Obesity/overweight Reduces the Risk of Active Tuberculosis: a Nationwide Population-based Cohort Study in Taiwan

Overview

Journal Int J Obes (Lond)

Specialty Endocrinology

Date 2017 Mar 11

PMID 28280271

Citations 16

Authors

Y-F Yen

H-Y Hu

Y-L Lee

P-W Ku

I-F Lin

D Chu

Y-J Lai

Affiliations

Soon will be listed here.

Abstract

Background: Obesity affects immune function by increasing the number of T helper lymphocytes, which may reduce the risk of tuberculosis (TB) infection. However, the effect of obesity on TB development has not been extensively studied. This nationwide population-based cohort study investigated the effect of obesity on TB development in Taiwanese adults.

Methods: We included 46 028 adult participants (age ⩾18 years) from three rounds (2001, 2005 and 2009) of the Taiwan National Health Interview Survey. Obesity and overweight were defined as a body mass index (BMI) ⩾27 and 24-26.9 (kg/m), respectively. Data on BMI and other covariates at baseline were collected by in-person interviews. Incident cases of active TB were identified from the National Health Insurance database. Multivariable logistic regression was used to estimate the associations of obesity and overweight with active TB, with adjustment for age, sex, smoking, alcohol consumption, socioeconomic status and other covariates.

Results: In total, 241 new cases of active TB occurred during the study period. Obesity (adjusted odds ratio [AOR], 0.43; 95% confident interval [CI], 0.28-0.67) and overweight (AOR, 0.67; 95% CI, 0.49-0.91) were associated with lower risk of incident TB, after adjusting for demographic characteristics and comorbidities. There was a linear dose-response relation of BMI with active TB incidence (AOR per unit change in BMI, 0.92; 95% CI, 0.88-0.95; P <0.001).

Conclusion: Obesity and overweight are associated with lower risk of active TB. Future studies should investigate the underlying mechanisms and clinical and epidemiological consequences of these findings.

Citing Articles

Diabetes as a risk factor for tuberculosis disease.

Franco J, Bongaerts B, Metzendorf M, Risso A, Guo Y, Pena Silva L Cochrane Database Syst Rev. 2024; 8:CD016013.

PMID: 39177079 PMC: 11342417. DOI: 10.1002/14651858.CD016013.pub2.

Undernutrition as a risk factor for tuberculosis disease.

Franco J, Bongaerts B, Metzendorf M, Risso A, Guo Y, Pena Silva L Cochrane Database Syst Rev. 2024; 6:CD015890.

PMID: 38860538 PMC: 11165671. DOI: 10.1002/14651858.CD015890.pub2.

Ambient PM exposures could increase risk of tuberculosis recurrence.

Min K, Kim S, Cho S Environ Health Prev Med. 2023; 28:48.

PMID: 37648454 PMC: 10480611. DOI: 10.1265/ehpm.23-00131.

Association between overweight/obesity and multidrug-resistant tuberculosis.

Peinado J, Lecca L, Jimenez J, Calderon R, Yataco R, Becerra M Rev Peru Med Exp Salud Publica. 2023; 40(1):59-66.

PMID: 37377237 PMC: 10953666. DOI: 10.17843/rpmesp.2023.401.12138.

Mouse Models for Pathogenesis: Show and Do Not Tell.

Soldevilla P, Vilaplana C, Cardona P Pathogens. 2023; 12(1).

PMID: 36678397 PMC: 9865329. DOI: 10.3390/pathogens12010049.

References

Yen Y, Chung M, Hu H, Lai Y, Huang L, Lin Y . Association of pulmonary tuberculosis and ethambutol with incident depressive disorder: a nationwide, population-based cohort study. J Clin Psychiatry. 2015; 76(4):e505-11. DOI: 10.4088/JCP.14m09403. View

Cegielski J, Arab L, Cornoni-Huntley J . Nutritional risk factors for tuberculosis among adults in the United States, 1971-1992. Am J Epidemiol. 2012; 176(5):409-22. PMC: 5788452. DOI: 10.1093/aje/kws007. View

Flegal K, Kit B, Orpana H, Graubard B . Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013; 309(1):71-82. PMC: 4855514. DOI: 10.1001/jama.2012.113905. View

Neyrolles O, Hernandez-Pando R, Pietri-Rouxel F, Fornes P, Tailleux L, Payan J . Is adipose tissue a place for Mycobacterium tuberculosis persistence?. PLoS One. 2006; 1:e43. PMC: 1762355. DOI: 10.1371/journal.pone.0000043. View

Garton N, Waddell S, Sherratt A, Lee S, Smith R, Senner C . Cytological and transcript analyses reveal fat and lazy persister-like bacilli in tuberculous sputum. PLoS Med. 2008; 5(4):e75. PMC: 2276522. DOI: 10.1371/journal.pmed.0050075. View

ORourke R, Kay T, Scholz M, Diggs B, Jobe B, Lewinsohn D . Alterations in T-cell subset frequency in peripheral blood in obesity. Obes Surg. 2005; 15(10):1463-8. DOI: 10.1381/096089205774859308. View

Farooqi I, Matarese G, Lord G, Keogh J, Lawrence E, Agwu C . Beneficial effects of leptin on obesity, T cell hyporesponsiveness, and neuroendocrine/metabolic dysfunction of human congenital leptin deficiency. J Clin Invest. 2002; 110(8):1093-103. PMC: 150795. DOI: 10.1172/JCI15693. View

Lyons J, Stewart S . Commentary: tuberculosis, diabetes and smoking: a burden greater than the sum of its parts. Int J Epidemiol. 2013; 42(1):230-2. DOI: 10.1093/ije/dys217. View

Wieland C, Florquin S, Chan E, Leemans J, Weijer S, Verbon A . Pulmonary Mycobacterium tuberculosis infection in leptin-deficient ob/ob mice. Int Immunol. 2005; 17(11):1399-408. DOI: 10.1093/intimm/dxh317. View

10.

Lau B, Cole S, Gange S . Competing risk regression models for epidemiologic data. Am J Epidemiol. 2009; 170(2):244-56. PMC: 2732996. DOI: 10.1093/aje/kwp107. View

11.

Cegielski J, McMurray D . The relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals. Int J Tuberc Lung Dis. 2004; 8(3):286-98. View

12.

Leung C, Lam T, Chan W, Yew W, Ho K, Leung G . Lower risk of tuberculosis in obesity. Arch Intern Med. 2007; 167(12):1297-304. DOI: 10.1001/archinte.167.12.1297. View

13.

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

14.

Procaccini C, Jirillo E, Matarese G . Leptin as an immunomodulator. Mol Aspects Med. 2011; 33(1):35-45. DOI: 10.1016/j.mam.2011.10.012. View

15.

Lin H, Ezzati M, Chang H, Murray M . Association between tobacco smoking and active tuberculosis in Taiwan: prospective cohort study. Am J Respir Crit Care Med. 2009; 180(5):475-80. DOI: 10.1164/rccm.200904-0549OC. View

16.

La Cava A, Matarese G . The weight of leptin in immunity. Nat Rev Immunol. 2004; 4(5):371-9. DOI: 10.1038/nri1350. View

17.

Haslam D, James W . Obesity. Lancet. 2005; 366(9492):1197-209. DOI: 10.1016/S0140-6736(05)67483-1. View

18.

Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J . Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009; 373(9669):1083-96. PMC: 2662372. DOI: 10.1016/S0140-6736(09)60318-4. View

19.

Chang C, Meloni S, Eisen G, Chaplin B, Akande P, Okonkwo P . Tuberculosis Incidence and Risk Factors Among Human Immunodeficiency Virus (HIV)-Infected Adults Receiving Antiretroviral Therapy in a Large HIV Program in Nigeria. Open Forum Infect Dis. 2015; 2(4):ofv154. PMC: 4654399. DOI: 10.1093/ofid/ofv154. View