Effect of malnutrition on radiographic findings and mycobacterial burden in pulmonary tuberculosis
The relationship between malnutrition and tuberculosis (TB) severity is understudied. We investigated the effect of malnutrition on radiographic findings and mycobacterial burden. Subjects included newly diagnosed, smear-positive, culture-confirmed, pulmonary TB cases enrolled in the Regional Prospe...
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| Published in | PloS one Vol. 14; no. 3; p. e0214011 |
|---|---|
| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Public Library of Science
27.03.2019
Public Library of Science (PLoS) |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1932-6203 1932-6203 |
| DOI | 10.1371/journal.pone.0214011 |
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| Abstract | The relationship between malnutrition and tuberculosis (TB) severity is understudied. We investigated the effect of malnutrition on radiographic findings and mycobacterial burden.
Subjects included newly diagnosed, smear-positive, culture-confirmed, pulmonary TB cases enrolled in the Regional Prospective Observational Research for TB (RePORT) cohort. Multivariate regression models were used to evaluate the relationship at start of treatment between body mass index (BMI) and chest radiograph (CXR) findings of cavitation and percentage of lung affected and mycobacterial growth indicator tube (MGIT) time to positive (TTP). Severe malnutrition was defined as BMI<16 kg/m2, moderate malnutrition as 16-18.4kg/m2, and "normal"/overweight as ≥18.5 kg/m2.
Of 173 TB cases with chest x-ray data, 131 (76%) were male. The median age was 45 years (range 16-82); 42 (24%) had severe malnutrition and 58 (34%) moderate malnutrition. Median percentage of lung affected was 32% (range 0-95), and 132 (76%) had cavitation. Individuals with severe malnutrition had, on average, 11.1% [95% CI: 4.0-13.3] more lung affected, compared to those with normal BMI, controlling for diabetes and cavitation. In multivariable analyses, cases with severe malnutrition had a 4.6-fold [95% CI, 1.5-14.1] increased odds of cavitation compared to those with normal BMI, controlling for smoking. Median MGIT TTP was 194.5 hours. Neither severe (aRR 0.99; 95% CI, 0.9-1.2) nor moderate (aRR 0.97; 95% CI, 0.8-1.1) malnutrition was associated with MGIT TTP.
We found that malnutrition was associated with increased extent of disease and cavitation on CXR. These findings may reflect the immunomodulatory effect of malnutrition on pulmonary pathology. |
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| AbstractList | The relationship between malnutrition and tuberculosis (TB) severity is understudied. We investigated the effect of malnutrition on radiographic findings and mycobacterial burden.
Subjects included newly diagnosed, smear-positive, culture-confirmed, pulmonary TB cases enrolled in the Regional Prospective Observational Research for TB (RePORT) cohort. Multivariate regression models were used to evaluate the relationship at start of treatment between body mass index (BMI) and chest radiograph (CXR) findings of cavitation and percentage of lung affected and mycobacterial growth indicator tube (MGIT) time to positive (TTP). Severe malnutrition was defined as BMI<16 kg/m2, moderate malnutrition as 16-18.4kg/m2, and "normal"/overweight as ≥18.5 kg/m2.
Of 173 TB cases with chest x-ray data, 131 (76%) were male. The median age was 45 years (range 16-82); 42 (24%) had severe malnutrition and 58 (34%) moderate malnutrition. Median percentage of lung affected was 32% (range 0-95), and 132 (76%) had cavitation. Individuals with severe malnutrition had, on average, 11.1% [95% CI: 4.0-13.3] more lung affected, compared to those with normal BMI, controlling for diabetes and cavitation. In multivariable analyses, cases with severe malnutrition had a 4.6-fold [95% CI, 1.5-14.1] increased odds of cavitation compared to those with normal BMI, controlling for smoking. Median MGIT TTP was 194.5 hours. Neither severe (aRR 0.99; 95% CI, 0.9-1.2) nor moderate (aRR 0.97; 95% CI, 0.8-1.1) malnutrition was associated with MGIT TTP.
We found that malnutrition was associated with increased extent of disease and cavitation on CXR. These findings may reflect the immunomodulatory effect of malnutrition on pulmonary pathology. Background The relationship between malnutrition and tuberculosis (TB) severity is understudied. We investigated the effect of malnutrition on radiographic findings and mycobacterial burden. Methods Subjects included newly diagnosed, smear-positive, culture-confirmed, pulmonary TB cases enrolled in the Regional Prospective Observational Research for TB (RePORT) cohort. Multivariate regression models were used to evaluate the relationship at start of treatment between body mass index (BMI) and chest radiograph (CXR) findings of cavitation and percentage of lung affected and mycobacterial growth indicator tube (MGIT) time to positive (TTP). Severe malnutrition was defined as BMI<16 kg/m2, moderate malnutrition as 16–18.4kg/m2, and “normal”/overweight as ≥18.5 kg/m2. Results Of 173 TB cases with chest x-ray data, 131 (76%) were male. The median age was 45 years (range 16–82); 42 (24%) had severe malnutrition and 58 (34%) moderate malnutrition. Median percentage of lung affected was 32% (range 0–95), and 132 (76%) had cavitation. Individuals with severe malnutrition had, on average, 11.1% [95% CI: 4.0–13.3] more lung affected, compared to those with normal BMI, controlling for diabetes and cavitation. In multivariable analyses, cases with severe malnutrition had a 4.6-fold [95% CI, 1.5–14.1] increased odds of cavitation compared to those with normal BMI, controlling for smoking. Median MGIT TTP was 194.5 hours. Neither severe (aRR 0.99; 95% CI, 0.9–1.2) nor moderate (aRR 0.97; 95% CI, 0.8–1.1) malnutrition was associated with MGIT TTP. Conclusion We found that malnutrition was associated with increased extent of disease and cavitation on CXR. These findings may reflect the immunomodulatory effect of malnutrition on pulmonary pathology. The relationship between malnutrition and tuberculosis (TB) severity is understudied. We investigated the effect of malnutrition on radiographic findings and mycobacterial burden.BACKGROUNDThe relationship between malnutrition and tuberculosis (TB) severity is understudied. We investigated the effect of malnutrition on radiographic findings and mycobacterial burden.Subjects included newly diagnosed, smear-positive, culture-confirmed, pulmonary TB cases enrolled in the Regional Prospective Observational Research for TB (RePORT) cohort. Multivariate regression models were used to evaluate the relationship at start of treatment between body mass index (BMI) and chest radiograph (CXR) findings of cavitation and percentage of lung affected and mycobacterial growth indicator tube (MGIT) time to positive (TTP). Severe malnutrition was defined as BMI<16 kg/m2, moderate malnutrition as 16-18.4kg/m2, and "normal"/overweight as ≥18.5 kg/m2.METHODSSubjects included newly diagnosed, smear-positive, culture-confirmed, pulmonary TB cases enrolled in the Regional Prospective Observational Research for TB (RePORT) cohort. Multivariate regression models were used to evaluate the relationship at start of treatment between body mass index (BMI) and chest radiograph (CXR) findings of cavitation and percentage of lung affected and mycobacterial growth indicator tube (MGIT) time to positive (TTP). Severe malnutrition was defined as BMI<16 kg/m2, moderate malnutrition as 16-18.4kg/m2, and "normal"/overweight as ≥18.5 kg/m2.Of 173 TB cases with chest x-ray data, 131 (76%) were male. The median age was 45 years (range 16-82); 42 (24%) had severe malnutrition and 58 (34%) moderate malnutrition. Median percentage of lung affected was 32% (range 0-95), and 132 (76%) had cavitation. Individuals with severe malnutrition had, on average, 11.1% [95% CI: 4.0-13.3] more lung affected, compared to those with normal BMI, controlling for diabetes and cavitation. In multivariable analyses, cases with severe malnutrition had a 4.6-fold [95% CI, 1.5-14.1] increased odds of cavitation compared to those with normal BMI, controlling for smoking. Median MGIT TTP was 194.5 hours. Neither severe (aRR 0.99; 95% CI, 0.9-1.2) nor moderate (aRR 0.97; 95% CI, 0.8-1.1) malnutrition was associated with MGIT TTP.RESULTSOf 173 TB cases with chest x-ray data, 131 (76%) were male. The median age was 45 years (range 16-82); 42 (24%) had severe malnutrition and 58 (34%) moderate malnutrition. Median percentage of lung affected was 32% (range 0-95), and 132 (76%) had cavitation. Individuals with severe malnutrition had, on average, 11.1% [95% CI: 4.0-13.3] more lung affected, compared to those with normal BMI, controlling for diabetes and cavitation. In multivariable analyses, cases with severe malnutrition had a 4.6-fold [95% CI, 1.5-14.1] increased odds of cavitation compared to those with normal BMI, controlling for smoking. Median MGIT TTP was 194.5 hours. Neither severe (aRR 0.99; 95% CI, 0.9-1.2) nor moderate (aRR 0.97; 95% CI, 0.8-1.1) malnutrition was associated with MGIT TTP.We found that malnutrition was associated with increased extent of disease and cavitation on CXR. These findings may reflect the immunomodulatory effect of malnutrition on pulmonary pathology.CONCLUSIONWe found that malnutrition was associated with increased extent of disease and cavitation on CXR. These findings may reflect the immunomodulatory effect of malnutrition on pulmonary pathology. The relationship between malnutrition and tuberculosis (TB) severity is understudied. We investigated the effect of malnutrition on radiographic findings and mycobacterial burden. Subjects included newly diagnosed, smear-positive, culture-confirmed, pulmonary TB cases enrolled in the Regional Prospective Observational Research for TB (RePORT) cohort. Multivariate regression models were used to evaluate the relationship at start of treatment between body mass index (BMI) and chest radiograph (CXR) findings of cavitation and percentage of lung affected and mycobacterial growth indicator tube (MGIT) time to positive (TTP). Severe malnutrition was defined as BMI<16 kg/m.sup.2, moderate malnutrition as 16-18.4kg/m.sup.2, and "normal"/overweight as [greater than or equal to]18.5 kg/m.sup.2. Of 173 TB cases with chest x-ray data, 131 (76%) were male. The median age was 45 years (range 16-82); 42 (24%) had severe malnutrition and 58 (34%) moderate malnutrition. Median percentage of lung affected was 32% (range 0-95), and 132 (76%) had cavitation. Individuals with severe malnutrition had, on average, 11.1% [95% CI: 4.0-13.3] more lung affected, compared to those with normal BMI, controlling for diabetes and cavitation. In multivariable analyses, cases with severe malnutrition had a 4.6-fold [95% CI, 1.5-14.1] increased odds of cavitation compared to those with normal BMI, controlling for smoking. Median MGIT TTP was 194.5 hours. Neither severe (aRR 0.99; 95% CI, 0.9-1.2) nor moderate (aRR 0.97; 95% CI, 0.8-1.1) malnutrition was associated with MGIT TTP. We found that malnutrition was associated with increased extent of disease and cavitation on CXR. These findings may reflect the immunomodulatory effect of malnutrition on pulmonary pathology. Background The relationship between malnutrition and tuberculosis (TB) severity is understudied. We investigated the effect of malnutrition on radiographic findings and mycobacterial burden. Methods Subjects included newly diagnosed, smear-positive, culture-confirmed, pulmonary TB cases enrolled in the Regional Prospective Observational Research for TB (RePORT) cohort. Multivariate regression models were used to evaluate the relationship at start of treatment between body mass index (BMI) and chest radiograph (CXR) findings of cavitation and percentage of lung affected and mycobacterial growth indicator tube (MGIT) time to positive (TTP). Severe malnutrition was defined as BMI<16 kg/m.sup.2, moderate malnutrition as 16-18.4kg/m.sup.2, and "normal"/overweight as [greater than or equal to]18.5 kg/m.sup.2. Results Of 173 TB cases with chest x-ray data, 131 (76%) were male. The median age was 45 years (range 16-82); 42 (24%) had severe malnutrition and 58 (34%) moderate malnutrition. Median percentage of lung affected was 32% (range 0-95), and 132 (76%) had cavitation. Individuals with severe malnutrition had, on average, 11.1% [95% CI: 4.0-13.3] more lung affected, compared to those with normal BMI, controlling for diabetes and cavitation. In multivariable analyses, cases with severe malnutrition had a 4.6-fold [95% CI, 1.5-14.1] increased odds of cavitation compared to those with normal BMI, controlling for smoking. Median MGIT TTP was 194.5 hours. Neither severe (aRR 0.99; 95% CI, 0.9-1.2) nor moderate (aRR 0.97; 95% CI, 0.8-1.1) malnutrition was associated with MGIT TTP. Conclusion We found that malnutrition was associated with increased extent of disease and cavitation on CXR. These findings may reflect the immunomodulatory effect of malnutrition on pulmonary pathology. Background The relationship between malnutrition and tuberculosis (TB) severity is understudied. We investigated the effect of malnutrition on radiographic findings and mycobacterial burden. Methods Subjects included newly diagnosed, smear-positive, culture-confirmed, pulmonary TB cases enrolled in the Regional Prospective Observational Research for TB (RePORT) cohort. Multivariate regression models were used to evaluate the relationship at start of treatment between body mass index (BMI) and chest radiograph (CXR) findings of cavitation and percentage of lung affected and mycobacterial growth indicator tube (MGIT) time to positive (TTP). Severe malnutrition was defined as BMI<16 kg/m2, moderate malnutrition as 16–18.4kg/m2, and “normal”/overweight as ≥18.5 kg/m2. Results Of 173 TB cases with chest x-ray data, 131 (76%) were male. The median age was 45 years (range 16–82); 42 (24%) had severe malnutrition and 58 (34%) moderate malnutrition. Median percentage of lung affected was 32% (range 0–95), and 132 (76%) had cavitation. Individuals with severe malnutrition had, on average, 11.1% [95% CI: 4.0–13.3] more lung affected, compared to those with normal BMI, controlling for diabetes and cavitation. In multivariable analyses, cases with severe malnutrition had a 4.6-fold [95% CI, 1.5–14.1] increased odds of cavitation compared to those with normal BMI, controlling for smoking. Median MGIT TTP was 194.5 hours. Neither severe (aRR 0.99; 95% CI, 0.9–1.2) nor moderate (aRR 0.97; 95% CI, 0.8–1.1) malnutrition was associated with MGIT TTP. Conclusion We found that malnutrition was associated with increased extent of disease and cavitation on CXR. These findings may reflect the immunomodulatory effect of malnutrition on pulmonary pathology. |
| Audience | Academic |
| Author | Hoyt, Kacie J. Horsburgh, C. Robert Sarkar, Sonali Salgame, Padmini Muthaiah, Muthuraj Ellner, Jerrold J. Roy, Gautam White, Laura Lakshminarayanan, Subitha Vinod Kumar, Saka Joseph, Noyal Mariya Hochberg, Natasha S. |
| AuthorAffiliation | 1 Department of Epidemiology, Boston University, Boston, MA, United States of America 8 Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, United States of America 5 Rutgers—New Jersey Medical School, Newark, NJ, United States of America 2 Department of Preventive and Social Medicine, JIPMER, Puducherry, India 6 Intermediate Reference Laboratory, Government Hospital for Chest Diseases, Puducherry, India 3 Department of Biostatistics, Boston University, Boston, MA, United States of America 4 Department of Microbiology, JIPMER, Puducherry, India 7 Department of Pulmonary Medicine, JIPMER, Puducherry, India Karolinska Institutet, SWEDEN |
| AuthorAffiliation_xml | – name: 1 Department of Epidemiology, Boston University, Boston, MA, United States of America – name: 8 Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, United States of America – name: 4 Department of Microbiology, JIPMER, Puducherry, India – name: 2 Department of Preventive and Social Medicine, JIPMER, Puducherry, India – name: 5 Rutgers—New Jersey Medical School, Newark, NJ, United States of America – name: 7 Department of Pulmonary Medicine, JIPMER, Puducherry, India – name: 6 Intermediate Reference Laboratory, Government Hospital for Chest Diseases, Puducherry, India – name: 3 Department of Biostatistics, Boston University, Boston, MA, United States of America – name: Karolinska Institutet, SWEDEN |
| Author_xml | – sequence: 1 givenname: Kacie J. orcidid: 0000-0002-3841-8432 surname: Hoyt fullname: Hoyt, Kacie J. – sequence: 2 givenname: Sonali surname: Sarkar fullname: Sarkar, Sonali – sequence: 3 givenname: Laura surname: White fullname: White, Laura – sequence: 4 givenname: Noyal Mariya surname: Joseph fullname: Joseph, Noyal Mariya – sequence: 5 givenname: Padmini surname: Salgame fullname: Salgame, Padmini – sequence: 6 givenname: Subitha surname: Lakshminarayanan fullname: Lakshminarayanan, Subitha – sequence: 7 givenname: Muthuraj surname: Muthaiah fullname: Muthaiah, Muthuraj – sequence: 8 givenname: Saka surname: Vinod Kumar fullname: Vinod Kumar, Saka – sequence: 9 givenname: Jerrold J. surname: Ellner fullname: Ellner, Jerrold J. – sequence: 10 givenname: Gautam surname: Roy fullname: Roy, Gautam – sequence: 11 givenname: C. Robert surname: Horsburgh fullname: Horsburgh, C. Robert – sequence: 12 givenname: Natasha S. surname: Hochberg fullname: Hochberg, Natasha S. |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30917170$$D View this record in MEDLINE/PubMed |
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| Copyright | COPYRIGHT 2019 Public Library of Science 2019 Hoyt et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2019 Hoyt et al 2019 Hoyt et al |
| Copyright_xml | – notice: COPYRIGHT 2019 Public Library of Science – notice: 2019 Hoyt et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. – notice: 2019 Hoyt et al 2019 Hoyt et al |
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| References_xml | – volume: 39 start-page: 149 issue: 1 year: 2010 ident: ref5 article-title: A consistent log-linear relationship between tuberculosis incidence and body mass index publication-title: Int J Epidemiol doi: 10.1093/ije/dyp308 – volume: 16 start-page: 1477 issue: 11 year: 2012 ident: ref12 article-title: Grading of a positive sputum smear and the risk of Mycobacterium tuberculosis transmission publication-title: Int J Tuberc Lung Dis doi: 10.5588/ijtld.12.0129 – volume: 13 start-page: 367 issue: 3 year: 2009 ident: ref28 article-title: Radiographic manifestations of culture-positive pulmonary tuberculosis: cavitary or non-cavitary? publication-title: Int J Tuberc Lung Dis – volume: 11 start-page: 285 issue: 3 year: 2017 ident: ref22 article-title: Tuberculosis associated chronic obstructive pulmonary disease publication-title: Clin Respir J doi: 10.1111/crj.12621 – volume: 126 start-page: 461 issue: 3 year: 2001 ident: ref20 article-title: CD45RA and CD45RO isoforms in infected malnourished and infected well-nourished children publication-title: Clin Exp Immunol doi: 10.1046/j.1365-2249.2001.01694.x – volume: 26 start-page: 268 issue: 2 year: 2011 ident: ref23 article-title: The risk of obstructive lung disease by previous pulmonary tuberculosis in a country with intermediate burden of tuberculosis publication-title: J Korean Med Sci doi: 10.3346/jkms.2011.26.2.268 – volume: 5 start-page: 579 issue: 2 year: 2013 ident: ref19 article-title: Effect of malnutrition on the expression of cytokines involved in Th1 cell differentiation publication-title: Nutrients doi: 10.3390/nu5020579 – volume: 83 start-page: 195 issue: 3 year: 1989 ident: ref21 article-title: Chronic obstructive airways disease following treated pulmonary tuberculosis publication-title: Respir Med doi: 10.1016/S0954-6111(89)80031-9 – volume: 6 start-page: 780 issue: 9 year: 2002 ident: ref11 article-title: Risk factors associated with default, failure and death among tuberculosis patients treated in a DOTS programme in Tiruvallur District, South India, 2000 publication-title: Int J Tuberc Lung Dis – volume: 66 start-page: 699 issue: 5 year: 2018 ident: ref4 article-title: Association of Obesity, Diabetes, and Risk of Tuberculosis: Two Population-Based Cohorts publication-title: Clin Infect Dis doi: 10.1093/cid/cix852 – volume: 29 start-page: 355 issue: 4 year: 1997 ident: ref7 article-title: HIV infection and malnutrition change the clinical and radiological features of pulmonary tuberculosis publication-title: Scand J Infect Dis doi: 10.3109/00365549709011830 – volume: 355 start-page: i5407 year: 2016 ident: ref15 article-title: Undernutrition, nutritionally acquired immunodeficiency, and tuberculosis control publication-title: BMJ doi: 10.1136/bmj.i5407 – volume: 80 start-page: 460 issue: 2 year: 2004 ident: ref24 article-title: Randomized controlled trial of nutritional supplementation in patients with newly diagnosed tuberculosis and wasting publication-title: Am J Clin Nutr doi: 10.1093/ajcn/80.2.460 – volume: 10 start-page: e0124260 issue: 4 year: 2015 ident: ref3 article-title: Prevalence and risk factors for adult pulmonary tuberculosis in a metropolitan city of South India publication-title: PLOS One doi: 10.1371/journal.pone.0124260 – year: 2018 ident: ref13 article-title: BMI Classification – volume: 158 start-page: 1789 issue: 16 year: 1998 ident: ref14 article-title: The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. 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| Title | Effect of malnutrition on radiographic findings and mycobacterial burden in pulmonary tuberculosis |
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