Nutritional status in female patients with nontuberculous mycobacterial lung disease and its association with disease severity

Abstract

Background In women, slender body habitus has been reported to be one of the predisposing factors underlying the development and poor prognosis of non-tuberculous mycobacterial lung disease (NTM-LD). Given the lack of nutritional data contributing to treatment strategies, we aimed to clarify the nutritional status of female patients with NTM-LD and its association with disease severity. Methods In this single-center observational study, we enrolled 81 female outpatients with NTM-LD. Data on healthy women of similar ages were selected from our previous survey data and categorized as controls. First, we compared anthropometric and dietary survey data between patients and controls. Second, after the patients were categorized into relatively mild (mild, n = 40) and relatively severe groups (severe, n = 41) based on pulmonary X-ray-image finding scores, body composition, nutritional intake, and biochemical markers were compared between the groups. To identify nutritional factors associated with disease severity, logistic regression analyses were performed. Results Compared with controls, patients with NTM-LD had significantly lower energy intake, body mass index, body fat, and skeletal muscle mass (all p < 0.001). Compared with the mild group, the severe group had significantly lower skeletal muscle mass (p = 0.037), albumin (p = 0.029), transthyretin (prealbumin) (p = 0.002), retinol-binding protein (p = 0.011), and hemoglobin (p = 0.001); however, no between-group differences were observed in energy or nutrient intake. Logistic analyses revealed that transthyretin (p = 0.025) and hemoglobin (p = 0.003) levels were independent factors associated with disease severity. Conclusions This is the first study to comprehensively report the association between NTM-LD severity and nutritional status, including body composition, nutrient intake, and biomarkers. The results suggest that initiating nutritional therapy from the mild stage of the disease to prevent undernutrition is warranted.

Analysis of the types and characteristics of non-tuberculous mycobacteria in high endemic areas of tuberculosis

“…These underlying diseases can damage the respiratory mucosa and reduce local immunity, leading to increased risk of infection and disease progression. In addition, our data showed that nearly half of the patients with NTM infections have low serum albumin, which can re ect the host nutritional or immune status, and <3.5 g/dL was one of the poor prognostic factors for death after NTM infection [21][22][23].…”

Association of body size distortion with low body mass index in female patients with nontuberculous mycobacterial lung disease

“…The study design was a single-center, cross-sectional study that included female patients with NTM-LD (age ≥ 20 years) who visited the outpatient clinic of the Respiratory Disease Center of Kitano Hospital, Osaka, Japan, between July and October 2018. The patients enrolled in the present study were described in our previous study [ 14 ].…”

“…Anthropometric and nutritional assessments. Height, weight, and body composition (InBody S10, BioSpace Co., Seoul, Korea) were measured on the same day as the interview and clinical measurements [14]. During the interview by registered dietitians, 1) maximum weight and weight at age 20 years, 2) dietary intake assessed by the 24-hour recall method for a typical weekday, 3) appetite using the Japanese version of the Simplified Nutritional Appetite Questionnaire [20], and 4) amount of physical activity as an indicator of energy expenditure using a shortened version of the International Standardized Physical Activity Questionnaire were assessed [21].…”

“…We have previously shown that female patients with NTM-LD are thinner and have lower energy and protein intakes than healthy controls of the same age group, and that low body weight is associated with disease severity [ 14 ]. However, in clinical practice, we often see NTM-LD female patients who feel uncomfortable increasing their dietary intake and body weight.…”

Usefulness of the mini nutritional assessment short-form for evaluating nutritional status in patients with nontuberculous mycobacterial pulmonary disease: a prospective cross-sectional study

“…Consequently, malnutrition may be prevalent in patients with NTM-PD. Although one preliminary study has investigated the nutritional status of female patients with NTM-PD [ 8 ], nutritional assessments are not routinely performed in clinical settings.…”