Malnutrition in tuberculosis: value of fat-free mass and creatinine-height index

Aliaeë A R Mohamed-Hussein,Medhat A Khalil,Safaa A Eid,Suzan S Salama

doi:10.4103/1687-8426.176790

Aliaeë A R Mohamed-Hussein, Medhat A Khalil + Show 2 more

Open Access

https://doi.org/10.4103/1687-8426.176790

Copy DOI

Abstract

The association between tuberculosis (TB) and undernutrition has long been known. TB worsens undernutrition and undernutrition weakens immunity, thereby increasing the likelihood that latent TB will develop into active disease. The aim of the study was to measure the fat-free mass, creatinine-height index (CHI) and other anthropometric measures, and serum albumin to assess the nutritional status of TB patients and to estimate the value of these indexes as prognostic factors of the disease. The present prospective analytic case–control study was conducted in the Chest Department, Assiut University Hospital. The nutritional status of 61 TB patients and 68 controls was assessed. Anthropometric measures such as ideal body weight (IBW), BMI, triceps skin-fold thickness, arm muscle area (AMA), fat mass index, and fat-free mass index (FFMI) were recorded, as well as laboratory assessment of CHI and serum albumin. There is significant decrease in BMI and IBW% (P < 0.01) in TB patients. The lean body mass using AMA and FFMI is significantly lower in TB patients than in controls (54.2 ± 6.9 vs. 61.9 ± 4.7 cm and 34.3 ± 5.0 vs. 35.8 ± 3.4 cm, respectively; P < 0.01). Loss of fat in TB patients is indicated by significant reduction in mid-arm circumference, skin-fold thickness, and fat mass index (P < 0.01 each). TB patients have significantly lower CHI and serum albumin compared with controls (76.5 ± 28.1 vs. 91.7 ± 24.2 and 37.4 ± 7.8 vs. 41.6 ± 4.2; P < 0.01). Using multiple regression, the significant determinants of malnutrition in TB patients are IBW, AMA, CHI, and serum albumin. Tuberculous patients have significantly decreased body weight with loss of both lean body mass and fat mass. The loss of CHI is a more significant marker than FFMI in this group of patients. These indexes as well as serum albumin may play an important role as prognostic markers in TB.

Highlights

It has long been known that there is an association between tuberculosis (TB) and malnutrition
The lean body mass using arm muscle area (AMA) and fat-free mass index (FFMI) is significantly lower in TB patients than in controls (54.2 ± 6.9 vs. 61.9 ± 4.7 cm and 34.3 ± 5.0 vs. 35.8 ± 3.4 cm, respectively; P < 0.01)
As muscle usually forms between 60 and 80% of fat-free mass (FFM) or lean body mass, FFM can be used as a surrogate marker for muscle mass, and the creatinine-height index (CHI) is used to confirm that reduced FFM correlates with reduced muscle mass in these patients [4]

Summary

Introduction

It has long been known that there is an association between tuberculosis (TB) and malnutrition. Malnutrition enhances the development of active TB, and active TB worsens malnutrition [1]. Patients with active pulmonary TB usually have reductions in visceral proteins, anthropometric indexes, and micronutrient status [3]. As muscle usually forms between 60 and 80% of fat-free mass (FFM) or lean body mass, FFM can be used as a surrogate marker for muscle mass, and the creatinine-height index (CHI) is used to confirm that reduced FFM correlates with reduced muscle mass in these patients [4]. The association between tuberculosis (TB) and undernutrition has long been known. TB worsens undernutrition and undernutrition weakens immunity, thereby increasing the likelihood that latent TB will develop into active disease

Methods

Results

Discussion

Conclusion