title: Nutritional status of adult patients with pulmonary tuberculosis in rural central India and its association with mortality.
abstract: Under-nutrition is a known risk factor for TB and can adversely affect treatment outcomes. However, data from India are sparse, despite the high burden of TB as well as malnutrition in India. We assessed the nutritional status at the time of diagnosis and completion of therapy, and its association with deaths during TB treatment, in a consecutive cohort of 1695 adult patients with pulmonary tuberculosis in rural India during 2004 - 2009.Multivariable logistic regression was used to obtain adjusted estimates of the association of nutritional status with deaths during treatment. At the time of diagnosis, median BMI and body weights were 16.0 kg/m(2)and 42.1 kg in men, and 15.0 kg/m(2)and 34.1 kg in women, indicating that 80% of women and 67% of men had moderate to severe under-nutrition (BMI<17.0 kg/m(2)). Fifty two percent of the patients (57% of men and 48% of women) had stunting indicating chronic under-nutrition. Half of women and one third of men remained moderately to severely underweight at the end of treatment. 60 deaths occurred in 1179 patients (5%) in whom treatment was initiated. Severe under-nutrition at diagnosis was associated with a 2 fold higher risk of death. Overall, a majority of patients had evidence of chronic severe under-nutrition at diagnosis, which persisted even after successful treatment in a significant proportion of them. These findings suggest the need for nutritional support during treatment of pulmonary TB in this rural population.
authors.affiliation: Department of Internal Medicine, Himalayan Institute of Medical Sciences, Jolly Grant, Uttarakhand, India.
authors.forename: Anurag
authors.initials: A
authors.lastname: Bhargava
authors.forename: Madhuri
authors.initials: M
authors.lastname: Chatterjee
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Jain
authors.forename: Biswaroop
authors.initials: B
authors.lastname: Chatterjee
authors.forename: Anju
authors.initials: A
authors.lastname: Kataria
authors.forename: Madhavi
authors.initials: M
authors.lastname: Bhargava
authors.forename: Raman
authors.initials: R
authors.lastname: Kataria
authors.forename: Ravi
authors.initials: R
authors.lastname: D'Souza
authors.forename: Rachna
authors.initials: R
authors.lastname: Jain
authors.forename: Andrea
authors.initials: A
authors.lastname: Benedetti
authors.forename: Madhukar
authors.initials: M
authors.lastname: Pai
authors.forename: Dick
authors.initials: D
authors.lastname: Menzies
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000401:mortality*