Effect of Malnutrition on the Course of Tuberculosis

To the extent that cellular immune function affects recovery from TB, one might expect malnutrition to retard or impair the response to treatment. The adverse consequences of malnutrition on the course and outcome of TB disease have been well documented. Malnutrition increases the risk of death in TB patients nearly twofold. Among approximately 1200 patients with TB followed prospectively, 10.9% of patients with moderate to severe malnutrition died in the first 4 weeks compared to 6.5% of patients with normal nutritional status or mild malnutrition. Another study found that TB patients with a BMI <17.0 kg/m2 were at increased risk of early death. These findings cannot be interpreted to mean malnutrition per se causes the increased mortality risk. For example, the duration or extent of disease or drug resistance may be the primary cause(s) of death. At the same time, these disease characteristics would lead to even worse malnutrition. In children, weight for age is an important indicator of the prognosis. In general, the severity of malnutrition is an important indicator of the progress of the disease, and normalization of body weight in response to treatment is a positive sign.

In addition, anemia and hypoalbuminemia are associated with severity of the clinical course of TB. Severe anemia has been negatively correlated with the response to treatment and is associated with early mortality from TB. Anemia in TB patients may be normocytic and normochromic, or it may be microcytic and hypochromic, suggesting a relationship to iron homeostasis in some cases. Iron metabolism is disrupted in active TB. Mycobacterium tuberculosis requires iron to grow and avidly scavenges iron from its environment. One aspect of the host response to TB is intense sequestration of iron that restricts microbial growth. Whether iron supplementation or iron chelation may play a role in the treatment of TB remains speculative.

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