Macronutrient intake and body composition changes during anti-tuberculosis therapy in adults

Abstract

Background Malnutrition is common in patients with active tuberculosis (TB), yet little information is available on serial dietary intake or body composition in TB disease. Objective To evaluate macronutrient intake and body composition in individuals with newly diagnosed with TB over time. Design Adults with active pulmonary TB (n=191; 23 with multidrug resistant TB (MDR-TB) and 36 culture-negative household contacts (controls) enrolled in a clinical trial of high-dose cholecalciferol (vitamin D3) were studied. Macronutrient intake was determined at baseline, 8 and 16 weeks. Serial body composition was assessed by body mass index (BMI; kg/m2) and bioelectrical impedance analysis (BIA) to estimate fat mass and fat-free mass. Descriptive statistics, repeated measures ANOVA for changes over time and linear regression were used. Results At baseline, mean daily energy, protein, fat and carbohydrate (CHO) intakes were significantly higher, and body weight, BMI, fat-free mass and fat mass were significantly lower, between TB subjects and controls. These remained significant after adjusting for age, gender, employment status and smoking. In all TB subjects, baseline mean daily intakes of energy, fat and protein were adequate when compared to the US Dietary Reference Intakes and protein significantly increased over time (p<0.0001). Body weight, BMI, and fat and fat-free mass increased over time. MDR-TB patients exhibited lower body weight and fat-free mass over time, despite similar daily intake of kcal, protein, and fat. Conclusions Macronutrient intake was higher in TB patients than controls, but TB-induced wasting was evident. As macronutrient intake of TB subjects increased over time, there was a parallel increase in BMI, while body composition proportions were maintained. However, individuals with MDR-TB demonstrated concomitantly decreased body weight and fat-free mass over time versus drug-sensitive TB patients, despite increased macronutrient intake. Thus, MDR-TB appears to blunt anabolism to macronutrient intake, likely reflecting the catabolic effects of TB.

Impact of adjuvant therapeutic surgery on the health-related quality of life of pulmonary tuberculosis patients

“…Patients with poor protein intake clearly dropped after surgery. Anti-TB treatment is known to improve appetite loss, nutrient malabsorption and metabolism alterations provoked by TB disease [25,27,28]. Hence, our findings are similar to those described in patients receiving pharmacological treatment for TB.…”

Predictors and patterns of weight gain during treatment for tuberculosis in the United States of America

“…Even with increased calorie and macronutrient intake, infection with TB leads to loss of fat-free and fat mass. 20 In this study, patients with a higher burden of disease, as evidenced by positive smears, cavitary disease, and/or extensive disease, had a greater weight gain over the course of treatment. This suggests that greater disease burden leads to more malnutrition at the time of diagnosis, which, in combination with adequate nutrition, can be reversed.…”

Nutritional status evaluation and nutrient intake in adult patients with pulmonary tuberculosis and their contacts

“…It is difficult to determine whether the presence of TB is due to poor nutritional status and, therefore, impaired immune status or, if this condition is the result of disease. A significant loss of body weight in TB patients has been described in the process of disease progression and treatment and, as a consequence, patients have a lower BMI [21][22][23]. Malnutrition in patients with TB may be caused by anorexia nervosa and/or hyporexia, because these disorders are characterized by the restriction of food intake resulting in the loss of body weight [24].…”