Dietary Practice and Nutritional Status of Tuberculosis Patients in Pokhara: A Cross Sectional Study

A study to assess the nutritional status and dietary gap among pulmonary tuberculosis patients in Raipur city

Background

Undernutrition raises the likelihood of progressing from tuberculosis (TB) infection to active TB illness and causes weight loss. Proper food and nutrition are important in the treatment of tuberculosis patients. Active tuberculosis necessitates a substantial energy expenditure. The Tuberculosis treatment guidelines neglect the nutritional supplementation part of Tuberculosis management. The study aims to determine the factors affecting the nutritional status of pulmonary Tuberculosis patients.

Material and Methods

A hospital-based cross-sectional study was conducted from December 2021 to January 2022 among the patients newly diagnosed and above 18 years of age coming to DOTS Centre (DMC) of Pt J.N.M. Medical College, Raipur. Total 120 subjects were selected by consecutive sampling method. Data was analyzed using SPSS version 24, and P value <0.05 was considered statistically significant.

Result

Among 120 study subjects, malnourished was 54.16% (BMI <18.50 kg/m2), normal was 35% (BMI 18.50-24.99 kg/m2), overweight was 6.67% (BMI 25-29.99 kg/m2), and obese were 4.17% (BMI 30-34.99 kg/m2). Among 120 study subjects, the maximum number of them (96.3%) had a dietary gap in their diets which was equal in two groups of 1-50% calorie deficit and 51-100% calorie deficit.

Conclusion

A high proportion of tuberculosis patients were undernourished, and even a very distal factor for undernutrition became proximal for tuberculosis patients. To control tuberculosis and to end the tuberculosis disease, an improvement in the nutritional status of the patient should be our priority. By knowing the importance of nutrition in TB patients, the primary care physicians can decrease the morbidity and mortality in TB patients.

Prognostic values of geriatric nutrition risk index on elderly patients after spinal tuberculosis surgery

Background

Spinal tuberculosis (STB) is a significant public health concern, especially in elderly patients, due to its chronic and debilitating nature. Nutritional status is a critical factor affecting the prognosis of STB patients. The geriatric nutritional risk index (GNRI) has been established as a reliable predictor of adverse outcomes in various diseases, but its correlation with surgical outcomes in elderly STB patients has not been studied.

Objective

The study aimed to assess the prognostic value of the GNRI in elderly patients with STB who underwent surgery.

Methods

We conducted a retrospective analysis of medical records of elderly patients (65 years or older) diagnosed with active STB who underwent surgical treatment. Data collection included patient demographics, comorbidities, clinical history, laboratory testing, and surgical factors. GNRI was calculated using serum albumin levels and body weight. Postoperative complications were observed and recorded. The patients were followed up for at least 1 year, and their clinical cure status was assessed based on predefined criteria.

Results

A total of 91 patients were included in the study. We found that a GNRI value of <98.63 g/dL was a cutoff value for predicting unfavorable clinical prognosis in elderly STB patients undergoing surgery. Patients with a low GNRI had higher Charlson Comorbidity Index scores, were more likely to receive red blood cell transfusions, and had a higher prevalence of overall complications, particularly pneumonia. The unfavorable clinical prognosis group had lower GNRI scores compared to the favorable prognosis group. Multivariate analysis showed that lower GNRI independently predicted unfavorable clinical outcomes in elderly STB patients.

Conclusion

The study concluded that the GNRI is a valuable biomarker for predicting prognosis in elderly STB patients undergoing surgical intervention. Patients with lower GNRI scores had worse outcomes and a higher incidence of complications.

Nutritional status and dietary intake before hospital admission of pulmonary tuberculosis patients

Conducting research on nutritional status and dietary intake of pulmonary tuberculosis patients is essential for developing interventions in clinical nutrition practice and treatment during hospitalization, which can improve the quality of patients life. This cross-sectional descriptive study aimed to determine nutritional status and some related factors (such as geography, occupation, educational level, economic classification, etc.) of 221 patients with pulmonary tuberculosis who were examined and treated at the Respiratory Tuberculosis Department, National Lung Hospital in July 2019-May 2020. The results showed that the risk of undernutrition: According to BMI (Body Mass Index): 45.8% of patients were malnourished, 44.2% normal and 10.0% overweight/obese. According to MUAC (Mid-Upper Arm Circumference): 60.2% of patients were malnourished, 39.8% of patients were normal. According to SGA (Subjective Global Assessment): 57.9% of patients were at risk of undernutrition, of which 40.7% were at moderate risk of undernutrition and 17.2% risk of severe undernutrition. Classification of nutritional status according to serum albumin index: 50% of patients were malnourished, the rate of undernutrition of mild, moderate and severe levels was 28.9%, 17.9% and 3.2%, respectively. Most patients eat with others and eat less than four meals a day. The average dietary energy of patients with pulmonary tuberculosis in was 1242.6 ± 46.5 Kcal and 1084 ± 57.9 Kcal, respectively. 85.52% of patients did not eat enough food, 4.07% had enough, 10.41% consumed excess energy. The ratio of energy-generating substances in the diet (Carbohydrate:Protein:Lipid) was on average 54:18:28 for males and 55:16:32 for females. Most of the study population had diets that did not meet the experimental study in terms of micronutrient content. Specifically, more than 90% do not meet the requirements for magnesium, calcium, zinc, and vitamin D. The water-soluble and fat-soluble vitamins respond poorly, only about 30-40%. Selenium is the mineral with the best response rate, above 70%. Our findings revealed that the majority of the study subjects had poor nutritional status, as evidenced by diets lacking in essential micronutrients.

Effect of Controlling Nutritional Status Score (CONUT) and Prognostic Nutritional Index (PNI) on patients after spinal tuberculosis surgery

The controlling nutritional status (CONUT) score and prognostic nutrition index (PNI) are immune-nutritional biomarkers that are related to clinical prognosis. Previous studies have reported using them to predict the prognosis of traumatic brain injury, tumours and other diseases. The purpose of this study was to evaluate the relationship between the PNI and CONUT score and the one-year prognosis of patients with spinal tuberculosis (STB). In this study, the clinical characteristics of 97 patients with STB who underwent debridement and internal fixation at our institution between 2015 and 2020 were retrospectively analysed. According to the receiver operating characteristic (ROC) curve, patients were divided into two groups: a high CONUT group and a low CONUT group. Patients were also divided into a high PNI group and a low PNI group. One-year postoperative prognosis was evaluated by the clinical cure standard. Patients in the favourable group were younger and had a lower rate of pneumonia and urinary tract infection, higher PNI and lower CONUT score than those in the favourable group (P < 0.05). There was an obvious correlation between the PNI and CONUT score (r = - 0.884, P < 0.05). The areas under the curve (AUCs) of the CONUT score and PNI for predicting unfavourable prognosis were 0.888 (95% CI 0.808-0.943, P < 0.001) and 0.896 (95% CI 0.818-0.949, P < 0.001), respectively. The adjusted odds ratios (ORs) of the CONUT score and PNI for predicting unfavourable outcomes were 2.447 (95% CI 1.518-4.043, P < 0.001) and 0.689 (95% CI 0.563-0.843, P < 0.001), respectively. Higher CONUT scores and a lower PNI were associated with adverse outcomes in patients with spinal tuberculosis, and the CONUT score and PNI might be independent predictors of adverse outcomes of spinal tuberculosis postoperatively.

Investigating Spatial Patterns of Pulmonary Tuberculosis and Main Related Factors in Bandar Lampung, Indonesia Using Geographically Weighted Poisson Regression

Tuberculosis (TB) is a highly infectious disease, representing one of the major causes of death worldwide. Sustainable Development Goal 3.3 implies a serious decrease in the incidence of TB cases. Hence, this study applied a spatial analysis approach to investigate patterns of pulmonary TB cases and its drivers in Bandar Lampung (Indonesia). Our study examined seven variables: the growth rate of pulmonary TB, population, distance to the city center, industrial area, green open space, built area, and slum area using geographically weighted Poisson regression (GWPR). The GWPR model demonstrated excellent results with an R2 and adjusted R2 of 0.96 and 0.94, respectively. In this case, the growth rate of pulmonary TB and population were statistically significant variables. Spatial pattern analysis of sub-districts revealed that those of Panjang and Kedaton were driven by high pulmonary TB growth rate and population, whereas that of Sukabumi was driven by the accumulation of high levels of industrial area, built area, and slums. For these reasons, we suggest that local policymakers implement a variety of infectious disease prevention and control strategies based on the spatial variation of pulmonary TB rate and its influencing factors in each sub-district.

Malnutrition assessment methods in adult patients with tuberculosis: a systematic review

OBJECTIVES

Malnutrition is associated with a twofold higher risk of dying in patients with tuberculosis (TB) and considered an important potentially reversible risk factor for failure of TB treatment. The construct of malnutrition has three domains: intake or uptake of nutrition; body composition and physical and cognitive function. The objectives of this systematic review are to identify malnutrition assessment methods, and to quantify how malnutrition assessment methods capture the international consensus definition for malnutrition, in patients with TB.

DESIGN

Different assessment methods were identified. We determined the extent of capturing of the three domains of malnutrition, that is, intake or uptake of nutrition, body composition and physical and cognitive function.

RESULTS

Seventeen malnutrition assessment methods were identified in 69 included studies. In 53/69 (77%) of studies, body mass index was used as the only malnutrition assessment method. Three out of 69 studies (4%) used a method that captured all three domains of malnutrition.

CONCLUSIONS

Our study focused on published articles. Implementation of new criteria takes time, which may take longer than the period covered by this review. Most patients with TB are assessed for only one aspect of the conceptual definition of malnutrition. The use of international consensus criteria is recommended to establish uniform diagnostics and treatment of malnutrition.

PROSPERO REGISTRATION NUMBER

CRD42019122832.

Factors associated with nutritional status, knowledge and attitudes among tuberculosis patients receiving treatment in Ghana: A cross-sectional study in the Tema Metropolis

Background

Nutritional deficiencies are generally associated with increased risk and severity of tuberculosis. This study investigated the nutritional status, knowledge, and attitudes of tuberculosis (TB) patients receiving treatment in the Tema Metropolis.

Method

A cross-sectional design was used to collect data on the nutritional knowledge, attitude, and status of TB patients. Nutritional status was analysed using World Health Organization’s formula for body mass index. Pearson’s chi-square and logistic regression models were used to assess associations between predictor and outcome variables. All statistical analyses were considered significant at p-values < 0.05.

Result

The prevalence of malnutrition among TB patients was 39.7%, 14.4%, and 4.8% for underweight, overweight, and obesity respectively. There was a high (61.0%) knowledge of nutrition among the patients. Also, 65.8% had good attitude towards nutrition. There were significant associations between normal nutritional status and age of the TB patients (p = 0.041), highest educational level attained (p = 0.036), employment status (p = 0.019), status of alcohol intake (p = 0.031), number of months on TB treatment (p = 0.021), and attitude towards nutrition (p = 0.028).

Conclusion

There was a reasonable nutrition-related knowledge and attitude towards nutrition among the TB patients. However, that did not reflect on their nutritional status. We recommend continuing education on smoking cessation, avoidance of harmful use of alcohol, and the establishment of food aid and other livelihood intervention programs for TB patients.

Barriers and facilitators of nutrition assessment, counseling, and support for tuberculosis patients: a qualitative study

Background

Nutrition has a substantial role in the prevention, treatment, and cure of tuberculosis. Thus, nutrition assessment, counseling, and support (NACS) have been implemented as part of tuberculosis treatment. However, evidence on the barriers and facilitators (enablers) of its implementation is lacking.

Objective

To explore barriers and facilitators of implementation of NACS for tuberculosis patients.

Methods

An exploratory qualitative study was conducted in public health facilities and health offices of Mekelle City, Northern Ethiopia. We conducted 17 interviews using purposively selected key informants comprising health professionals (n = 12) and tuberculosis patients (n = 5). Interviews were tape-recorded, transcribed verbatim, and coded and analyzed using a thematic approach in ATLAS.ti 7 software.

Results

Barriers were identified at three levels -organization, care provider, and patient levels. Suboptimal nutritional supply, lack of supportive supervision, lack of adequate workforce, staff turn-over, the sudden withdrawal of partners, and weak link with social service were the barriers at the organization level. Lack of commitment was reported as the only barrier at the care provider level, and socioeconomic status of patients, sharing and selling of supplies, perceived improved status, and perceived stigma were identified as the major barriers for the implementation of nutrition assessment, counseling, and support service. While training, availability of measurement and educational tools, the inclusion of nutrition indicators in the tuberculosis register, and the presence of collaborating partners were identified as facilitators at the organizational level. Patients’ motivation to know their health status was reported to be a facilitator at the patient level.

Conclusions

Organization, care provider, and patient-level barriers and facilitators were found to influence the implementation of NACS. Hence, multilevel factors should be considered to successfully implement the program and to gain its potential impact.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-021-00463-x.

Factor Associated with Underweight among People with Tuberculosis

Background: The relationship between Tuberculosis (TB) and nutritional status is a significant one. Patients with TB who are underweight face a higher risk of death. Purpose: This research aims to analyze the factors related to the occurrence of being underweight among TB patients at the Public Health Center (PHC) in Perak Timur, Surabaya. Method: This was an analytical observational study and used a cross-sectional design. The sample for this research was 41 respondents, who were TB patients and were undergoing treatment at the PHC in Perak Timur, Surabaya. Data collection was done from March 2020 to June 2020. Primary data was collected by conducting interviews using a questionnaire. Data analysis was performed using a chi-square test. Results: The results indicated that, out of the 41 respondents, there were 21 respondents who were underweight (51.22%). Descriptively, underweight TB patients were more likely to be in the intensive phase of treatment (90%), have a low income (56.76%), have a low education status (65.38%), and be unemployed (59.38%), with PR=0.43 and 95%CI=0.76–9.38. The results of this research indicated a link between the treatment phase and TB patients being underweight (p=0.01; PR=2.33; 95% CI=1.43–3.79), the level of education attained by underweight TB patients (p=0.04; PR=0.41; 95% CI=0.17–0.99), and the income of underweight TB patients (p=0.04; PR=0.43; 95%CI=0.30–0.63). The results of this research indicated that there was a correlation between the work status and TB patients being underweight (p=0.07; PR=2.67; 95%CI=0.76–9.38). Conclusion: The treatment phase, education level and income are significantly related to TB patients being underweight.

Determinants of Junk Food Consumption Among Adolescents in Pokhara Valley, Nepal

Background: Junk food consumption and its consequences has become a major public health concern globally because of its deteriorating health consequences and surging prevalence. Though its adverse health consequences are widely prevalent in all age groups, children and adolescents are more at risk. It may lead to obesity and act as a risk factor for different non-communicable diseases (NCD's) like heart diseases, cardiovascular disease, cancer, hypertension, diabetes, etc. This study was carried out to explore the junk food consumption and its associated factors among adolescent students. Methods: A cross-sectional study was conducted among 538 adolescent students of Kaski district, Nepal. We used a stratified proportionate sampling technique to recruit the participants. A self-administered questionnaire was used for data collection. Descriptive and bivariate statistical analysis was performed. The odds ratio was computed to test the association. Results: The study found that more than half of the participants (60.30%) consumed junk foods over the last 30 days, more prevalent among public school participants (65.1%) followed by participants of private school (56.3%). More than half of the participants consumed salty snacks (58.7%) followed by sweets (57.5%). The time of consumption was found to be higher together with friends (83.9%). Similarly, it was consumed more while the participants were on a trip (70.1%). Consumption of junk foods was significantly associated with public school (OR: 1.44, CI = 1.01-2.06), single family (OR: 1.46, CI = 1.01-2.10), living with parents (OR: 1.64, CI = 1.03-2.63), while on travel (OR: 1.99, CI = 1.33-2.98), while reading (OR: 2.01, CI = 1.16-3.47), at home (OR: 2.20, CI = 1.53-3.16), at school (OR: 2.86, CI = 1.98-4.12), friends' influence (OR: 2.01, CI = 1.37-2.94), and junk food availability at home (OR: 1.92, CI = 1.33-2.76). Conclusion: Consumption of junk foods among adolescent students was remarkably high in both public school and private school adolescents. Regardless of adequate knowledge on harmful consequences of junk foods, school-going adolescents are consuming junk foods due to its easy availability and ready-to-use packaging. The government of Nepal should strictly standardize and regulate advertising policies and extravagant health claims advertised by junk food manufacturers. An appropriate intervention targeted to adolescents to improve food behaviors is recommended.

Nutritional Status of Patients with Tuberculosis and Associated Factors in the Health Centre Region of Burkina Faso

Extreme hunger and poverty remain a significant barrier to maintaining a normal and healthy life, and increase the burden of tuberculosis (TB) in sub-Saharan African countries. The purpose of this study was to assess the prevalence and factors associated with undernutrition among adult patients with TB in Burkina Faso. In the Health Centre Region of Burkina Faso, we conducted a cross-sectional survey with face-to-face interviews of patients aged 15 years and older with TB (n = 302), from March to April 2019. Undernutrition was defined as a body mass index of <18.5 kg/m². Multiple logistic regression analyses were performed to determine the correlates of undernutrition. The prevalence of undernutrition was 35.8%, in which severe, moderate, and mild thinness were 7.7%, 8.9%, and 19.5%, respectively. Low food frequency per day (adjusted odds ratio [aOR] = 3.28, confidence interval [CI]: 1.42–7.55, p = 0.005), human immunodeficiency virus infection (aOR = 6.18, CI: 2.26–16.88, p < 0.001), and diabetes mellitus (aOR = 17.52, 95% CI: 1.88–162.97, p = 0.012) and young age (45–54 years vs. 65 years and older, aOR = 2.93, 95% CI: 1.11–7.70, p = 0.029) were associated with increased odds of undernutrition. We concluded that the assessment of comorbidity and nutritional status should be part of the treatment for adult TB patients.

Undernutrition and Mortality among Adult Tuberculosis Patients in Addis Ababa, Ethiopia

Background

In developing countries, there are several adult tuberculosis (TB) patients suffering from profound undernutrition. Undernutrition is a significant risk factor for developing tuberculosis. In the world, TB is one of the top ten and leading causes of death. To appropriately intervene death of adult TB patients, it is crucial to understand the magnitude of undernutrition and its associated factors among them. The study assessed undernutrition and mortality among adult tuberculosis patients in Addis Ababa, Ethiopia.

Methods

Institutional-based retrospective study was conducted in Addis Ababa, Ethiopia, from January 2019 to August 2019. The total sample size of the study was 284. The source populations were TB patients who have followed up for TB treatment at public health facilities of Addis Ababa. The sample size was allocated to the selected health facilities proportional to their size, and study subjects were enrolled to the study during the study period. Data were collected by a structured data sheet from the selected health center registration book. Data were entered into Epi Data software and analyzed by using SPSS version 20. Descriptive statistical methods were used to summarize the sociodemographic characteristics of the study participants. Survival curves were generated using the Kaplan-Meier method for all TB patients.

Result

A total of 284 study participants were included in the study. It was found that 46.8% of the study population have undernutrition (BMI <18.5 kg/m²) at the time of registration for treatment. Out of undernourished patients, 54 (19.0%) had severe malnutrition and 78 (27.5%) had moderate undernutrition. At the end of the two-month intensive treatment period, the under nutrition prevalence declined to 38.7%. Of the 284 patients, 17 (6.0%) died before completing anti-TB treatment. Three quarters of all forms of TB deaths occurred within 57 days after the start of anti-TB treatment. The proportion of deaths by nutritional status at treatment initiation among normal, moderate acute malnutrition, and severe acute malnutrition TB patients was 3.1%, 8.9%, and 16.3%, respectively.

Conclusion

Almost half of the TB patients were undernourished at the start of anti-TB treatment based on BMI. From the malnourished, less than 20% of the participants gained weight and moved to normal weight at the end of the two-month intensive treatment period. The high death rate was reported among severely malnourished tuberculosis patients, but it needs a larger study to further understand predictors. To enhance the increment of nutritional status during treatment, the government should give attention to support nutritional supplements for TB patients.

Risk factors for mortality among inpatients with smear positive pulmonary tuberculosis

Objective

To evaluate risk factors having significant effect on mortality of smear positive Pulmonary Tuberculosis (PTB) inpatients.

Methods

A descriptive cross-sectional study was conducted at Ojha Institute of Chest Diseases, Dow University Hospital Ojha Campus, Karachi. One hundred and seventy (170) inpatients of smear positive PTB confirmed by Acid Fast Bacilli (AFB) smear, aged between 13-80 years were enrolled by using consecutive sampling technique while patients with drug resistant Tuberculosis (TB) and extra pulmonary TB were excluded from the study. Selected patients were interviewed for collecting demographic data and risk factor data by using a standard questionnaire.

Results

Out of 170 PTB inpatients, mortality was observed in 23 (13.5%) patients among which male patients were 12 (52.2%), and female were 11 (47.8%). Mortality was significantly associated with increasing age (p=0.003), socioeconomic status (p=0.019), anemia (p=0.03), Chronic Liver Disease (CLD) (p=0.005), Diabetes Mellitus (DM) (p=0.001), Human Immunodeficiency Virus (HIV) (p=0.007), Hypertension (HTN) (p=0.006), recurrent TB (p=0.001), and smoking (p=0.001).

Conclusion

Increasing age, poverty, smoking history, and presence of comorbidities like DM, CLD, HIV, hypertension, and anemia are associated with higher mortality in smear positive PTB cases.