Abstract
Diabetes and undernutrition are common risk factors for TB, associated with poor treatment outcomes and exacerbated by TB. We aimed to assess non-communicable multimorbidity (co-occurrence of two or more medical conditions) in Filipino TB outpatients, focusing on malnutrition and diabetes. In a cross-sectional study, 637 adults (70% male) from clinics in urban Metro Manila (N = 338) and rural Negros Occidental (N = 299) were enrolled. Diabetes was defined as HbA1c of ≥6.5% and/or current diabetes medication. Study-specific HIV screening was conducted. The prevalence of diabetes was 9.2% (54/589, 95%CI: 7.0–11.8%) with 52% newly diagnosed. Moderate/severe undernutrition (body mass index (BMI) <17 kg/2) was 20.5% (130/634, 95%CI: 17.4–23.9%). Forty percent of participants had at least one co-morbidity (diabetes, moderate/severe undernutrition or moderate/severe anaemia (haemoglobin <11 g/dL)). HIV infection (24.4%, 74/303) was not associated with other co-morbidities (but high refusal in rural clinics). Central obesity assessed by waist-to-hip ratio was more strongly associated with diabetes (Adjusted Odds Ratio (AOR) = 6.16, 95%CI: 3.15–12.0) than BMI. Undernutrition was less common in men (AOR = 0.44, 95%CI: 0.28–0.70), and associated with previous history of TB (AOR = 1.97, 95%CI: 1.28–3.04) and recent reduced food intake. The prevalence of multimorbidity was high demonstrating a significant unmet need. HIV was not a risk factor for increased non-communicable multimorbidity.
Highlights
Diabetes and undernutrition are common risk factors for TB, associated with poor treatment outcomes and exacerbated by TB
For implementation of the END TB strategy, it is recommended that “All persons with TB need to be assessed for nutritional status and receive nutritional counselling and care according to need” and “all persons with TB should be screened for diabetes” and, “in addition to HIV/AIDS, other co-morbidities and health risks associated with TB require integrated management”[9]
The extent of overlap between diabetes, moderate or severe undernutrition, moderate or severe anaemia and HIV are illustrated with Venn diagrams
Summary
Diabetes and undernutrition are common risk factors for TB, associated with poor treatment outcomes and exacerbated by TB. For implementation of the END TB strategy, it is recommended that “All persons with TB need to be assessed for nutritional status and receive nutritional counselling and care according to need” and “all persons with TB should be screened for diabetes” and, “in addition to HIV/AIDS, other co-morbidities and health risks associated with TB require integrated management”[9] Both diabetes and TB can increase the short and long-term risk of cardiovascular[10] and respiratory conditions[11] requiring lifelong management to reduce population health and economic impacts and are recognised as priorities for cost-effective disease control[12,13]. The relationship of these in persons with active TB disease is likely to differ, due to TB-associated weight loss
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