Impact of malnutrition on clinical presentation, clinical course, and mortality in MDR-TB patients.
Despite the adoption of strategies to prevent and treat multidrug-resistant tuberculosis (MDR-TB) over the past decade, Latvia continues to have one of the highest rates of MDR-TB in the world. It is important to identify modifiable factors that may impact on MDR-TB patient outcomes. A study was conducted to elucidate the association between nutritional status and clinical presentation, clinical course, and mortality in 995 adult patients treated for MDR-TB from 2000 to 2004. Twenty percent of patients were underweight, defined as a body mass index <18·5, at the time of diagnosis. These patients were significantly more likely to have clinical evidence of advanced disease, and had a greater risk of experiencing ≥3 side-effects [adjusted odds ratio 1·5, 95% confidence interval (CI) 1·1-2·1] and death (adjusted hazard ratio 1·9, 95% CI 1·1-3·5) compared to patients who were normal or overweight. Interventions aimed at these high-risk patients, including nutritional supplementation as an adjunct to anti-TB therapy, should be considered and evaluated by TB programmes.
Podewils
L J
LJ
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. lpp8@cdc.gov
Holtz
T
T
Riekstina
V
V
Skripconoka
V
V
Zarovska
E
E
Kirvelaite
G
G
Kreigere
E
E
Leimane
V
V
D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007844:Latvia / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000150:complications*; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D016017:Odds Ratio; D012189:Retrospective Studies; D013851:Thinness / Q000150:complications; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications* / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D055815:Young Adult
D000995:Antitubercular Agents