Effects of underweight and overweight on mortality in patients with pulmonary tuberculosis

Jinsoo Min; Ju Sang Kim; Hyung Woo Kim; Yousang Ko; Jee Youn Oh; Yun-Jeong Jeong; Eun Hye Lee; Bumhee Yang; Ki Man Lee; Joong Hyun Ahn; Jin Woo Kim; Yong Il Hwang; Sung Soon Lee; Jae Seuk Park; Hyeon-Kyoung Koo

doi:10.3389/fpubh.2023.1236099

Effects of underweight and overweight on mortality in patients with pulmonary tuberculosis

Front Public Health. 2023 Sep 19:11:1236099. doi: 10.3389/fpubh.2023.1236099. eCollection 2023.

Authors

Jinsoo Min¹, Ju Sang Kim², Hyung Woo Kim², Yousang Ko³, Jee Youn Oh⁴, Yun-Jeong Jeong⁵, Eun Hye Lee⁶, Bumhee Yang⁷, Ki Man Lee⁷, Joong Hyun Ahn², Jin Woo Kim⁸, Yong Il Hwang⁹, Sung Soon Lee¹⁰, Jae Seuk Park¹¹, Hyeon-Kyoung Koo¹⁰

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
² Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
³ Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
⁴ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
⁵ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
⁶ Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
⁷ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
⁸ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea.
⁹ Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.
¹⁰ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea.
¹¹ Division of Pulmonary Medicine, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea.

Abstract

Background: Poor nutrition increases disease severity and mortality in patients with tuberculosis (TB). There are gaps in our understanding of the effects of being underweight or overweight on TB in relation to sex.

Methods: We generated a nationwide TB registry database and assessed the effects of body mass index (BMI) on mortality in patients with pulmonary TB. The cause of death was further classified as TB-related or non-TB-related deaths. First, logistic regression analysis was performed to assess the association between BMI (a continuous variable) and mortality, and subgroup analyses of the multivariable logistic regression model were performed separately in male and female patients. Second, we categorized BMI into three groups: underweight, normal weight, and overweight, and assessed the impact of being underweight or overweight on mortality with reference to normal weight.

Results: Among 9,721 patients with pulmonary TB, the mean BMI was 21.3 ± 3.4; 1,927 (19.8%) were underweight, and 2,829 (29.1%) were overweight. In multivariable logistic regression analysis, mortality was significantly increased with the decrement of BMI (adjusted odds ratio [aOR] = 0.893, 95% confidence interval [CI] = 0.875-0.911). In subgroup analyses, underweight patients had significantly higher odds of mortality, especially TB-related deaths (aOR = 2.057, 95% CI = 1.546-2.735). The association with mortality and male patients was higher (aOR = 2.078, 95% CI = 1.717-2.514), compared with female patients (aOR = 1.724, 95% CI = 1.332-2.231). Being overweight had a significant protective effect against TB-related death only in females (aOR = 0.500, 95% CI = 0.268-0.934), whereas its effect on non-TB-related death was observed only in males (aOR = 0.739, 95% CI = 0.587-0.930).

Conclusion: Being underweight was linked to high mortality, whereas being overweight had beneficial effects in patients with pulmonary TB.

Keywords: body mass index; death; mortality; nutrition; tuberculosis; undernutrition.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Female
Humans
Male
Overweight / epidemiology
Risk Factors
Thinness / epidemiology
Tuberculosis* / complications
Tuberculosis, Pulmonary* / epidemiology

Grants and funding

The Public-Private Mix Tuberculosis Control Project was supported by the National Health Promotion Fund, funded by the Korea Disease Control and Prevention Agency, Republic of Korea.