Relationship of Acute Phase Reactants and Fat Accumulation during Treatment for Tuberculosis

Abstract

Background. Tuberculosis causes inflammation and muscle wasting. We investigated how attenuation of inflammation relates to repletion of body composition during treatment in an underserved population. Design. Twenty-four patients (23 to 79 years old) with pulmonary tuberculosis and inflammation (pretreatment albumin = 2.96 ± 0.13 g/dL, C-reactive protein [CRP] = 6.71 ± 1.34 μg/dL, and beta-2-microglobulin = 1.68 ± 0.10 μg/L) were evaluated and had BIA over 24 weeks. Results. Weight increased by 3.02 ± 0.81 kg (5.5%; P = 0.007) at week 4 and by 8.59 ± 0.97 kg (15.6%; P < 0.0001) at week 24. Repletion of body mass was primarily fat, which increased by 2.09 ± 0.52 kg at week 4 and 5.05 ± 0.56 kg at week 24 (P = 0.004 and P < 0.0001 versus baseline). Fat-free mass (FFM), body cell mass (BCM), and phase angle did not increase until study week 8. Albumin rose to 3.65 ± 0.14 g/dL by week 4 (P < 0.001) and slowly increased thereafter. CRP levels declined by ∼50% at each interval visit. Conclusions. During the initial treatment, acute phase reactants returned towards normal. The predominant accrual of fat mass probably reflects ongoing, low levels of inflammation.

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

“…(4, 8-11, 18-20) However, our study adds to limited data on serial dietary intake and body composition changes during pulmonary TB. (9, 10) Our baseline body composition data show that despite the increased caloric and macronutrient intake, adults with recently diagnosed TB disease have significantly lower body weight and BMI, and markedly lower body fat and fat-free mass compared to asymptomatic adults from the same household. This suggests the possibility that enhanced lipolysis and skeletal muscle wasting occurs early in the disease course.…”

“…Improved body weight with TB treatment is well known to occur. (9, 10, 18-20) All TB patients in Georgia are encouraged to increase their overall food intake as part of standard clinical care, but no specific nutrient supplements are provided. This, coupled with potentially improved appetite after initiation of anti-TB drugs likely resulted in the improved body mass over time.…”

“…(9) Sanchez et al used BIA to assess body composition in 24 adults with TB in Los Angeles, CA at baseline and weeks 4, 8, 16 and 24 after initiation of anti-TB drugs. (10) They found a 5.5% increase from baseline in body weight by week 4 and 15.6% by week 24; repletion of body weight was primarily as fat (increased by ≈ 2 and 5 kg by weeks 4 and 24, respectively), but fat-free mass increased by approximately 1 kg (2.0%) by week 4 and by ≈ 3 kg (6.6% by week 16); PA was shown to improve over time. (10) Neither of these latter studies provided concomitant dietary intake data or information on MDR-TB status.…”

“…(10) They found a 5.5% increase from baseline in body weight by week 4 and 15.6% by week 24; repletion of body weight was primarily as fat (increased by ≈ 2 and 5 kg by weeks 4 and 24, respectively), but fat-free mass increased by approximately 1 kg (2.0%) by week 4 and by ≈ 3 kg (6.6% by week 16); PA was shown to improve over time. (10) Neither of these latter studies provided concomitant dietary intake data or information on MDR-TB status. Our overall data on body weight and BMI changes are consistent with the data of Schwenk et al and Sanchez et al, while our BIA-derived fat-free mass is consistent with Sanchez et al(9, 10)…”

“…(4, 7) Further, it has been shown that TB patients with low BMI (<18.5 kg/m 2 ) are at increased risk for TB-related mortality and treatment failure. (4, 7, 8) Despite the abundance of cross-sectional data on the relationship between drug-sensitive TB and body composition, there are few serial studies of body composition in TB(9, 10) or that combine dietary intake and body composition during anti-TB drug treatment. Also, the relationship between nutrient intake and body composition in individuals with multidrug resistant TB (MDR-TB) compared to those with drug-sensitive TB has not been reported.…”