Abstract
BackgroundDiabetes prevalence and body mass index reflect the nutritional profile of populations but have opposing effects on tuberculosis risk. Interactions between diabetes and BMI could help or hinder TB control in growing, aging, urbanizing populations.Methods and FindingsWe compiled data describing temporal changes in BMI, diabetes prevalence and population age structure in rural and urban areas for men and women in countries with high (India) and low (Rep. Korea) TB burdens. Using published data on the risks of TB associated with these factors, we calculated expected changes in TB incidence between 1998 and 2008. In India, TB incidence cases would have increased (28% from 1.7 m to 2.1 m) faster than population size (22%) because of adverse effects of aging, urbanization, changing BMI and rising diabetes prevalence, generating an increase in TB incidence per capita of 5.5% in 10 years. In India, general nutritional improvements were offset by a fall in BMI among the majority of men who live in rural areas. The growing prevalence of diabetes in India increased the annual number of TB cases in people with diabetes by 46% between 1998 and 2008. In Korea, by contrast, the number of TB cases increased more slowly (6.1% from 40,200 to 42,800) than population size (14%) because of positive effects of urbanization, increasing BMI and falling diabetes prevalence. Consequently, TB incidence per capita fell by 7.8% in 10 years. Rapid population aging was the most significant adverse effect in Korea.ConclusionsNutritional and demographic changes had stronger adverse effects on TB in high-incidence India than in lower-incidence Korea. The unfavourable effects in both countries can be overcome by early drug treatment but, if left unchecked, could lead to an accelerating rise in TB incidence. The prevention and management of risk factors for TB would reinforce TB control by chemotherapy.
Highlights
Most countries with a high burden of tuberculosis (TB) have adopted and widely implemented the World Health Organization’s Stop TB Strategy, the rate of decline in case numbers has been slower than expected [1,2]
The unfavourable effects in both countries can be overcome by early drug treatment but, if left unchecked, could lead to an accelerating rise in TB incidence
This study examined the consequences for TB epidemiology and control of changes in body mass index (BMI), diabetes, population age structure and urbanization in two contrasting countries for which there are substantial bodies of data: India, which is in a comparatively early stage of epidemiologic and demographic transition, has a high burden of TB per capita and an increasing prevalence of diabetes; and the Republic of Korea, which is at a later stage of transition, has a lower TB burden, and a stable or declining prevalence of diabetes
Summary
Most countries with a high burden of tuberculosis (TB) have adopted and widely implemented the World Health Organization’s Stop TB Strategy, the rate of decline in case numbers has been slower than expected [1,2]. Low body mass and diabetes have been treated as distinct risk factors for tuberculosis [4,5,6,7] they are linked components of the nutritional profile of populations. TB incidence changes with age directly (because the prevalence of infection and the risk of progression from infection to active TB are agedependent), and indirectly through its effects on BMI and DM as risk factors. Will TB control programmes be helped or hindered as diabetes prevalence increases with better nutrition in growing, aging, urbanizing populations?. Diabetes prevalence and body mass index reflect the nutritional profile of populations but have opposing effects on tuberculosis risk. Interactions between diabetes and BMI could help or hinder TB control in growing, aging, urbanizing populations
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