135102
Pays : United States
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Déclaration de conflit d'intérêts
Potential conflicts of interest . D. J. C., N. P., and S. P. B. report grants or contracts to institution from the Warren Alpert Foundation. N. S. H. reports a Warren Alpert Foundation grant paid to institution and current employment with the Novartis Institute for Biomedical Research. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
Références
PLoS One. 2014 Aug 25;9(8):e105017
pubmed: 25153531
Alcohol Clin Exp Res. 2007 Jul;31(7):1208-17
pubmed: 17451397
Am J Respir Crit Care Med. 2006 Aug 1;174(3):344-8
pubmed: 16709935
BMJ Open. 2016 Feb 25;6(2):e010542
pubmed: 26916698
PLoS One. 2015 Jun 05;10(6):e0128187
pubmed: 26046649
Public Health Action. 2021 Jun 21;11(2):108
pubmed: 34159072
Int J Tuberc Lung Dis. 2002 Sep;6(9):780-8
pubmed: 12234133
Eur J Clin Nutr. 1988 Dec;42(12):969-81
pubmed: 3148462
Glob Health Action. 2019;12(1):1633725
pubmed: 31328678
J Infect Dis. 2020 Apr 7;221(9):1416-1424
pubmed: 31724035
J Assoc Physicians India. 2009 Feb;57:163-70
pubmed: 19582986
Epidemiol Infect. 2011 Jan;139(1):113-20
pubmed: 20429966
Int J Tuberc Lung Dis. 2014 May;18(5):564-70
pubmed: 24903794
Clin Infect Dis. 2022 Sep 10;75(4):577-585
pubmed: 34910141
Int J Tuberc Lung Dis. 2022 Jan 1;26(1):80
pubmed: 34969436
Clin Infect Dis. 2015 Oct 15;61Suppl 3:S155-9
pubmed: 26409277
PLoS One. 2015 Dec 15;10(12):e0144244
pubmed: 26669737
BMJ Open. 2019 Dec 29;9(12):e033158
pubmed: 31888934
J Tuberc Res. 2016 Dec;4(4):213-219
pubmed: 28042591
Int J Tuberc Lung Dis. 2013 Jun;17(6):800-6
pubmed: 23676165
J Infect Dis. 2019 Apr 16;219(9):1356-1363
pubmed: 30476125
Am J Trop Med Hyg. 2020 Sep;103(3):1050-1056
pubmed: 32618243
Clin Infect Dis. 2020 Dec 3;71(9):e392-e398
pubmed: 31955202
Int J Tuberc Lung Dis. 2004 Feb;8(2):211-7
pubmed: 15139450
PLoS One. 2017 Aug 23;12(8):e0183195
pubmed: 28832615
Int J Tuberc Lung Dis. 2010 Nov;14(11):1403-10
pubmed: 20937179
PLoS One. 2013 Oct 24;8(10):e77979
pubmed: 24205052
J Infect Dis. 2019 Jun 19;220(2):340-341
pubmed: 30835281
PLoS One. 2019 Mar 27;14(3):e0214011
pubmed: 30917170