Nutritional assessment among adult patients with suspected or confirmed active tuberculosis disease in rural India

Yu, Elaine A.; Finkelstein, Julia L.; Brannon, Patsy M.; Bonam, Wesley; Russell, David G.; Glesby, Marshall J.; Mehta, Saurabh

doi:10.1371/journal.pone.0233306

Cited by 9 publications

(6 citation statements)

References 70 publications

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“…Limited research has been conducted at the individual level. Moreover, the published literature on individual-level DBM among adults has mainly examined the co-occurrence of overweight/obesity and anemia or vitamin A deficiency [ 6 , 7 , 8 , 9 , 10 , 11 ]. Characterizing DBM using anemia and vitamin A deficiency as the only measures of micronutrient deficiency may be constrained because, in other countries, iodine deficiency is also of public health significance.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Determinants of the Co-Occurrence of Overweight or Obesity and Micronutrient Deficiencies among Adults in the Philippines: Results from a National Representative Survey

Juras

Hsu

2021

Nutrients

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The double burden of malnutrition (DBM) affects many low- and middle-income countries. However, few studies have examined DBM at the individual level, or undernutrition and overnutrition co-occurring within the same person. This study aims to investigate the prevalence and determinants of DBM among adults in the Philippines. Data from the 2013 National Nutrition Survey were used. The sample size in the analysis was 17,010 adults aged ≥20 years old, after excluding pregnant and lactating women. DBM was defined as the co-occurrence of overweight/obesity and anemia (definition #1), overweight/obesity and anemia or vitamin A deficiency (definition #2), and overweight/obesity and anemia or vitamin A deficiency or iodine insufficiency (definition #3). Anthropometric measurements and biochemical markers were used for DBM assessment. Data were analyzed using descriptive statistics, the chi-square test, and logistic regression by R software. Results showed that definition #3 is the predominant type of DBM (7.0%) in the general population, whereas the prevalence of DBM has increased to 23.7% in overweight/obese persons. Sex, age, educational attainment, marital status, household size, wealth quintile, and smoking status were the determinants of DBM. This study revealed that Filipino adults experience malnutrition critically and must be addressed through food and nutrition interventions.

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Section: Introductionmentioning

confidence: 99%

Prevalence and Determinants of the Co-Occurrence of Overweight or Obesity and Micronutrient Deficiencies among Adults in the Philippines: Results from a National Representative Survey

Juras

Hsu

2021

Nutrients

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“…This cross-sectional study included adult outpatients (N 5 32) and a subset of participants in a larger cohort (N 5 834) from whom gut microbiome data were available. 32 Study participants were recruited and enrolled at a hospital (Arogyavaram Medical Center) in a rural region of South India. Inclusion criteria were as follows: outpatient status; ATBD based on Xpert MTB/RIF; and initiating anti-TB treatment.…”

Section: Methodsmentioning

confidence: 99%

Nutrition, Inflammation, and the Gut Microbiota among Outpatients with Active Tuberculosis Disease in India

Huey

Finkelstein

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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India has the highest rates of tuberculosis (TB) globally and a high prevalence of malnutrition; however, the interplay between host nutritional status, inflammation, and the gut microbiome in active tuberculosis disease (ATBD) is less well-studied. We examined differences in gut microbial composition and diversity based on undernutrition and inflammation status among outpatients with ATBD at the time of treatment initiation. During this exploratory cross-sectional study, outpatients (N = 32) with ATBD (confirmed by Xpert MTB/RIF) were enrolled in anti-TB treatment initiated at a hospital in rural southern India. The 16S rRNA sequencing was used to assess the composition of the gut microbiome. We assessed multiple markers of nutritional status, including micronutrient status concentrations (vitamin D [25(OH)D], vitamin B12, ferritin), anthropometry (body mass index, mid-upper arm circumference, and height), and C-reactive protein (CRP), as indicators of inflammation. We found that 25(OH)D was positively associated with the relative abundance of Oscillospira spp., a butyrate-producing genus linked with anti-inflammation effects, and that ferritin was positively associated with Proteobacteria taxa, which have been associated with worse inflammation in other studies. Finally, we found a greater abundance of inflammation-associated taxa from the Proteobacteria phylum and lower alpha-diversity indices among those who were underweight or who had low mid-upper arm circumference or short stature. In summary, we found differences in the gut microbiota composition and diversity among those with undernutrition compared with those with adequate nutrition status at the time of initiation of treatment among patients with ATBD in India. Clinical implications of these findings will need to be examined by larger longitudinal studies.

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“…Given that TB prevalence is higher among malnourished individuals and a large proportion of people living with TB are malnourished, there is a critical potential role for concurrent screening for malnutrition and TB. Unfortunately, BMI, which is often used as a measure of malnutrition, is not an ideal indicator, particularly in the context of South and Southeast Asia [25]. Nutritional assessment for PWTB with anthropometry, even though metrics like BMI are imperfect nutritional measures, should be the minimum standard given the prognostic value of nutritional status [14].…”

Section: Detection Of Tbmentioning

confidence: 99%

Nutritionally acquired immunodeficiency must be addressed with the same urgency as HIV to end tuberculosis

Dauphinais,

Koura,

Narasimhan

et al. 2024

BMC Global Public Health

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Tuberculosis (TB) is the leading infectious killer worldwide, with 10.6 million cases and 1.6 million deaths in 2021 alone. One in 5 incident TB cases were attributable to malnutrition, more than double the fraction attributed to HIV. Like HIV, malnutrition is a cause of secondary immunodeficiency and has even been dubbed nutritionally acquired immunodeficiency syndrome (N-AIDS). However, malnutrition remains the neglected cousin of HIV in global TB elimination efforts. Malnutrition increases the risk for TB progression, increases disease severity, and worsens TB treatment outcomes. Thus, it is both a TB determinant and comorbidity. In this perspective, we discuss decades of data to make the case that N-AIDS, just like HIV/AIDS, also deserves special consideration in the TB elimination discourse. Fortunately, malnutrition is a modifiable risk factor and there is now empirical evidence that addressing nutrition can help us curb the TB pandemic. Recognizing malnutrition as a key determinant and comorbidity is key to detecting and treating the missing millions while also preventing additional millions from suffering TB disease.

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Nutritional assessment among adult patients with suspected or confirmed active tuberculosis disease in rural India

Cited by 9 publications

References 70 publications

Prevalence and Determinants of the Co-Occurrence of Overweight or Obesity and Micronutrient Deficiencies among Adults in the Philippines: Results from a National Representative Survey

Prevalence and Determinants of the Co-Occurrence of Overweight or Obesity and Micronutrient Deficiencies among Adults in the Philippines: Results from a National Representative Survey

Nutrition, Inflammation, and the Gut Microbiota among Outpatients with Active Tuberculosis Disease in India

Nutritionally acquired immunodeficiency must be addressed with the same urgency as HIV to end tuberculosis

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