Epidemiology and Infection

Original Papers

Tuberculosis

Impact of malnutrition on clinical presentation, clinical course, and mortality in MDR-TB patients

L. J. PODEWILSa1 c1, T. HOLTZa1, V. RIEKSTINAa2, V. SKRIPCONOKAa2, E. ZAROVSKAa2, G. KIRVELAITEa2, E. KREIGEREa2 and V. LEIMANEa2

a1 Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA

a2 State Agency of Tuberculosis and Lung Diseases, Riga, Latvia

SUMMARY

Despite the adoption of strategies to prevent and treat multidrug-resistant tuberculosis (MDR-TB) over the past decade, Latvia continues to have one of the highest rates of MDR-TB in the world. It is important to identify modifiable factors that may impact on MDR-TB patient outcomes. A study was conducted to elucidate the association between nutritional status and clinical presentation, clinical course, and mortality in 995 adult patients treated for MDR-TB from 2000 to 2004. Twenty percent of patients were underweight, defined as a body mass index <18·5, at the time of diagnosis. These patients were significantly more likely to have clinical evidence of advanced disease, and had a greater risk of experiencing ⩾3 side-effects [adjusted odds ratio 1·5, 95% confidence interval (CI) 1·1–2·1] and death (adjusted hazard ratio 1·9, 95% CI 1·1–3·5) compared to patients who were normal or overweight. Interventions aimed at these high-risk patients, including nutritional supplementation as an adjunct to anti-TB therapy, should be considered and evaluated by TB programmes.

(Accepted March 25 2010)

(Online publication April 30 2010)

Correspondence:

c1 Author for correspondence: L. J. Podewils, Epidemiologist, International Research and Programs Branch, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-10, Atlanta, GA 30333, USA. (Email: lpp8@cdc.gov)

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