Impact of Undernutrition on Tuberculosis Treatment Outcomes in India: A Multicenter Prospective Cohort Analysis.

P. Sinha, C. Ponnuraja, N. Gupte, S. Prakash Babu, S. Cox, S. Sarkar, V. Mave, Mandar Paradkar, C. Cintron, S. Govindarajan, A. Kinikar, N. Priya, S. Gaikwad, B. Thangakunam, Arutselvi Devarajan, M. Dhanasekaran, J. Tornheim, Amita Gupta, P. Salgame, D. J. Christopher, H. Kornfeld, V. Viswanathan, J. Ellner, C. Horsburgh, Jr., A. Gupte, C. Padmapriyadarsini, N. Hochberg
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引用次数: 6

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 five sites in the Regional Prospective Observational Research on Tuberculosis (RePORT) India consortium (2015-2019). Using multivariable Poisson regression, we assessed independent 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 two months of TB treatment. Unfavorable outcome was defined as a composite of treatment failure, death, or relapse within 6 months of treatment completion. FINDINGS 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 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 four and five-fold higher rate of death, respectively. INTERPRETATIONS 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 for addressing this widely prevalent TB comorbidity. Nutritional assessment should be integrated into standard TB care.
营养不良对印度结核病治疗结果的影响:一项多中心前瞻性队列分析。
背景:营养不良是全球结核病的主要危险因素。它对治疗结果的影响尚不明确。方法:我们在印度结核病区域前瞻性观察研究(报告)联盟(2015-2019)中对5个地点的成人药物敏感性肺结核患者进行了前瞻性队列分析。使用多变量泊松回归,我们评估了不良结局与营养状况之间的独立关联,基于体重指数(BMI)治疗开始时的营养状况、结核病前的BMI、发育迟缓以及结核病治疗两个月后BMI停滞或下降。不良结果定义为治疗失败、死亡或治疗完成后6个月内复发的综合结果。研究结果:治疗开始时严重营养不良(BMI < 16 kg/m2)和结核病发病前严重营养不良均与不良结局相关(调整后发病率比[aIRR]: 2.05;95%置信区间[CI]: 1.42-2.91和2.20;95% CI分别为1.16-3.94)。此外,治疗开始后BMI未增加与不良结局增加相关(aIRR: 1.81;95% ci: 1.27-2.61)。严重发育不良(身高年龄比z-score < -3)与不良结局相关(aIRR: 1.52;95% ci: 1.00-2.24)。治疗开始时严重营养不良和治疗期间缺乏BMI增加分别与死亡率高出4倍和5倍相关。结论:慢性营养不良、治疗开始时营养不良、强化治疗后缺乏BMI增加以及严重发育迟缓与结核病治疗结果不利相关。这些数据突出了解决这一广泛流行的结核病合并症的必要性。营养评估应纳入标准结核病治疗。
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