Association Of Dietary Intake And Underweight In Patients With Pulmonary Tuberculosis

Objective:To investigate dietary intake of cereals and tubers products,protein rich foods and prevalence of underweight(BMI<18.5 Kg/m2)among sputum positive initial treated patients and to explore the relationship between underweight and dietary intake among this population.Methods:This is a cross-sectional study.Patients aged 18 and above who visited the clinics of Tuberculosis Prevention and Control office in 5 counties across eastern,middle and western areas in China during 2013.7-2014.6 and who were newly diagnosed as bacteriological positive pulmonary TB were included in this study.Totally 340 patients were recruited to take a face-to-face questionnaire interview on their demographic characteristics and dietary intake during past 12 months,and to take a physical examination on height and weight.The simplified semi-quantitative food frequency method was used to estimate the average daily dietary intake for different types of foods.Approximately 98.8%of the patients(n=336)offered complete information for analysis.Underweight was defined as Body Mass Index(BMI)<18.5 Kg/m2.Inadequate intake of each type of food was defined as patients’ daily intake for this type of food is lower than the minimum daily intake recommended for adults based upon the "2016 Chinese dietary guidelines".Inadequate intake of protein rich foods was defined as patient’s intake was inadequate in at least 4 types of protein rich food.The association between intake of cereals and tubers products,intake of protein rich food and Underweight was examined with logistic regression analysis.Results:These newly diagnosed bacteriological positive pulmonary TB patients from 5 counties were mainly middle-aged,with the mean(±SD)of age as 51.5(± 16.6)years.Approximately 65.2%were men.The survey was completed 0-63d after TB diagnosis.There were significant difference in patients’ age,family income,education level and smoking status across 5 counties(P<0.05).Patients’ mean BMI was 21.4(± 3.4)Kg/m2.About 30.4%of them were underweight(n=102).No significant difference in proportion of underweight was found across the 5 counties.Patients’ average daily intake of cereal/tubers products and soybean/soybean products achieved the recommended daily minimum intake criteria for healthy adults,with mean of 334.9 g and 35.0 g,respectively.Patients’ daily intake of aquatic products,dairy products and eggs were lower than the recommended daily minimum intake criteria,with mean intake as 18.5 g,25.2 g,and 31.7 g,respectively.Patients’ daily intake of livestock and poultry meat was much higher than the recommended minimum intake criteria,with a mean of 160.4 g.The differences between patients’ average daily intake and the recommended minimum intake criteria for the above six types of food were statistically significant.Intake of cereal/tubers products was inadequate in 26.5%(89/336)of the patients.Intake of protein rich foods(at least 4 types of food)was inadequate in 39.3%(132/336)of the patients.There were 14.9%of the patients whose intake was inadequate in both cereal/tubers products and protein rich foods.No participates met the recommended standard for daily intake of milk.More than 90%of the patients had inadequate intake in aquatic products.Two logistic regression models were used to analyze the association between inadequate intake in cereal/tubers products and/or protein rich food and underweight,when adjusting all other potential confounders.Model I showed that,across increasing age groups,the likelihood of being underweight decreased among these newly diagnosed bacteriological positive pulmonary tuberculosis patients,with OR(95%CI)to be 0.400(0.211,0.760)and 0.379(0.180,0.797)when comparing patients aged 40-60 years old and those aged ≥60 years old to those<40 years old;Patients doing non-manual work was more likely to be underweight than those doing manual work[OR(95%CI][1.758(1.018,3.037)].No significant association was found between inadequate intake of cereal/tubers products and/or protein rich food and underweight.The OR(95%CI)were 1.008(0.559,1.819).1.449(0.693,3.029)and 1.586(0.816,3.082),respectively,when comparing inadequate intake of cereal/tubers products only,inadequate intake of protein rich food only,inadequate intake of both type of foods to adequate intake of both type of foods patients.Model Ⅱ showed that,across increasing age groups,the likelihood of being underweight decreased among these newly diagnosed bacteriological positive pulmonary tuberculosis patients,with OR(95%CI)to be 0.412(0.218,0.777)and 0.395(0.190,0.822)when comparing patients aged 40-60 years old and those aged ≥60 years old to those<40 years old;Patients doing non-manual work was more likely to be underweight than those doing manual work[OR(95%CI][1.766(1.027,3.035)].Insufficient intake of both cereal/tubers products and protein rich food were associated with underweight[OR(95%CI):2.012(1.051,3.852)].Conclusion:The proportion of underweight among newly diagnosed bacteriological positive pulmonary tuberculosis patients from 5 counties was 30.4%,which is much higher than general population.Inadequate intake of cereal/tubers products and protein rich food is prevalent among the newly diagnosed bacteriological positive pulmonary tuberculosis patients.Patients’ dietary intake is unbalanced with regard to the type of protein rich food.Insufficient intake of both cereal/tubers products and protein rich food were associated with underweight among the newly diagnosed bacteriological positive pulmonary tuberculosis patients.