Nutrient partitioning during treatment of tuberculosis: gain in body fat mass but not in protein mass.
BACKGROUND
Tuberculosis is an important cause of wasting. The functional consequences of wasting and recovery may depend on the distribution of lost and gained nutrient stores between protein and fat masses.


OBJECTIVE
The goal was to study nutrient partitioning, ie, the proportion of weight change attributable to changes in fat mass (FM) versus protein mass (PM), during antimycobacterial treatment.


METHODS
Body-composition measures were made of 21 men and 9 women with pulmonary tuberculosis at baseline and after 1 and 6 mo of treatment. All subjects underwent dual-energy X-ray absorptiometry and deuterium bromide dilution tests, and a four-compartment model of FM, total body water (TBW), bone minerals (BM), and PM was derived. The ratio of PM to FM at any time was expressed as the energy content (p-ratio). Changes in the p-ratio were related to disease severity as measured by radiologic criteria.


RESULTS
Patients gained 10% in body weight (P < 0.001) from baseline to month 6. This was mainly due to a 44% gain in FM (P < 0.001); PM, BM, and TBW did not change significantly. Results were similar in men and women. The p-ratio decreased from baseline to month 1 and then fell further by month 6. Radiologic disease severity was not correlated with changes in the p-ratio.


CONCLUSIONS
Microbiological cure of tuberculosis does not restore PM within 6 mo, despite a strong anabolic response. Change in the p-ratio is a suitable parameter for use in studying the effect of disease on body composition because it allows transformation of such effects into a normal distribution across a wide range of baseline proportion between fat and protein mass.
Schwenk
Achim
A
Department of Cellular and Molecular Medicine-Infectious Diseases, St George's Hospital Medical School, London, United Kingdom. a.schwenk@doctors.org.uk
Hodgson
Lisa
L
Wright
Antony
A
Ward
Leigh C
LC
Rayner
Charlotte F J
CF
Grubnic
Sisa
S
Griffin
George E
GE
Macallan
Derek C
DC
D015502:Absorptiometry, Photon; D000273:Adipose Tissue; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D001823:Body Composition; D001835:Body Weight; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy / Q000378:metabolism*; D019282:Wasting Syndrome / Q000209:etiology / Q000378:metabolism
D000995:Antitubercular Agents