title: Macronutrient intake and body composition changes during anti-tuberculosis therapy in adults.
abstract: BACKGROUND
  Malnutrition is common in patients with active tuberculosis (TB), yet little information is available on serial dietary intake or body composition in TB disease.
  
  
  OBJECTIVE
  To evaluate macronutrient intake and body composition in individuals with newly diagnosed TB over time.
  
  
  METHODS
  Adults with active pulmonary TB (n = 191; 23 with multidrug resistant TB (MDR-TB) and 36 culture-negative household contacts (controls) enrolled in a clinical trial of high-dose cholecalciferol (vitamin D3) were studied. Macronutrient intake was determined at baseline, 8 and 16 weeks. Serial body composition was assessed by body mass index (BMI; kg/m(2)) and bioelectrical impedance analysis (BIA) to estimate fat mass and fat-free mass. Descriptive statistics, repeated measures ANOVA for changes over time and linear regression were used.
  
  
  RESULTS
  At baseline, mean daily energy, protein, fat and carbohydrate (CHO) intakes were significantly higher, and body weight, BMI, fat-free mass and fat mass were significantly lower, between TB subjects and controls. These remained significant after adjusting for age, gender, employment status and smoking. In all TB subjects, baseline mean daily intakes of energy, fat and protein were adequate when compared to the US Dietary Reference Intakes and protein significantly increased over time (p < 0.0001). Body weight, BMI, and fat and fat-free mass increased over time. MDR-TB patients exhibited lower body weight and fat-free mass over time, despite similar daily intake of kcal, protein, and fat.
  
  
  CONCLUSIONS
  Macronutrient intake was higher in TB patients than controls, but TB-induced wasting was evident. As macronutrient intake of TB subjects increased over time, there was a parallel increase in BMI, while body composition proportions were maintained. However, individuals with MDR-TB demonstrated concomitantly decreased body weight and fat-free mass over time versus drug-sensitive TB patients, despite increased macronutrient intake. Thus, MDR-TB appears to blunt anabolism to macronutrient intake, likely reflecting the catabolic effects of TB.
authors.affiliation: Graduate Division of Biological and Biomedical Sciences, Nutrition and Health Sciences Graduate Program, Laney Graduate School, Emory University, Atlanta, GA 30322, United States; Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States; Center for Clinical and Molecular Nutrition, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Frediani
authors.affiliation: National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia.
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Sanikidze
authors.affiliation: National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia.
authors.forename: Maia
authors.initials: M
authors.lastname: Kipiani
authors.affiliation: National Center for Tuberculosis and Lung Disease, Tbilisi, Georgia.
authors.forename: Nestani
authors.initials: N
authors.lastname: Tukvadze
authors.affiliation: Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States; Center for Clinical and Molecular Nutrition, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States.
authors.forename: Gautam
authors.initials: G
authors.lastname: Hebbar
authors.affiliation: Graduate Division of Biological and Biomedical Sciences, Nutrition and Health Sciences Graduate Program, Laney Graduate School, Emory University, Atlanta, GA 30322, United States; Center for Clinical and Molecular Nutrition, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States.
authors.forename: Usha
authors.initials: U
authors.lastname: Ramakrishnan
authors.affiliation: Graduate Division of Biological and Biomedical Sciences, Nutrition and Health Sciences Graduate Program, Laney Graduate School, Emory University, Atlanta, GA 30322, United States; Center for Clinical and Molecular Nutrition, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States; Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States.
authors.forename: Dean P
authors.initials: DP
authors.lastname: Jones
authors.affiliation: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States.
authors.forename: Kirk A
authors.initials: KA
authors.lastname: Easley
authors.affiliation: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States.
authors.forename: Neeta
authors.initials: N
authors.lastname: Shenvi
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States.
authors.forename: Russell R
authors.initials: RR
authors.lastname: Kempker
authors.affiliation: Graduate Division of Biological and Biomedical Sciences, Nutrition and Health Sciences Graduate Program, Laney Graduate School, Emory University, Atlanta, GA 30322, United States; Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States; Center for Clinical and Molecular Nutrition, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States.
authors.forename: Vin
authors.initials: V
authors.lastname: Tangpricha
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States.
authors.forename: Henry M
authors.initials: HM
authors.lastname: Blumberg
authors.affiliation: Graduate Division of Biological and Biomedical Sciences, Nutrition and Health Sciences Graduate Program, Laney Graduate School, Emory University, Atlanta, GA 30322, United States; Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States; Center for Clinical and Molecular Nutrition, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States. Electronic address: tzieg01@emory.edu.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Ziegler
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001823:Body Composition; D015992:Body Mass Index; D001835:Body Weight; D004040:Dietary Carbohydrates / Q000008:administration & dosage / Q000032:analysis; D004041:Dietary Fats / Q000008:administration & dosage / Q000032:analysis; D004044:Dietary Proteins / Q000008:administration & dosage / Q000032:analysis; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D017097:Electric Impedance; D002149:Energy Intake; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D044342:Malnutrition / Q000097:blood*; D008875:Middle Aged; D015596:Nutrition Assessment; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications* / Q000188:drug therapy; D014807:Vitamin D / Q000008:administration & dosage / Q000032:analysis; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D014807:Vitamin D
keywords: Body composition; Diet; Macronutrient; Tuberculosis