Abstract
Background and Purpose: Drug-induced liver injury is challenging during tuberculosis treatment. There is no epidemiological data investigating the relation between dietary intake and the risk of drug-induced liver injury during tuberculosis treatment. The aim of this study is to investigate the association of food and nutrient intake with the incidence of tuberculosis-drug-induced liver injury.Methods: A cohort study was conducted in two city-level tuberculosis-specialized hospitals in Linyi City and Qingdao City, China from January 2011 to December 2013. The dietary intake was assessed by a 3-day 24-h food recall survey and a standard food-frequency questionnaire. The liver functions including aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were monitored throughout the 6-month tuberculosis therapy. Liver injury was defined as ALT or AST higher than two times of the upper limit of normal (ULN). Liver dysfunction was defined as ALT or AST higher than the ULN. The ULN for ALT and AST is 40 U/L. Multivariate logistic regression analyses were performed to determine the dietary factors associated with the incidence of liver injury and liver dysfunction.Results: A total of 605 patients were included in the analysis. During the treatment, 8.1% patients exhibited liver injury and 23.3% patients exhibited liver dysfunction. A lower intake of vegetables was associated with a higher risk of liver injury [OR (95% CI): 3.50 (1.52–8.08), P = 0.003) and liver dysfunction [OR (95% CI): 2.37 (1.31–4.29), P = 0.004], while a lower intake of cooking oil was associated with a lower risk of liver injury [OR (95% CI): 0.44 (0.20–0.96), P = 0.040)] and liver dysfunction [OR (95% CI): 0.51 (0.31–0.85), P = 0.009].Conclusion: The current study indicated that the higher risks of tuberculosis-drug-induced liver injury and liver dysfunction were statistically associated with decreased vegetable intake and increased cooking oil intake.
Highlights
Tuberculosis is a communicable disease caused by Mycobacterium tuberculosis and the infection mainly happens in the lung
The aim of this study is to investigate the associations between dietary food and nutrient intake and the incidence of tuberculosis-drug-induced liver injury by a cohort study
The characteristics of liver injury and liver dysfunction events were presented in Supplementary Table 1
Summary
Tuberculosis is a communicable disease caused by Mycobacterium tuberculosis and the infection mainly happens in the lung (about 85% of the cases). Four antibiotics were used, including isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB); in the continuation phase, INH and RIF were used [2]. This long-term and high-dose antibiotic treatment is effective but hepatotoxic. Liver injury is defined as aspartate aminotransferase (AST) or alanine aminotransferase (ALT) two times higher than its upper limit of normal (ULN) [3]. There is no epidemiological data investigating the relation between dietary intake and the risk of drug-induced liver injury during tuberculosis treatment. The aim of this study is to investigate the association of food and nutrient intake with the incidence of tuberculosis-drug-induced liver injury
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