Changes in Nutritional Status in Pulmonary Tuberculosis: Longitudinal Changes in BMI According to Acid-Fast Bacilli Smear Positivity

Outcomes of Treating Tuberculosis Patients with Drug-Resistant Tuberculosis, Human Immunodeficiency Virus, and Nutritional Status: The Combined Impact of Triple Challenges in Rural Eastern Cape

BACKGROUND

Treatment outcomes are critical measures of TB treatment success, especially in resource-limited settings where tuberculosis remains a major public health issue. This study evaluated the treatment outcomes of patients with drug-resistant tuberculosis (DR-TB), co-infected with human immunodeficiency virus (HIV), and the impact of nutritional status, as measured by body mass index (BMI), on these outcomes in rural areas of the Olivier Reginald Tambo District Municipality, Eastern Cape, South Africa.

METHODS

A retrospective review of 360 patient files from four TB clinics and one referral hospital was conducted between January 2018 and December 2020. Data collected included patient demographics, clinical characteristics, BMI (categorized as underweight, normal, overweight, or obese), HIV status, DR-TB type, and treatment outcomes. Statistical analyses assessed the association between BMI categories, HIV status, and treatment outcomes. A scatter plot was used to illustrate BMI trends as a continuous variable in relation to age, enabling an analysis of BMI distribution across different age groups. Additionally, bar charts were utilized to explore categorical relationships and patterns in BMI across these groups.

RESULTS

The majority of patients were co-infected with HIV and had DR-TB, with rifampicin-resistant TB (RR-TB) and multidrug-resistant TB (MDR-TB) being the most prevalent forms. Treatment outcomes varied significantly by BMI category. Underweight patients had the lowest cure rates (23.2%), highlighting the adverse impact of malnutrition on DR-TB treatment success. Patients with normal BMI demonstrated higher cure rates (34.7%), while overweight and obese patients had moderate outcomes. HIV co-infection further reduced cure rates, with co-infected individuals showing poorer outcomes than HIV-negative patients. Gender disparities were also observed, with females achieving higher cure rates (39.1%) compared to males (31.4%). Weak trends linked BMI and DR-TB type, such as a higher prevalence of normal BMI among RR-TB cases.

CONCLUSION

This study underscores the significant influence of nutritional status on DR-TB treatment outcomes, particularly among patients co-infected with HIV. Underweight patients face the greatest risk of poor outcomes, emphasizing the need for nutritional support as a critical component of DR-TB management. Comprehensive HIV care and gender-specific interventions are also essential to address disparities in treatment success. Tailored strategies focusing on these aspects can significantly enhance outcomes in high-burden, resource-limited settings.

Nutritional scores predict the prognosis of patients with pulmonary tuberculosis

Background

Although malnutrition is associated with poor prognosis in Pulmonary Tuberculosis (PTB) patients, no nutrition-based prediction model has been established for PTB. Herein, we explored the clinical utility of common nutrition scores in predicting the prognosis of PTB patients.

Methods

We retrospectively collected clinical baseline data from 167 patients with secondary PTB who had not previously received anti-TB treatment. Subsequently, we determined the CONUT score, PNI index, and NPS score and evaluated the treatment efficacy using changes in lung lesions revealed by the chest CT scan. The Area Under the Receiver Operating Characteristic (AUROC) curve was used to quantify the predictive values of CONUT, PNI, and NPS scores for anti-TB efficacy in new-onset PTB patients, and the critical CONUT, PNI, and NPS values were determined using the Youden Index. We also performed univariate and multivariate analyses of prognostic factors in PTB patients to determine the nutrition scores and other clinical factors associated with the prognosis of patients with the new-onset PTB.

Results

The Youden Index revealed that the critical CONUT score value for patients with PTB was 4.5, with a sensitivity of 72.2% and specificity of 96.6%. In contrast, the critical cut-off values of the PNI index and the NPS score were 39.825 and 3.5, respectively. Univariate analysis of the predictors of poor prognosis in PTB patients showed that patients with diabetes, COPD, pneumonia, and hypoproteinemia (which were risk factors) had a poor prognosis (p < 0.05). Multivariate analysis revealed that the CONUT score, PNI, NPS, and NRS-2002 were independent predictors of unfavorable PTB outcomes, with adjusted ORs of 60.419 (95%CI: 16.186-225.524, p < 0.0001), 23.667 (95% CI: 9.317-60.115, p < 0.0001), 8.512 (95% CI: 3.762-19.257, p < 0.0001), 0.612 (95% CI: 4.961-39.161, p < 0.0001), respectively. The Area Under the Curve (AUC) of the CONUT score in predicting poor prognosis of PTB patients was 0.885 (95% CI:0.830-0.940, p < 0.0001), which is comparable to that of the PNI index (0.862, 95% CI: 0.805-0.920, p < 0.0001), but higher than that of NPS (0.774, 95% CI: 0.702-0.846, p < 0.0001), BMI (0.627, 95% CI: 0.541-0.717, p < 0.0001), and NRS-2002 (0.763, 95% CI: 0.688-0.838, p < 0.0001). We discovered that older patients (p < 0.0001), male participants (p < 0.05), and patients with Diabetes Mellitus (DM) (p < 0.0001) and Chronic Obstructive Pulmonary Disease (COPD) (p < 0.05) were more likely to have a high CONUT score.

Conclusion

The poor prognosis of PTB patients was related to a high CONUT score, low PNI index, and high NPS score, of which the specificity and sensitivity of the CONUT score were higher than those of the PNI index and the NPS score.

Prevalence and influencing factors of malnutrition in diabetic patients: A systematic review and meta-analysis

The prevalence of malnutrition in diabetic patients and its influencing factors remain poorly described. We aim to investigate the prevalence of malnutrition and the influencing factors in diabetic patients through meta-analysis. Utilizing search terms, such as diabetes, malnutrition, and prevalence, we systematically searched eight databases, including Embase, PubMed, Web of Science, The Cochrane Library, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Chinese Biomedical Database (CBM), and VIP Database, from inception to May 4, 2023. The search aimed to identify studies related to the prevalence of malnutrition and its influencing factors in adult patients with diabetes. Cohort studies, case-control studies, and cross-sectional studies that met the inclusion criteria were included in the analysis. Stata 16.0 software was used for meta-analysis. Quality of the evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). The study protocol is registered with Prospective Register of Systematic Reviews (PROSPERO), CRD42023443649. A total of 46 studies were included, involving 18 062 patients with ages ranging from 18 to 95 years. The overall malnutrition prevalence was 33% (95% confidence interval [CI]: 0.25-0.40), compared with an at-risk prevalence of 44% (95% CI: 0.34-0.54). Sixteen factors associated with malnutrition in diabetic patients were identified. This meta-analysis provides insights into the prevalence of malnutrition and its risk factors in diabetic patients. Regular nutritional screening for patients with risk factors is essential for early detection and intervention.

Pyrazinamide-induced Hyperuricemia in Pulmonary Tuberculosis Patients

BACKGROUND

Pyrazinamide is one of the antitubercular drugs used for 2 months in the intensive phase. One of the adverse effects of pyrazinamide is hyperuricemia, with a symptom of arthralgia. This study aims to analyze the incidence of hyperuricemia and arthralgia and their causality in pulmonary tuberculosis (TB) patients undergoing treatment in the intensive phase.

METHODS

It was an analytic observational study with a prospective cohort design. Three ml of blood from each pulmonary TB patient was withdrawn to examine uric acid levels before and after 2 months of treatment with pyrazinamide. The Wilcoxon test was used to analyze changes in uric acid levels and the Chi-square test to analyze the association between uric acid levels and arthralgia. Naranjo algorithm is used to analyze the causality of hyperuricemia.

RESULTS

Twenty pulmonary TB patients met the inclusion criteria in this study. Eight out of 12 (60%) TB patients showed uric acid levels ≥7 mg/dl and 8 of them (66.6%) showed symptoms of arthralgia. The median uric acid level increased significantly before (5.14 mg/dl) and after 2 months of treatment (7.74 mg/dl), P-value = 0.001. Uric acid levels ≥7 mg/dl were significantly associated with arthralgia (P-value = 0.017; odds ratio 14.00; 95% confidence interval 1.25-156.61). Based on the Naranjo algorithm, those with hyperuricemia, eight and four patients had a total score of 7 and 8, respectively, which are classified as probable.

CONCLUSION

Uric acid levels significantly increased during the intensive phase. Pulmonary TB patients with hyperuricemia are a risk factor for arthralgia.

Tuberculosis and osteoporotic fracture risk: development of individualized fracture risk estimation prediction model using a nationwide cohort study

Purpose

Tuberculosis (TB) is linked to sustained inflammation even after treatment, and fracture risk is higher in TB survivors than in the general population. However, no individualized fracture risk prediction model exists for TB survivors. We aimed to estimate fracture risk, identify fracture-related factors, and develop an individualized risk prediction model for TB survivors.

Methods

TB survivors (n = 44,453) between 2010 and 2017 and 1:1 age- and sex-matched controls were enrolled. One year after TB diagnosis, the participants were followed-up until the date of fracture, death, or end of the study period (December 2018). Cox proportional hazard regression analyses were performed to compare the fracture risk between TB survivors and controls and to identify fracture-related factors among TB survivors.

Results

During median 3.4 (interquartile range, 1.6-5.3) follow-up years, the incident fracture rate was significantly higher in TB survivors than in the matched controls (19.3 vs. 14.6 per 1,000 person-years, p < 0.001). Even after adjusting for potential confounders, TB survivors had a higher risk for all fractures (adjusted hazard ratio 1.27 [95% confidence interval 1.20-1.34]), including hip (1.65 [1.39-1.96]) and vertebral (1.35 [1.25-1.46]) fractures, than matched controls. Fracture-related factors included pulmonary TB, female sex, older age, heavy alcohol consumption, reduced exercise, and a higher Charlson Comorbidity Index (p < 0.05). The individualized fracture risk model showed good discrimination (concordance statistic = 0.678).

Conclusion

TB survivors have a higher fracture risk than matched controls. An individualized prediction model may help prevent fractures in TB survivors, especially in high-risk groups.

Intestinal helminth co-infection and associated factors among pulmonary tuberculosis patients in Africa and Asia: a systematic review and meta-analysis

INTRODUCTION

Tuberculosis (TB) and intestinal helminths have huge public health importance, and they are geographically overlapped. Data about the burden of intestinal helminth and TB co-infection in these areas are fragmented. In this systematic review and meta-analysis we compile the current literatures and generate pooled prevalence. We also identity factors associated with intestinal helminth co-infection among TB patients.

METHODS

Original articles published in English language up to March 23, 2022 were systematically searched from electronic database (PubMed/Medline, Scopus, Science Direct, Google Scholars and HINARI). The search was done using medical subject heading terms and keywords. Identified articles were exported into the EndNote library. The identified articles were screened using PRISMA flow diagram. Then the methodological quality of included articles was evaluated and rated using the modified version of Newcastle-Ottawa Scale. Data were extracted using Microsoft Excel. Sensitivity analysis and Egger regression test were used for the assessment of heterogeneity and publication bias. Finally the results are presented with a meta-analysis of pooled estimates, forest plots, and tables. The quantitative data were analyzed using Stata version 14.

RESULTS

From a total of 5457 searched articles, 22 eligible articles were included in the review. The pooled prevalence of helminth co-infection among TB cases was 29.69% (95%CI: 21.10, 38.29). TB patients were found to more frequently harbor one or more intestinal helminths than TB negative individuals (OR = 1.72 (95%CI: 1.20, 2.48)). Among the reported helminths, Schistosoma mansoni and Strongyloides stercoralis had the highest pooled prevalence among TB cases. However, unlike other individual helminths, only Strongyloides stercoralis (OR = 2.67 (95% CI, 1.20-6.76)) had significant association with TB cases compared to TB negatives. BMI was significantly associated with intestinal helminth co-infection among TB patients (OR = 2.75 (95%CI: 1.19, 6.38)).

CONCLUSIONS

Patients with TB have been shown to harbor co-infection with one or more intestinal helminths with considerable proportions when compared with TB-negative individuals. The higher prevalence of helminth infection in TB cases might indicate that co-infection promotes active TB disease. Thus, routine intestinal helminth screening and assessment of their nutritional status is suggested for TB patients.

Effects of underweight and overweight on mortality in patients with pulmonary tuberculosis

Background

Poor nutrition increases disease severity and mortality in patients with tuberculosis (TB). There are gaps in our understanding of the effects of being underweight or overweight on TB in relation to sex.

Methods

We generated a nationwide TB registry database and assessed the effects of body mass index (BMI) on mortality in patients with pulmonary TB. The cause of death was further classified as TB-related or non-TB-related deaths. First, logistic regression analysis was performed to assess the association between BMI (a continuous variable) and mortality, and subgroup analyses of the multivariable logistic regression model were performed separately in male and female patients. Second, we categorized BMI into three groups: underweight, normal weight, and overweight, and assessed the impact of being underweight or overweight on mortality with reference to normal weight.

Results

Among 9,721 patients with pulmonary TB, the mean BMI was 21.3 ± 3.4; 1,927 (19.8%) were underweight, and 2,829 (29.1%) were overweight. In multivariable logistic regression analysis, mortality was significantly increased with the decrement of BMI (adjusted odds ratio [aOR] = 0.893, 95% confidence interval [CI] = 0.875-0.911). In subgroup analyses, underweight patients had significantly higher odds of mortality, especially TB-related deaths (aOR = 2.057, 95% CI = 1.546-2.735). The association with mortality and male patients was higher (aOR = 2.078, 95% CI = 1.717-2.514), compared with female patients (aOR = 1.724, 95% CI = 1.332-2.231). Being overweight had a significant protective effect against TB-related death only in females (aOR = 0.500, 95% CI = 0.268-0.934), whereas its effect on non-TB-related death was observed only in males (aOR = 0.739, 95% CI = 0.587-0.930).

Conclusion

Being underweight was linked to high mortality, whereas being overweight had beneficial effects in patients with pulmonary TB.

Prevalence and risk factors of malnutrition in patients with pulmonary tuberculosis: a systematic review and meta-analysis

Background

Malnutrition is prevalent in patients with pulmonary tuberculosis (PTB) and is associated with a poor prognosis.

Objective

This study aims to assess the prevalence and risk factors of malnutrition in patients with PTB.

Methods

Studies related to the prevalence and risk factors of malnutrition in patients with PTB were searched through PubMed, Embase, Web of Science, and Cochrane Library databases from January 1990 to August 2022, and two researchers screened the literature, evaluated the quality, and extracted data independently. A random-effects model was used to pool the effect sizes and 95% confidence intervals. Subgroup analysis, meta-regression analysis, and sensitivity analysis were further performed to identify sources of heterogeneity and evaluate the stability of the results. Publication bias was assessed by Doi plot, Luis Furuya-Kanamori (LFK) asymmetry index, funnel plot, and Egger's tests.

Results

A total of 53 studies involving 48, 598 participants were identified in this study. The prevalence of malnutrition was 48.0% (95% CI, 40.9-55.2%). Subgroup analysis revealed that malnutrition was more common among male gender (52.3%), bacterial positivity (55.9%), family size over 4 (54.5%), drug resistance (44.1%), residing in rural areas (51.2%), HIV infection (51.5%), Asian (51.5%), and African (54.5%) background. The prevalence of mild, moderate, and severe malnutrition was 21.4%, 14.0%, and 29.4%, respectively. Bacterial positivity (OR = 2.08, 95% CI 1.26-3.41), low income (OR = 1.44, 95% CI 1.11-1.86), and residing in rural areas (OR = 1.51, 95% CI 1.20-1.89) were risk factors of malnutrition in patients with PTB. However, male (OR = 1.04, 95% CI 0.85-1.26) and drinking (OR = 1.17, 95% CI 0.81-1.69) were not risk factors for malnutrition in patients with PTB. Due to the instability of sensitivity analysis, HIV infection, age, family size, smoking, and pulmonary cavity need to be reevaluated. Meta-regression suggested that sample size was a source of heterogeneity of prevalence. The Doi plot and LFK asymmetry index (LFK = 3.87) indicated the presence of publication bias for prevalence, and the funnel plot and Egger's test showed no publication bias for risk factors.

Conclusion

This meta-analysis indicated that malnutrition was prevalent in patients with PTB, and bacterial positivity, low income, and those residing in rural areas were risk factors for malnutrition. Therefore, clinical workers should pay attention to screening the nutritional status of patients with PTB and identifying the risk factors to reduce the incidence of malnutrition and provide nutritional interventions early to improve the prognosis in patients with PTB.

Nutritional status and dietary intake before hospital admission of pulmonary tuberculosis patients

Conducting research on nutritional status and dietary intake of pulmonary tuberculosis patients is essential for developing interventions in clinical nutrition practice and treatment during hospitalization, which can improve the quality of patients life. This cross-sectional descriptive study aimed to determine nutritional status and some related factors (such as geography, occupation, educational level, economic classification, etc.) of 221 patients with pulmonary tuberculosis who were examined and treated at the Respiratory Tuberculosis Department, National Lung Hospital in July 2019-May 2020. The results showed that the risk of undernutrition: According to BMI (Body Mass Index): 45.8% of patients were malnourished, 44.2% normal and 10.0% overweight/obese. According to MUAC (Mid-Upper Arm Circumference): 60.2% of patients were malnourished, 39.8% of patients were normal. According to SGA (Subjective Global Assessment): 57.9% of patients were at risk of undernutrition, of which 40.7% were at moderate risk of undernutrition and 17.2% risk of severe undernutrition. Classification of nutritional status according to serum albumin index: 50% of patients were malnourished, the rate of undernutrition of mild, moderate and severe levels was 28.9%, 17.9% and 3.2%, respectively. Most patients eat with others and eat less than four meals a day. The average dietary energy of patients with pulmonary tuberculosis in was 1242.6 ± 46.5 Kcal and 1084 ± 57.9 Kcal, respectively. 85.52% of patients did not eat enough food, 4.07% had enough, 10.41% consumed excess energy. The ratio of energy-generating substances in the diet (Carbohydrate:Protein:Lipid) was on average 54:18:28 for males and 55:16:32 for females. Most of the study population had diets that did not meet the experimental study in terms of micronutrient content. Specifically, more than 90% do not meet the requirements for magnesium, calcium, zinc, and vitamin D. The water-soluble and fat-soluble vitamins respond poorly, only about 30-40%. Selenium is the mineral with the best response rate, above 70%. Our findings revealed that the majority of the study subjects had poor nutritional status, as evidenced by diets lacking in essential micronutrients.

Incidence and risk factors of tuberculosis in patients following gastrectomy or endoscopic submucosal dissection: a cohort analysis of country-level data

BACKGROUND

Gastric cancer adversely affects nutrition and immunity, while increasing the risk of tuberculosis (TB). This study investigated the incidence and risk factors for TB in gastric cancer patients who had undergone gastrectomy or endoscopic submucosal dissection (ESD).

METHODS

This retrospective cohort study was conducted using Korean national insurance claims data. We defined three study groups (total gastrectomy, subtotal gastrectomy, and ESD) of patients diagnosed with gastric cancer plus a cancer-free control group. The latent TB infection (LTBI) screening status, TB incidence, and potential confounders in each cohort were analyzed, and the risk of TB was analyzed using a Cox proportional hazard model.

RESULTS

LTBI tests were performed in less than 1% of all patients, and the TB incidence rates were 473.8, 287.4, 199.4, 111.1 events/100,000 person-years in the total gastrectomy, subtotal gastrectomy, ESD, and control cohorts, respectively. Compared to the control cohort, the total gastrectomy cohort showed the highest hazard ratio (HR) for TB incidence (HR: 2.896, 95% CI: 2.559-2.337), while the ESD cohort showed a significantly increased risk (HR: 1.578, 95% CI: 1.957-1.980). Age, body mass index, and lack of exercise were risk factors in all cohorts. Comorbidities were also considered risk factors, depending on the cohort type.

CONCLUSIONS

Patients who underwent gastrectomy or ESD had an increased risk of TB, and this risk was correlated with the scope of gastrectomy. Considering the low rate of LTBI diagnostic tests and increased risk of TB in the study cohorts, more specific and practical guidelines for TB management are required for gastric cancer patients.

Long-Term Mortality of Tuberculosis Survivors in Korea: A Population-based Longitudinal Study

BACKGROUND

When assessing long-term tuberculosis (TB) mortality, few studies addressed the impact of behavior habits and socioeconomic status. Therefore, we aimed to evaluate long-term TB mortality and risk factors while accounting for potential confounders.

METHODS

This cohort study included TB survivors (n = 82 098) aged ≥20 years between 2010 and 2017, and 1:1 age- and sex-matched controls (n = 82 098). The participants were followed up for death 1 year after study enrollment until December 2018. Long-term mortality was adjusted for behavior habits (smoking, alcohol consumption, or exercise), income level, body mass index (BMI), and comorbidities.

RESULTS

During a median of 3.7 years of follow-up, the incidence rate of mortality was significantly higher in TB survivors than those in the matched controls (18.2 vs. 8.8 per 1000 person-years, P < .001). Even after adjusting for potential confounders, the mortality risk was 1.62-fold (95% confidence interval [CI], 1.54-1.70) higher in TB survivors than those in the matched controls. In addition, the hazard of mortality in TB survivors relative to matched controls significantly increased in participants aged ≥30 years, with the highest risk in those in their 40s. Male sex (adjusted hazard ratio [HR]: 2.31; 95% CI, 2.16-2.47), smoking pack-years (HR: 1.005; 95% CI, 1.004-1.006), heavy alcohol consumption (HR: 1.12; 95% CI, 1.01-1.23), and lowest income (HR: 1.27; 95% CI, 1.18-1.37) were positively associated with increased hazards for mortality, whereas higher BMI (HR: 0.91; 95% CI, .90-.92) and regular exercise (HR: 0.82; 95% CI, .76-.88) reduced the hazards of long-term mortality in TB survivors.

CONCLUSIONS

The long-term mortality risk was significantly higher in TB survivors than those in the matched controls, even after adjusting for potential confounders.