Lean Tissue Mass Wasting is Associated with Increased Risk of Mortality Among Women with Pulmonary Tuberculosis in Urban Uganda

Overview

Journal Ann Epidemiol

Publisher Elsevier

Specialty Public Health

Date 2012 May 12

PMID 22575813

Citations 25

Authors

Ezekiel Mupere

LaShaunda Malone

Sarah Zalwango

Allan Chiunda

Alphonse Okwera

Isabel Parraga

Catherine M Stein

Daniel J Tisch

Roy Mugerwa

W Henry Boom

Harriet Mayanja

Christopher C Whalen

Affiliations

Soon will be listed here.

Abstract

Objectives: We assessed the impact of wasting on survival in patients with tuberculosis by using a precise height-normalized lean tissue mass index (LMI) estimated by bioelectrical impedance analysis and body mass index (BMI).

Methods: In a retrospective cohort study, 747 adult pulmonary patients with tuberculosis who were screened for HIV and nutritional status were followed for survival.

Results: Of 747 patients, 310 had baseline wasting by BMI (kg/m(2)) and 103 by LMI (kg/m(2)). Total deaths were 105. Among men with reduced BMI, risk of death was 70% greater (hazard ratio [HR] 1.7, 95% confidence interval [95% CI] 1.03-2.81) than in men with normal BMI. Survival did not differ by LMI among men (HR 1.1; 95% CI 0.5-2.9). In women, both the BMI and LMI were associated with survival. Among women with reduced BMI, risk of death was 80% greater (HR 1.8; 95% CI 0.9-3.5) than in women with normal BMI; risk of death was 5-fold greater (HR 5.0; 95% CI 1.6-15.9) for women with low LMI compared with women with normal LMI.

Conclusions: Wasting assessed by reduced BMI is associated with an increased risk for death among both men and women whereas reduced LMI is among women with tuberculosis.

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References

Macallan D . Malnutrition in tuberculosis. Diagn Microbiol Infect Dis. 1999; 34(2):153-7. DOI: 10.1016/s0732-8893(99)00007-3. View

Mupere E, Zalwango S, Chiunda A, Okwera A, Mugerwa R, Whalen C . Body composition among HIV-seropositive and HIV-seronegative adult patients with pulmonary tuberculosis in Uganda. Ann Epidemiol. 2010; 20(3):210-6. PMC: 2824615. DOI: 10.1016/j.annepidem.2009.11.001. View

Schwenk A, Macallan D . Tuberculosis, malnutrition and wasting. Curr Opin Clin Nutr Metab Care. 2000; 3(4):285-91. DOI: 10.1097/00075197-200007000-00008. View

Harries A, Nkhoma W, Thompson P, Nyangulu D, Wirima J . Nutritional status in Malawian patients with pulmonary tuberculosis and response to chemotherapy. Eur J Clin Nutr. 1988; 42(5):445-50. View

. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1995; 854:1-452. View

Stein C, Nshuti L, Chiunda A, Boom W, Elston R, Mugerwa R . Evidence for a major gene influence on tumor necrosis factor-alpha expression in tuberculosis: path and segregation analysis. Hum Hered. 2005; 60(2):109-18. DOI: 10.1159/000088913. View

Lucas S, Hounnou A, Peacock C, Beaumel A, Djomand G, Ngbichi J . The mortality and pathology of HIV infection in a west African city. AIDS. 1993; 7(12):1569-79. DOI: 10.1097/00002030-199312000-00005. View

van Lettow M, Kumwenda J, Harries A, Whalen C, Taha T, Kumwenda N . Malnutrition and the severity of lung disease in adults with pulmonary tuberculosis in Malawi. Int J Tuberc Lung Dis. 2004; 8(2):211-7. View

Kyle U, Genton L, Pichard C . Body composition: what's new?. Curr Opin Clin Nutr Metab Care. 2002; 5(4):427-33. DOI: 10.1097/00075197-200207000-00012. View

10.

Wenger J, Whalen C, Lederman M, Spech T, Carey J, Tomford J . Prognostic factors in acquired immunodeficiency syndrome. J Gen Intern Med. 1988; 3(5):464-70. DOI: 10.1007/BF02595923. View

11.

Mayanja-Kizza H, Jones-Lopez E, Okwera A, Wallis R, Ellner J, Mugerwa R . Immunoadjuvant prednisolone therapy for HIV-associated tuberculosis: a phase 2 clinical trial in Uganda. J Infect Dis. 2005; 191(6):856-65. PMC: 4515766. DOI: 10.1086/427995. View

12.

VANITALLIE T, Yang M, Heymsfield S, Funk R, Boileau R . Height-normalized indices of the body's fat-free mass and fat mass: potentially useful indicators of nutritional status. Am J Clin Nutr. 1990; 52(6):953-9. DOI: 10.1093/ajcn/52.6.953. View

13.

Niyongabo T, Mlika-Cabanne N, Barihuta T, Henzel D, Aubry P, Larauze B . Malnutrition, tuberculosis and HIV infection in Burundi. AIDS. 1994; 8(6):851-2. View

14.

van Lettow M, Fawzi W, Semba R . Triple trouble: the role of malnutrition in tuberculosis and human immunodeficiency virus co-infection. Nutr Rev. 2003; 61(3):81-90. DOI: 10.1301/nr.2003.marr.81-90. View

15.

Whalen C, Zalwango S, Chiunda A, Malone L, Eisenach K, Joloba M . Secondary attack rate of tuberculosis in urban households in Kampala, Uganda. PLoS One. 2011; 6(2):e16137. PMC: 3038854. DOI: 10.1371/journal.pone.0016137. View

16.

Hanrahan C, Golub J, Mohapi L, Tshabangu N, Modisenyane T, Chaisson R . Body mass index and risk of tuberculosis and death. AIDS. 2010; 24(10):1501-8. PMC: 3063388. DOI: 10.1097/QAD.0b013e32833a2a4a. View

17.

Nunn P, Brindle R, Carpenter L, Odhiambo J, Wasunna K, Newnham R . Cohort study of human immunodeficiency virus infection in patients with tuberculosis in Nairobi, Kenya. Analysis of early (6-month) mortality. Am Rev Respir Dis. 1992; 146(4):849-54. DOI: 10.1164/ajrccm/146.4.849. View

18.

Kyle U, Piccoli A, Pichard C . Body composition measurements: interpretation finally made easy for clinical use. Curr Opin Clin Nutr Metab Care. 2003; 6(4):387-93. DOI: 10.1097/01.mco.0000078988.18774.3d. View

19.

Kyle U, Bosaeus I, De Lorenzo A, Deurenberg P, Elia M, Gomez J . Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr. 2004; 23(6):1430-53. DOI: 10.1016/j.clnu.2004.09.012. View

20.

Shah S, Whalen C, Kotler D, Mayanja H, Namale A, Melikian G . Severity of human immunodeficiency virus infection is associated with decreased phase angle, fat mass and body cell mass in adults with pulmonary tuberculosis infection in Uganda. J Nutr. 2001; 131(11):2843-7. DOI: 10.1093/jn/131.11.2843. View