Abstract
Diabetes and undernutrition are common risk factors for tuberculosis (TB), associated with poor treatment outcomes and exacerbated by TB. Limited data exist describing patterns and risk factors of multiple comorbidities in persons with TB. Nine-hundred participants (69.6% male) were enrolled in the Starting Anti-TB Treatment (St-ATT) cohort, including 133 (14.8%) initiating treatment for multi-drug resistant TB (MDR-TB). Comorbidities were defined as: diabetes, HbA1c ≥6.5% and/or on medication; hypertension, systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg and/or on medication; anaemia (moderate/severe), haemoglobin <11g/dL; and, undernutrition (moderate/severe) body-mass-index <17 kg/m2. The most common comorbidities were undernutrition 23.4% (210/899), diabetes 22.5% (199/881), hypertension 19.0% (164/864) and anaemia 13.5% (121/899). Fifty-eight percent had ≥1 comorbid condition (496/847), with 17.1% having ≥2; most frequently diabetes and hypertension (N = 57, 6.7%). Just over half of diabetes (54.8%) and hypertension (54.9%) was previously undiagnosed. Poor glycemic control in those on medication (HbA1c≥8.0%) was common (N = 50/73, 68.5%). MDR-TB treatment was associated with increased odds of diabetes (Adjusted odds ratio (AOR) = 2.48, 95% CI: 1.55-3.95); but decreased odds of hypertension (AOR = 0.55, 95% CI: 0.39-0.78). HIV infection was only associated with anaemia (AOR = 4.51, 95% CI: 1.01-20.1). Previous TB treatment was associated with moderate/severe undernutrition (AOR = 1.98, 95% CI: 1.40-2.80), as was duration of TB-symptoms before starting treatment and household food insecurity. No associations for sex, alcohol or tobacco use were observed. MDR-TB treatment was marginally associated with having ≥2 comorbidities (OR = 1.52, 95% CI: 0.97-2.39). TB treatment programmes should plan for large proportions of persons requiring diagnosis and management of comorbidities with the potential to adversely affect TB treatment outcomes and quality of life. Dietary advice and nutritional management are components of comprehensive care for the above conditions as well as TB and should be included in planning of patient-centred services.
Highlights
Tuberculosis (TB) remains the leading cause of death globally from an infectious disease with strong poverty-associated social determinants including malnutrition [1, 2]
Within a cross-sectional study of persons on TB treatment we reported that up to 40% of Filipino persons registered for TB treatment had at least one comorbidity of diabetes, moderate or severe anaemia or moderate or severe undernutrition (Body Mass Index (BMI)
A cross-sectional analysis of data collected at enrolment into a facility-based prospective cohort study conducted in public TB Directly Observed Treatment (DOT) clinics in the Philippines (ISRCTN16347615)
Summary
Tuberculosis (TB) remains the leading cause of death globally from an infectious disease with strong poverty-associated social determinants including malnutrition [1, 2]. Many low- and middle-income countries, similar to Philippines, are undergoing nutrition transition with rapidly increasing nutrition-related non-communicable diseases (NCDs) such as diabetes and hypertension, not limited to higher income groups and associated with poorquality but energy-dense diets, sedentary lifestyles and other behavioural risk factors such as alcohol and tobacco use, risk factors for TB [3, 4]. Undernutrition is an important risk factor for developing TB disease [5], can result from its physiological and socio-economic consequences [6] and is associated with adverse TB treatment outcomes including death [7]. Diabetes is a risk factor for developing active TB disease and adverse treatment outcomes including death and relapse or recurrent TB [8,9,10]. Despite many NCDs and TB sharing nutrition-related risk factors and management strategies, consideration of nutrition screening and linkage with nutrition services for TB and NCDs is rarely considered
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