| Objective:Malnutrition is common in patients with pulmonary tuberculosis(PTB),particularly underweight,hypoproteinemia,anemia,and lymphocytopenia.This study intends to investigate the dietary intake of PTB patients with malnutrition and analyze the effect of malnutrition on one-month anti-tuberculosis therapy.This study aims to realize the adverse effect of malnutrition,improve the malnutrition state in time,and provide scientific references for strengthening the efficacy of anti-tuberculosis treatment.Methods:A total of 679 patients who were diagnosed as PTB in a hospital in Shandong Province from 2019 to 2021 were included in this study.All participants provided informed consent.Baseline demographic information of the patients was collected by questionnaire.The body mass index(BMI)was calculated for each patient based on height and weight;underweight was defined as BMI<18.5 kg/m~2.The serum total protein(TP),serum albumin(ALB),hemoglobin(Hb),and total lymphocyte count(TLC)levels of PTB patients were measured.Hypoproteinemia was defined as an ALB value<35 g/L or TP value<60 g/L;anemia was determined according to Hb concentration(for men<120 g/L,for women<110g/L);lymphocytopenia was defined as a TLC<1.0(10~9/L).The dietary intake was assessed by a semi-quantitative food frequency questionnaire(SFFQ).The dietary intake was divided into three categories with a close number of participants.Multivariate logistic regression analyses were performed to determine the dietary factors associated with malnutrition in PTB patients.On this basis,clinical information including clinical symptoms,sputum smear and culture testing,chest computerized tomography,as well as gastrointestinal symptoms,and the indexes of liver function were collected during one-month treatment.The TB score was used as a comprehensive index for the assessment of the severity of clinical symptoms.The TB score was based on the presence of typical manifestations of active PTB,including cough,sputum production,hemoptysis,chest pain,fever,night sweats,fatigue,and loss of appetite;patients who reported any of the eight listed symptoms scored one point for each symptom.For a BMI of<16,16–18,>18,two,one,and zero points were added to the TB score,respectively.In total,the TB scores ranged from 0 to 10.The association between malnutrition and the outcome of one-month anti-tuberculosis treatment(including improvement of clinical symptoms,sputum conversion,and lung lesions)of PTB patients was analyzed by generalized estimation equation(GEE).Result:Among the 679 patients with PTB,278(40.9%)patients were malnourished during one-month anti-tuberculosis treatment;in addition,25.3%,12.7%,14.4%,and 9.1%patients exhibited underweight malnutrition,hypoproteinemia,anemia,and lymphocytopenia,respectively.The intake of cereal and tubers,livestock and poultry meat,aquatic products,and fruits and vegetables in malnourished PTB patients were significantly lower than those in non-malnourished patients;the average intake of beans,aquatic products,milk,and fruits and vegetables in malnourished PTB patients was 14.0 g/d,10.0 g/d,33.3 g/d,and 391.0 g/d,respectively,which were lower than the recommended intake in China.The intake of cereal and tubers≥251.8 g/d,livestock and poultry meat≥73.4 g/d,aquatic products≥21.1 g/d,and fruits and vegetables≥360.0 g/d were associated with a reduced risk of underweight malnutrition in PTB patients(P all<0.05).The intake of livestock and poultry meat≥73.4g/d was associated with a reduced risk of hypoproteinemia and lymphocytopenia in PTB patients(P<0.05).In GEE analyses,patients with underweight had a 3.343-fold(P<0.001)increased risk of TB score>3 and a 1.772-fold(P=0.008)increased risk of number of lung field involvement>3,compared to those with BMI≥18.5 kg/m~2.Patients with hypoproteinemia had a 2.265-fold(P<0.001)increased risk of TB score>3,a 3.310-fold(P<0.001)increased risk of sputum positive and a 2.358-fold(P=0.003)increased risk of number of lung field involvement>3,compared to those with non-hypoproteinemia.Patients with anemia had a 1.963-fold(P<0.001)increased risk of sputum positive and a 2.473-fold(P=0.003)increased risk of number of lung field involvement>3,compared to those with non-anemia.Patients with lymphocytopenia had a 1.620-fold(P=0.017)increased risk of TB score>3,a 2.046-fold(P=0.002)increased risk of sputum positive and a 2.406-fold(P=0.005)increased risk of number of lung field involvement>3,compared to those with non-lymphocytopenia.Conclusion:During the early stage of anti-tuberculosis treatment,the detection rate of underweight,hypoproteinemia anemia,and lymphocytopenia in PTB patients were higher.Insufficient intake of cereal and tubers,beans,livestock and poultry meat,aquatic products,and fruits and vegetables were associated with an increased risk of malnutrition.During one-month treatment,patients with malnutrition had worse outcomes including delayed recovery of PTB clinical symptoms and lung injury,delayed sputum conversion,and a higher detection rate of abnormal liver function.Therefore,it is suggested that PTB patients with malnutrition could consider a balanced diet with a variety of foods,increase energy intake appropriately to restore normal and healthy weight as soon as possible,increase intake of animal foods in moderation,timely correct their protein-energy malnutrition,ensure adequate intake of vegetables and fruits to meet the body’s needs for vitamins and minerals and other micronutrients.This would be helpful to maintain and improve the immune function,effectively improve the outcomes of anti-tuberculosis treatment,and promote disease recovery. |
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