Body composition studies in patients with wasting associated with tuberculosis

doi:10.1016/j.nut.2005.06.009

Nutrition

Volume 22, Issue 3, March 2006, Pages 245-251

https://doi.org/10.1016/j.nut.2005.06.009 Get rights and content

Abstract

Objective

Wasting is a well-recognized manifestation of tuberculosis (TB), but little is known about the alterations in body composition that occur. Therefore, we measured regional and whole-body composition in patients with TB and wasting.

Methods

Body composition was measured by dual-energy x-ray absorptiometry in 18 patients with newly diagnosed TB and wasting (10 coinfected with human immunodeficiency virus [HIV]) and 22 controls (10 coinfected with HIV).

Results

Patients with TB and wasting had significantly lower body weight (48.6 versus 62.0 kg), lean body mass (39.6 versus 45.6 kg), and fat mass (6.2 versus 12.6 kg) than did controls. Patients with TB had significantly reduced lean tissue in the limbs (15.2 versus 19.1 kg) and trunk (21.3 versus 23.2 kg) and significantly higher trunk-to-limb lean ratio (1.41 versus 1.22) compared with controls. Patients with TB had significantly reduced fat in the limbs (3.4 versus 6.1 kg) and trunk (2.1 versus 5.7 kg) and significantly lower trunk-to-limb fat ratio (0.52 versus 0.92) compared with controls. Body composition measurements were no different in patients with and without HIV coinfection.

Conclusions

Wasting in TB is associated with depletion of whole-body lean and fat tissue in approximately equal proportions overall, but lean tissue depletion is greater in the limbs and fat tissue depletion is greater in the trunk. HIV coinfection does not affect the magnitude or distribution of the body composition changes.

Introduction

Patients with tuberculosis (TB) often have profound wasting, and this is regarded as one of the cardinal features of the disease. Wasting associated with TB is likely caused by a combination of decreased appetite, leading to a decrease in energy intake, interacting with increased losses and altered metabolism as part of the inflammatory and immune responses [1], [2], [3]. Wasting leads to impaired physical function [4] and increased mortality in patients with TB [5], [6], [7], [8]. Although body weight usually increases during TB treatment, recovery may be slow and significant wasting may persist for months after the start of effective TB therapy [1], [9]. In many developing countries, a large proportion of patients with TB also have coinfection with human immunodeficiency virus (HIV) and such patients may be at great risk of profound wasting. Postmortem examination of patients who died of “slim disease” has suggested that infection with TB exacerbates the wasting process of HIV-infected people in Africa [10].

In the clinical setting, extent of wasting in patients with TB is usually assessed by measurement of body weight. However, this simple parameter provides only limited information about the nutritional alterations in patients with TB. Measurement of body composition is necessary to obtain a true picture of the nutritional status in TB because compartmental changes may be disproportionate and such changes may have important consequences for health. For example, a disproportionate loss of lean tissue is likely to have greater adverse effects on survival than is loss of fat mass. Few studies of whole-body composition have been conducted in patients with TB, and most of those have used indirect prediction methods rather than reference techniques. There have been no studies of regional body composition in TB, although there is increasing recognition of the importance of changes in the distribution of body fat in general and their effect on health. Further, it is not known whether HIV coinfection influences the pattern of body composition change in patients with TB.

In this study we set out to determine the regional and whole-body compositions of patients with wasting associated with TB and to assess whether the presence of HIV coinfection makes a difference to the pattern of body composition changes.

Section snippets

Patients

The study was conducted at the Communicable Disease Centre, Tan Tock Seng Hospital, Singapore from October 1999 to June 2000. Male patients 18 to 60 y of age were recruited in four clinical groups according to the specific inclusion criteria described below. We excluded subjects from all groups if they had insulin-dependent diabetes mellitus, diarrhea (defined as more than three loose stools per day at any time during the previous week), symptoms of an upper respiratory tract infection, or

Results

Forty subjects were studied: 12 controls without HIV infection (nine hospital staff and three carriers of hepatitis B; three were confirmed to be negative for the HIV antibody), 10 controls with HIV infection, eight patients with only TB (three were confirmed to be negative for the HIV antibody), and 10 with TB and HIV. The HIV control group had a mean CD4 count of 259 cells/mm³ and a mean HIV viral load of 4.4 log₁₀ copies/mL, and four were taking antiretroviral treatment at the time of study

Discussion

In this cross-sectional study we found that patients with TB-associated wasting weighed on average 12 kg less than did controls and that this weight difference comprised approximately 50% fat and 50% lean tissue. This is similar to the proportion seen in a previous study of whole-body composition in TB (all patients also had HIV) by using the technique of total body water measurement in which the weight difference between the TB and control groups comprised about 54% lean [1]. When patients

Acknowledgments

Nicholas Paton designed the study, contributed to the recruitment of patients and collection of data, analyzed the data, and wrote the draft of the manuscript. Yau-Ming Ng performed the body composition measurements and contributed to the manuscript. The authors have no conflicts of interest in relation to this research. The authors thank Drs. Annelies Wilder-Smith, Anna Cherian, Cynthia Chee, and Mark Chen for assistance with recruiting patients, Drs. Bernard Peperstraete and Jamila Aboulhab

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To evaluate macronutrient intake and body composition in individuals with newly diagnosed TB over time.
Adults with active pulmonary TB (n = 191; 23 with multidrug resistant TB (MDR-TB) and 36 culture-negative household contacts (controls) enrolled in a clinical trial of high-dose cholecalciferol (vitamin D₃) were studied. Macronutrient intake was determined at baseline, 8 and 16 weeks. Serial body composition was assessed by body mass index (BMI; kg/m²) and bioelectrical impedance analysis (BIA) to estimate fat mass and fat-free mass. Descriptive statistics, repeated measures ANOVA for changes over time and linear regression were used.
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View all citing articles on Scopus

: The study was funded by the Tan Tock Seng Hospital Endowment Fund.

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Applied nutritional investigationBody composition studies in patients with wasting associated with tuberculosis

Abstract

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Patients

Results

Discussion

Acknowledgments

Am J Clin Nutr

Chest

Trans R Soc Trop Med Hyg

Nutrition

Am J Clin Nutr

Am J Clin Nutr

Metabolism

J Nutr

Trans R Soc Trop Med Hyg

Am J Clin Nutr

Lancet

Impact of tuberculosis on the body composition of HIV-infected men in Brazil

J Acquir Immune Defic Syndr

Whole body protein metabolism in human pulmonary tuberculosis and undernutritionevidence for anabolic block in tuberculosis

Clin Sci

Nutritional status in Malawian patients with pulmonary tuberculosis and response to chemotherapy

Eur J Clin Nutr

Applied nutritional investigation
Body composition studies in patients with wasting associated with tuberculosis