title: Inadequate Diet Is Associated with Acquiring Mycobacterium tuberculosis Infection in an Inuit Community. A Case-Control Study.
abstract: BACKGROUND
  Tuberculosis predominantly affects socioeconomically disadvantaged communities. The extent to which specific dietary and lifestyle factors contribute to tuberculosis susceptibility has not been established.
  
  
  METHODS
  A total of 200 residents of a village in Northern Quebec were investigated during a tuberculosis outbreak and identified to have active tuberculosis, latent tuberculosis infection, or neither. Participants completed questionnaires about their intake of food from traditional and commercial sources, and provided blood samples. Adults were asked about recent smoking and drug and alcohol intake. Nutritional adequacy was evaluated with reference to North American standards. Multiple dietary, lifestyle, and housing factors were combined in a logistic regression model evaluating the contributions of each to disease and infection.
  
  
  RESULTS
  After adjusting for potential confounding, new infection was associated with inadequate intake of fruit and vegetables (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.03-4.3), carbohydrates (OR, 4.4; 95% CI, 1.2-16.3), and certain vitamins and minerals. A multivariable model, combining nutrition, housing, and lifestyle factors, found associations between new infection and inadequate fruit and vegetable intake (OR, 2.3; 95% CI, 1.0-5.1), living in the same house as a person with smear-positive tuberculosis (OR, 14.7; 95% CI, 1.6-137.3), and visiting a community gathering house (OR, 3.7; 95% CI, 1.7-8.3). Current smoking was associated with new infection (OR, 9.4; 95% CI, 1.2-72) among adults completing a detailed lifestyle survey.
  
  
  CONCLUSIONS
  Inadequate nutrition was associated with increased susceptibility to infection, but not active tuberculosis. Interventions addressed at improving nutrition may reduce susceptibility to infection in settings where access to healthy foods is limited.
authors.affiliation: 1 Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada.|2 McGill International Tuberculosis Centre, Montreal, Quebec, Canada.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Fox
authors.affiliation: 2 McGill International Tuberculosis Centre, Montreal, Quebec, Canada.|3 Department of Epidemiology & Biostatistics, McGill University, Montreal, Quebec, Canada.
authors.forename: Robyn S
authors.initials: RS
authors.lastname: Lee
authors.affiliation: 4 Department of Social & Preventive Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Lucas
authors.affiliation: 1 Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada.|2 McGill International Tuberculosis Centre, Montreal, Quebec, Canada.
authors.forename: Faiz Ahmad
authors.initials: FA
authors.lastname: Khan
authors.affiliation: 5 Public Health Unit of the Régie Régionale de la Santé et de Services Sociaux of Nunavik, Quebec City, Quebec, Canada; and.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Proulx
authors.affiliation: 1 Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Hornby
authors.affiliation: 1 Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada.
authors.forename: Shelley
authors.initials: S
authors.lastname: Jung
authors.affiliation: 1 Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada.|2 McGill International Tuberculosis Centre, Montreal, Quebec, Canada.|3 Department of Epidemiology & Biostatistics, McGill University, Montreal, Quebec, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Benedetti
authors.affiliation: 2 McGill International Tuberculosis Centre, Montreal, Quebec, Canada.|6 Montreal University Health Centre, McGill University, Montreal, Quebec, Canada.
authors.forename: Marcel A
authors.initials: MA
authors.lastname: Behr
authors.affiliation: 1 Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada.|2 McGill International Tuberculosis Centre, Montreal, Quebec, Canada.
authors.forename: Dick
authors.initials: D
authors.lastname: Menzies
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D016022:Case-Control Studies; D004032:Diet / Q000208:ethnology*; D004196:Disease Outbreaks; D005260:Female; D005638:Fruit; D006801:Humans; D004930:Inuit / Q000208:ethnology*; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000472:pathogenicity*; D009752:Nutritional Status / Q000208:ethnology*; D016017:Odds Ratio; D011792:Quebec / Q000208:ethnology; D012111:Residence Characteristics; D012307:Risk Factors; D012907:Smoking; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000188:drug therapy / Q000208:ethnology*; D014675:Vegetables; D014815:Vitamins; D055815:Young Adult
chemical_list: D014815:Vitamins
keywords: disease outbreaks; latent tuberculosis; nutrition; nutritional status; tuberculosis