DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20181301

A study of nutritional assessment of newly diagnosed tuberculosis patients in a tertiary care hospital of Tripura, India

Somnath Das, Sukanta Sen, Ankita Debnath, Sumitra Basuthakur, Prabir Kumar Saha, Chinmoy Biswas

Abstract


Background: Tuberculosis kills more than any infection in India. TB is a serious public health problem in India. Tuberculosis causes immense morbidity. The mortality rate of this disease is also very high. Tuberculosis causes a great distress to the patients. To control this infection is a challenge to the health care facility of India. A lot of steps are being taken at various levels to end this disease. Still a huge number of patients are dying everyday from these deadly diseases. Out of so many recognised risk factors, malnutrition is considered to be as one of the most important among them. The immunity of a malnourished patient is suppressed. When the patient’s immunity is ineffective, the conversion of latent tuberculosis to diseases happens. Malnutrition invites tuberculosis and tuberculosis again causes morbidity, so there is a complex relation between this two. Malnutrition and tuberculosis are both problems of considerable magnitude in most of the underdeveloped regions of the world.

Methods: In this cross sectional hospital based study involving 400 newly diagnosed Tuberculosis cases were taken. Their nutritional status was measured by BMI.

Results: It was found that 66% of the study population is having malnutrition (BMI <18.5kg/m2). Malnutrition was more in females (71%). Mean BMI is 17.9Kg/m2. Mean height of the population is 1.53 meters.

Conclusions: Nutritional supplementation may represent a novel approach for fast recovery in tuberculosis patients. In addition, raising nutritional status of population may prove to be an effective measure to control tuberculosis in underdeveloped areas of world. This study has demonstrated that half of newly diagnosed adult TB patients were malnourished at the time of starting treatment, with more than a quarter having moderate to severe malnutrition.


Keywords


BMI, Malnutrition, Nutrition, Tuberculosis

Full Text:

PDF

References


Jindal SK, Aggarwal AN, Gupta D, Agarwal R, Kumar R, Kaur T, et al. Indian study on epidemiology of asthma, respiratory symptoms and chronic bronchitis in adults (INSEARCH). Int J Tuberc Lung Dis. 2012; 16:1270-7.

Macallan DC. Malnutrition in tuberculosis. Diagn Microbiol Infect Dis. 1999;34:153-7.

Rao KN, Gopalan C. The role of nutritional factors in tuberculosis. Indian J Tuberculosis. 1966;13:102-6.

Gupta KB, Gupta R, Atreja A, Verma M, Vishvkarma S. Tuberculosis and nutrition. Lung India. 2009 Jan;26(1):9-16.

Edwards LB, Livesay VT, Acquaviva FA, Palmer CE. Height, weight, tuberculosis infection, and tuberculous disease. Arch Environ Health. 1971;22:106-12.

Guideline: Nutritional care and support for patients with tuberculosis. World Health Organization 2013. Available at: http://www.who.int/elena/titles/full_recommendations/tb_nutrition/en/

Bobrowitz ID, Rodescu D, Marcus H, Abeles H. The destroyed tuberculous lung. Scand J Respir Dis. 1974;55:82-8.

Cegielski JP, McMurray DN. The relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals. Int J Tuberc Lung Dis. 2004;8:286-98.

Lönnroth K, Williams BG, Cegielski P, Dye C. A consistent loglinear relationship between tuberculosis incidence and body mass index. Int J Epidemiol. 2010;39:149-55.

Steinbrook R. Tuberculosis and HIV in India. N Engl J Med. 2007;356:1198-9.

Van Lettow M, Kumwenda JJ, Harries AD, Whalen CC, Taha TE et al. Malnutrition and the severity of lung disease in adults with pulmonary tuberculosis in Malawi. Int J Tuberc Lung Dis. 2004;8:211-7.

Zachariah R, Spielmann MP, Harries AD, Salaniponi FM. Moderate to severe malnutrition in patients with tuberculosis is a risk factor associated with early death. Trans R Soc Trop Med Hyg. 2002;96:291-4.

Kennedy N, Ramsay A, Uiso L, Gutmann J, Ngowi FI. Nutritional status and weight gain in patients with pulmonary tuberculosis in Tanzania. Trans R Soc Trop Med Hyg. 1996;90:162-6.

Villamor E, Saathoff E, Mugusi F, Bosch RJ, Urassa W. Wasting and body composition of adults with pulmonary tuberculosis in relation to HIV-1 coinfection, socioeconomic status, and severity of tuberculosis. Eur J Clin Nutr. 2006;60:163-71.

Pray God G, Range N, Faurholt-Jepsen D, Jeremiah K, Faurholt-Jepsen M. Weight, body composition and handgrip strength among pulmonary tuberculosis patients: a matched cross-sectional study in Mwanza, Tanzania. Trans R Soc Trop Med Hyg. 2011;105:140-7.

Cegielski JP, McMurray DN. The relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals. Int. J. Tuberc. Lung Dis. 2004;8:286-98.11.

Lönnroth K, Williams BG, Cegielski P, Dye C. A consistent log-linear relationship between tuberculosis incidence and body mass index. Int. J. Epidemiol. 2010;39:149-55.

Van Lettow M. Malnutrition and the severity of lung disease in adults with pulmonary tuberculosis in Malawi. Int. J. Tuberc. Lung Dis. 2004;8:211-7.

Papathakis P, Piwoz E. Nutrition and tuberculosis: a review of the literature and considerations for TB control programs. USAID/Africa’s Health for 2010. Washington DC: Agency for International Development; 2008. Available at: http://pdf.usaid.gov/pdf_docs/PNADL992.pdf, accessed 19 September 2017).

The influence of nutrition on the risk and outcomes of tuberculosis. In: HIV/AIDS, TB, and nutrition: scientific inquiry into the nutritional influences on human immunity with special reference to HIV infection and active TB in South Africa. Pretoria: Academy of Science of South Africa; 2007:153-172. Available at: http://www.nationalacademies.org/asadi/PDFs/HIVAIDSTBandNutrition.pdf, accessed 22 September 2017.

Management of severe malnutrition: a manual for physicians and other senior health workers. Geneva: World Health Organization; 1999. Available at: http://www.who.int/nutrition/publications/severemalnutrition/9241545119/en, accessed 3 September 2013.

Dodor E. Evaluation of nutritional status of new tuberculosis patients at the effia-nkwanta regional hospital. Ghana Med. J. 2008;42(1):22-8. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2423338/, accessed 3 September 2013.

Ramakrishnan CV, Rajendran K, Jacob PG, Fox W, Radhakrishna S. The role of diet in the treatment of pulmonary tuberculosis. An evaluation in a controlled chemotherapy study in home and sanatorium patients in South India. Bull. World Health Organ. 1961;25:39-59.

Vijayamalini M, Manoharan S. Lipid peroxidation, vitamins C, E and reduced glutathione levels in patients with pulmonary tuberculosis. Cell Biochem. Funct. 2004;22(1):19-22.

Semba RD, Darnton-Hill I, de Pee S, Addressing tuberculosis in the context of malnutrition and HIV coinfection. Food Nutr. Bull. 2010;31:S345-64.

van Lettow M. Micronutrient malnutrition and wasting in adults with pulmonary tuberculosis with and without HIV co-infection in Malawi. BMC Infect. Dis. 2004;4(1):61.

Wilkinson RJ. Influence of vitamin D deficiency and vitamin D receptor polymorphisms on tuberculosis among Gujarati Asians in west London: a case-control study. Lancet. 2000;355:618-21.

Metcalfe N. A study of tuberculosis, malnutrition and gender in Sri Lanka. Trans. R. Soc. Trop. Med. Hyg. 2005;99(2):115-9.

Podewils LJ. Impact of malnutrition on clinical presentation, clinical course, and mortality in MDR-TB patients. Epidemiol. Infect. 2011;139:113-20.

Hanrahan CF. Body mass index and risk of tuberculosis and death. AIDS, 2010;24(10):1501-8.

Khan A, Sterling TR, Reves R, Vernon A, Horsburgh CR. Lack of weight gain and relapse risk in a large tuberculosis treatment trial. Am. J. Respir. Crit. Care Med. 2006;174(3):344-8.

Dodor E. Evaluation of Nutritional Status of New Tuberculosis Patients at the Effia-Nkwanta Regional Hospital. Ghana Medical Journal. 2008;42(1):22-8.

Miller LG, Asch SM, Yu EI, Knowles L, Gelberg L, Davidson P. A population based survey of tuberculosis symptoms: How atypical are atypical presentations? Clin Infect Dis. 2000;30:293-9.

Bhargava A, Chatterjee M, Jain Y, Chatterjee B, Kataria A, Bhargava M, et al. Nutritional Status of Adult Patients with Pulmonary Tuberculosis in Rural Central India and Its Association with Mortality. PLoS One. 2013 Oct 24;8(10):e77979.

Zachariah R, Spielmann MP, Harries AD, Salaniponi FM. Moderate to severe malnutrition in patients with tuberculosis is a risk factor associated with early death. Trans R Soc Trop Med Hyg. 2002;96:291-4.

Leung CC, Yew WW, Tam CM, Chan CK, Chang KC, Law WS, et al. Socio-economic factors and tuberculosis: a district-based ecological analysis in Hong Kong. Int J Tuberc Lung Dis. 2004;8(8):958- 64.

Villamor E, Saathoff E, Mugusi F, Bosch RJ, Urassa W, Fawzi WW. Wasting and body composition of adults with pulmonary tuberculosis in relation to HIV-1 coinfection, socioeconomic status, and severity of tuberculosis. Eur. J. Clin. utr. 2006;60:163-71.

Baldwin MR, Yori PP, Ford C, Moore DAJ, Gilman RH, Vidal C, et al. Tuberculosis and nutrition: disease perceptions and health seeking behavior of household contacts in the Peruvian Amazon. Int J Tuberc Lung Dis. 2004;8(12):1484-91.

Caminero Luna JA. A tuberculosis Guide for Specialist Physician. Paris, France: International Union Against Tuberculosis and Lung Diseases; 2003.