Impact of Undernutrition on Tuberculosis Treatment Outcomes in India: A Multicenter, Prospective, Cohort Analysis
Year: 2022
Type: article
Study design: Observational Study
Abstract: 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.
Source: Clinical Infectious Diseases
DOI: 10.1093/cid/ciac915
Authors: Pranay Sinha, Chinnaiyan Ponnuraja, Nikhil Gupte, Senbagavalli Prakash Babu, Samyra R Cox, Sonali Sarkar, Vidya Mave, Mandar Paradkar, Chelsie Cintron, S Govindarajan, Aarti Kinikar, Nadesan Priya, Sanjay Gaikwad, Balamugesh Thangakunam, Arutselvi Devarajan, Mythili Dhanasekaran, Jeffrey A Tornheim, Amita Gupta, Padmini Salgame, Devashyam Jesudas Christopher, Hardy Kornfeld, Vijay Viswanathan, Jerrold J Ellner, C Robert Horsburgh, Akshay N Gupte, Chandrasekaran Padmapriyadarsini, Natasha S Hochberg
Institutions: Boston University, Indian Council of Medical Research, National Institute of Research in Tuberculosis, Johns Hopkins University, B. J. Medical College & Sassoon Hospital, Jawaharlal Institute of Post Graduate Medical Education and Research, Christian Medical College, Vellore, Rutgers Health, Rutgers New Jersey Medical School, University of Massachusetts Chan Medical School
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Burroughs Wellcome Fund, American Society of Tropical Medicine and Hygiene, CRDF Global, Wellcome Trust, Department of Biotechnology, Ministry of Science and Technology, India, Indian Council of Medical Research, National Institutes of Health, National Institute of Allergy and Infectious Diseases
Awards: Phenotype, Progression and Immune Correlates of Post-Tuberculosis Lung Disease, G1964676865, G4618788355, G6892297769, Whole Genome Sequencing of Drug Resistant Tuberculosis in India: Genotype-Phenotype Correlation, Clinical Impact of Resistance, and Sequencing Directly from Sputum, G8693164225, BU Clinical HIV/AIDS Research Training Program (BU-CHART
OpenAlex ID: W4309944710